A well respected man

First patient

Recently retired professional, ended her career on a high point. Happily married. Granchild recently born. Phones an ambulance with palpitations. Arrives in ED. I pick up the chart look at the normal ECG, have a quick chat with the med student about what to look for and thankfully leave the student outside the cubicle.

After a fairly standard “you have benign sounding palpitations” type of chat I ask is there anything else worrying her. Queue floods of tears and confession of 2 years of alcohol abuse and loss of position and importance since retirement. Frustration with life and continual guilt and negative thinking fueling the cycle.

She had palpitations because she had alcohol withdrawl from recently stopping her bottle and a half of wine a day habit.

I say nice things, point out the positve aspects of her life and and family and her willingness and motivation to change and as I leave I have the impression that – yes, probably I have probably played a key and significant role in changing this woman’s life.

Second patient

Woman, early forties [incidentally both these patients are women, not because they’re all weak and useless but because they have the balls (sorry) to actually deal and talk about the issuesin their lives. If they were men they’d just drink more and beat the wife…] is brought to ED following what sounds very clearly and obviously a fainting episode while attending an out-patient appointment.

Tells me she has been under a lot of stress lately. [Again, incidentally, if you go and ask all the patients in our waiting room, all of them will tell you they’re been under a lot of stress lately –  therefore stress causes all illness right?…] I ask why.

Queue floods of tears regarding pressure of caring for ageing mother, guilt over not being able to live with and care for mother, constant worry and anxiety over her health coupled with poor sleep and poor diet – both leading to further anxiety.

I tell her my story of responsibility (to a minor degree) for my own mother and my mother’s story of responsibility for caring for her elderly mother and how yes this is very difficult. Again I stress the importance of positive features and motivation to think better about things and change.

As she leaves the cubicle she shakes my hand and thanks me with a knowing “you’ve changed my life” look.

These are probably the two most useful and effective interventions I have made in the past two months. Well OK so I’ve seen a few sickies too, but even then the majority of who I see and treat will either die (if they’re that sick) or will get better anyhow and who knows if what I did actually helped.

With these two patients I’m pretty sure I made an impact.

When I came out from both these patients I was in many ways disappointed by my realisation of this.

To stress it again – I most enjoy (and think I am actually most talented) at resuscitating really, really sick people. I think I’m quite good at it. Never mind the fact that I’m not sure it makes that much of a difference. If you’re that sick that you need my skills then there’s a fair chance you’re stuffed anyhow.

I see making sick people better as my key role. Yet here I am changing lives by being a decent human being.

So perhaps I should explain how I changed their lives.

1) Very simply – I was a decent human being. I listened, I encouraged, I dispelled myths and pointed to encouraging signs. I empathised.

I learnt none of this in medical school. Well they tried to teach me this in medical school I just don’t think they did it very well. If I am a decent human being to my patients then it is not because of anything I learnt in medical school. I learned more at my parents knee and and my friends love.

2) And this is the clincher. It was because the person who was a decent human being to them was a doctor that made all the difference.

We have a mythical (and I think misplaced and usually undeserved) respect and understanding of virtually any possible problem. If an engineer and a doctor are faced with a problem regarding astrophysics or the economy then I imagine people would side with the doctor’s opinion. Not because they know but because they must be really smart – cause they’re a doctor. Because remember you don’t have to be smart to be an engineer.

It is slowly diminishing but the respect that is given to the medical profession is colossal. What we say goes.

What I say to the family of the dead motorcyclist is indelibly printed on their minds for the rest of their lives. People don’t remember what the nurse says who stays with the family after I leave. The sound byte that’s passed around about uncle billy’s health will be always be what the doctor says.

So there you go – I change lives by being a decent human being but it only works cause of the scrubs and the stethoscope.


4 Responses to “A well respected man”

  1. 1 Roads December 15, 2009 at 7:52 pm

    Wow, what fantastic, insightful writing this is. You should make a book out of this, there’s just no doubt about it.

    I can see exactly what you’re saying, but I don’t see the contradiction in the same way. The doctors I’ve met, and I’ve met quite a few, were (mostly) incredibly good as people-persons. Engineers, on the whole are not.

    That might be just random, but I really don’t think it is. On the whole, I don’t expect that the average student would consider subjecting themselves to seven years of medical school and many more years of houseman-torture to follow if they didn’t have a pretty huge shred of human kindness buried deep within their hearts.

    Beyond that, I’m certain that living through the experiences of life and death and personal transformation as you so regularly describe can’t fail to change a life’s perspectives. Insights which might cross other people’s minds once or twice in a lifetime are pelted at you almost every single day, and surely despite your protestations, it can’t fail to make you a wiser person and (ultimately, through all that experience) a much better and more compassionate doctor as a result.

    Bedside manner and patient empathy are such important skills which you note (with some frustration) aren’t taught in medical school. But I suppose the question is, can you really teach this stuff, or doesn’t it just have to be learnt?

    I’ve often thought that the ability to put people at their ease so that they open up is surely one of the most important skills of all for a doctor, and I imagine that only really comes with experience. It’s unlikely to be something you could easily teach a first-year student who is unsure of their technical knowledge and still ignorant of their human gifts.

    That said, I’m sure that there is much more work to be done in exploring how important these skills really are, and how they can be shared, mentored and improved upon. Worthwhile food for thought, perhaps, next time you are asked to set down some long-term priorities for improving care within your team…, or when you start to write that book.

  2. 2 Nelly And I December 16, 2009 at 10:31 am

    i think i overemphasise the point in order to make it – i do this for everything. Yes medicine probably does attract slightly more altruistic folk than some other professions but i certainly do not think that we’re all angelic ghandi followers by any means. This is the assumption that i’m trying to correct.

    I believe that engineers who give their time, energy, talents and enthusiasm to their vocation should get the same kudos as i do – that is where the imbalance lies.

    without doubt my personality is shaped by my vocation but i would also say vice-versa – that how i do my job is based on my own humanity. this is kind of obvious when i think about it.

    i really don’t think you can teach this stuff – certainly not to 18 year olds (when i started med school). You learn that by loving, being loved and having your heart broken.

    Now if they made medicine a graduate course then that might be a different story. All the grad students i’ve worked with have a much better understanding of the real world and what makes people tick. much better than i did when i was 18.

  3. 3 SteveWC January 3, 2010 at 11:47 pm

    I hate to burst anyone’s carefully crafted bubble, but the critical reasoning skills required of engineers leave MD’s in the dust. I know. I have graduate degrees in both (MD, MSEE).

  4. 4 Nelly And I January 4, 2010 at 12:15 am

    I won’t arguue there apart from stating the blindingly obvious that neither profession is Co
    posed of people so homogenous to be able to make such sweeping statements that one is”better” than the other. Surely it depends on the person and the specific subject.

    and to be fair the point was that people think that doctors are more altruistic and kind than other professions and had little to do with their recognition of critical reasoning skills – the comment about engineers not needing to be smart was intended to be ironic, sorry if that didn’t come across clearly.

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