I was contemplating what to write about this week, when this story unfolded right in front of me.
True story:
A friend of mine was awakened in the middle of the night this week when her son called from college to say he was having chest pain. He'd been diagnosed with mononucleosis a week earlier, and was feeling worse and worse. He ended up calling 911 and going to the hospital in town while she jumped out of bed, packed a bag, and embarked on the five-hour drive to her son's bedside..
By the time she got to the ER, they had already ordered a chest Xray and blood work. Her son's d-dimer level was elevated, so he underwent a CT scan of the chest to rule out a blood clot in his lung. It showed pneumonia, instead. He was admitted and started on two powerful antibiotics and a blood thinner.
His mother and I exchanged frequent texts the next day as I attempted to answer her questions...without being too critical of the level of care her son was receiving. I explained what the elevated d-dimer test meant. That it doesn't necessarily portend a blood clot. That infectious pneumonia by itself can raise the level. That, in this case, the blood thinner was a precautionary measure.
"Nobody cares how much you know
until they know how much you care."
~Theodore Roosevelt~
My friend wanted to know what else she should ask the doctor when he came in. I asked if they'd done any other testing. Sputum cultures? No. Cold agglutinins? No. Follow up Covid testing? No. Was his doctor aware that he'd just completed a full course of antibiotics for an ear infection that had complicated his mono? No. No one asked. Did anyone ask about vaping? No.
"The most important part of the story
is the piece of it you don't know."
~Barbara Kingsolver~
Did the doctor come in to see his patient, a new admission? No. It was Friday afternoon, and he wasn't planning to make rounds.
My friend did manage to get him on the phone, however, noting that he sounded slightly miffed when she put my questions to him. Nevertheless, shortly thereafter, there was a flurry of activity as blood was drawn and cultures were obtained.
The thing is, no one took a thorough history to begin with. If they had, they wouldn't have prescribed the same antibiotic he'd just finished.
If they'd submitted sputum cultures when he was admitted, they wouldn't have prescribed a full course of inappropriate (aka. "shot gun") antibiotic therapy.
I explained to my friend that I'm "old school" in my approach to medicine. This means more than simply obtaining the patient's history, performing an examination, ordering tests, and recommending treatment. It involves explaining what is happening every step of the way, and the reasoning that goes into our decision making. It means sharing our expectations for the patient. Even our fears. It means responding to theirs.
It involves not just the patient, but the people who gather at his bedside because they care about him. Because they love him. When we treat a patient, we treat his family and friends, as well. They need to understand what is happening and what to expect. They deserve our attention. They need our consideration, compassion, and support, too.
The overwhelmed physician may suggest this is what we have nurses, social workers, psychologists, pastors, and family and friends for. In today's health care culture, you can get away with this. You can focus on the bulleted lists in the electronic medical record and leave the rest of it to your staff. You can apply what you know about medical and pharmaceutical technology without really knowing your patient. He will still heal. But by disengaging yourself from your patient's psychological, emotional, and spiritual life, and from his family and friends, you sacrifice your connection with him. Unless you include them in his care, you disconnect him from his support system. From his caretakers.
This can leave all of them with fear, uncertainty, confusion, and dread when what they need is engagement, support, and understanding.
"A kind gesture can reach a wound
that only compassion can heal."
~Steve Maraboli~
Things eventually worked out for my friend and her son. He is home now. The cultures nailed the diagnosis, and the antibiotics were changed. He has a trusted PCP who will monitor his recovery. It's time to let the healing begin.
"The good physician treats the disease.
The great physician treats the patient who
has the disease."
~Sir William Osler~
jan
PS: I'll be off the grid at Kripalu Center for Yoga and Health in Massachusetts this week. I expect to come back heavily meditated...
No comments:
Post a Comment