Category Archives: Doctor Story

The model doctor

Doctor, please:

  • Show respect to all your patients, irrespective …
  • Try using a sense of humor.
  • As your patient walks into your surgery, observe him.
  • While keeping a respectable professional distance, showing a tiny bit of T.L.C. (tender loving care) won’t harm, you know.
  • It’s not a bad idea to consider your patient and his/her family as a team players.
  • Do inform your patient about any expected side-effects of medication.

 

 

 

 

Dear doctor, you might be a patient one day …

hospital doctor Dear Doctor,

One day you might have the misfortune to be on the other side of the medical system and become a patient. A nurse will hand you a hospital gown that does not close at the back showing your rear end to all and sundry, and suddenly, you will understand how embarrassing that can be. You will lie in a hospital bed and feel just like the rest of us. When you need a nurse’s help, she might ask you to wait because she is busy with the more seriously ill patients. When your doctor friends follow the same recommendations you have given every single one of your patients in the past, you might begin to feel awful. Things like; ‘Don’t worry, you will soon be out of here. Or, you are getting the best treatment, you know.’ But, after a few days, when your condition persists and you don’t feel that you are being treated well or not being treated at all, you will find it hard to believe that you are simply not getting better. You might consult with some of your colleagues on the outside and be amazed to discover how callous their remarks can be, no matter how well-intentioned. Didn’t you say similar things countless times to your own patients? Oh it can’t be that bad, or, it probably started a while ago and you didn’t notice the symptoms. Don’t be upset, it is rather minor, you know. You should barely be aware that you have this complaint at all. ‘But,’ you probably replied. ‘Minor or not, it is driving me crazy.’ “Oh, it can’t be that bad,’ is what they shoot back at you instead of some tea and sympathy. Maybe a colleague will even dare to say, ‘It’s so minor that it does not even fulfill the criteria for treatment in a hospital.’ But you probably replied. Minor or not, I know how I am feeling!’

 My dear doctor – until this happens to you, you’ll probably have prided yourself on your communication skills with your patients yet here you are, being schooled on what it means to be in a hospital and worse still, without any sympathy whatsoever. And when you recover sufficiently to return to work in your clinic, will you remember that no matter how minor a condition is, it’s painful, frightening, depressing and very real to the person concerned? Have you ever wondered why after giving advice to a patient, he will probably ask; ‘Would you recommend this if your wife were suffering from the same condition, doctor?’

 

 

The operating theatre

operating theatre I had to have surgery on my shoulders after an acccident. The one side needed ligaments repaired but the other side was diagnosed as a rotator cuff injury which is serious and it’s usually something that athletes manage to do to themselves, not an average mother. I did as I was advised by my doctor which left me with no sense of control or power over the situation. Even though I was in so much pain, there were times when I felt invisible. I wondered whether the surgeon remembered my name, whether he’d studied my case history, seen the results of the innumerable tests I’d undergone, and whether he knew which shoulder he had to operate on – the right or the left. So, I took a pen and wrote a large R on my right arm.  He’d asked so few questions. Did he know how I came by this injury? Getting down to business and moving on seemed to be all he was interested in doing. I needed him to look at me straight in the eye. I needed to see a smile on his face or a sympathetic expression. But no, he was entirely focused on his work. ‘How painful will this operation be?’ I needed to know. ‘That’s hard for me to tell as I’m always on the other side of the operating table you know.’ I was hurting, afraid and very upset and I needed some human kindness. How come he didn’t know that? Shouldn’t he have learned that at medical school?

Narrative medicine

narrative medicineDoctors who practice narrative medicine do so with the skill to recognize, absorb, interpret and be moved by stories pertaining to illness. To practice narrative medicine, be it in internal medicine, family medicine, pediatrics, obstetrics, surgery or psychiatry, a physician has to develop the sophisticated skills to read a patient’s body language and attend to what they are saying, particularly psychiatric patients.

If medicine is practiced with these skills, the clinician or trainee has much to offer his/her patient. By listening with attention, he/she can hear and receive in full complexity what the patient is conveying in words, silences, gestures, body positions as well as physical findings.

As a result, this clinician, by using narrative competence, becomes a witness instead of a judge, a companion instead of an interrogator, an ally instead of a bearer of bad news or the inflictor of discomfort only.  This gives the doctor sufficient knowledge to develop a clinically helpful and useful affiliation with the person he is treating.

In my humble opinion, narrative medicine is meant to treat the whole person and not only the illness. If doctors and psychiatrists are able to brush up on their listening skills, life will be a lot easier for their patients.

 

Are doctors still discriminating?

Are doctors still discriminating?         

 This is the second in a series of ‘mentally ill people visiting doctor’ stories.

On another occasion, a man with a mental illness was lying on the examining table when a gastroenterologist he was visiting for the first time looked at his list of drugs, then shook his finger at his patient saying; “Get yourself together psychologically or your stomach will never come right.” Now nobody who meets this young man would guess that he had a mental illness as his meds worked well.

At the support group I ran I met many people with mentally ill children and one of them had managed to get through her adult life without anybody finding out that she suffered from Bipolar disorder. But, as soon as she had to reveal it to a doctor, everything changed, wiping clean the rest of her resume; her education, her accomplishments, reducing her to a diagnosis of mental illness.

Are doctors still discriminating?

This is the first in a series of doctor stories.

It  has been said that people with serious mental illnesses who use the public health care system, die 25 years earlier than other patients. Suicide is a big factor that accounts for 30 to 40 percent of early deaths yet 60 percent of people suffering from a mental illness will die of preventable or treatable conditions.’

To all the health care workers out there.

Every mentally ill patient is someone’s wife, someone’s husband, or someone’s son or daughter, or maybe even somebody’s parent. Please listen to what your patients are telling you. Don’t stare at their charts and when the word mental illness jumps out at you, change your attitude to that patient. As I see it, your job is to recognize, absorb, interpret and act on the symptoms. Medicine that is practiced with narrative competence is a model for humane and effective medical practice. Humanizing programs should become a requirement for all health care workers. I feel strongly that DO NO HARM should apply to everyone; even to mentally ill people.

 A young man told me that he’d made an emergency appointment to visit an ENT specialist due to a severe ear infection that was causing a level of pain he had not experienced since having  gallstones removed. The doctor went through the list of medications he was taking for his schizophrenia disorder and then closed this patient’s file saying; “I feel uncomfortable prescribing anything else for you as you are taking so many meds already. Try Tylenol. Then he indicated that the appointment was over. The following day, the young man’s eardrum ruptured and the hospital doctor told him that he’d been left with minor but permanent hearing loss.