“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Saturday, July 7, 2007

Not everyone will like you...

“Knowing is not enough; we must apply. Willing is not enough; we must do.”
~Johann Wolfgang von Goethe

I was told once by one of my mentors that "not everyone will like you." At the time I didn't understand the wisdom in that statement and just went about my day. As I progressed through residency, fellowship, and into practice, I have begun to understand the enormity of that statement.

It is summer time. For the pediatric orthopaedist, this is the busy season. Both elective and emergent surgical cases peak, and clinic volume is maxed. So, let it be known that my wife hates this time of year. The past few weeks, I have been swamped. The other day during a long OR day, I was consulted by one of my general surgeon colleagues about a difficult case. He asked if I would review the chart and radiographic studies and help them come up with a plan of action. I told him I would review everything and get back to him.

After my cases were completed, I sent the residents on their way (they had to prepare for conference in the morning). I started rounding on my patients. It was more like social rounds. You know, "how are you doing? ... and yada yada yada." This is usually quick; it's not work rounds. Patients like to see their "doctor" even if you aren't really doing anything. I started with my inpatients. I went into each room and sat on the edge of the bed and talked to the child and his/her family. I answered a number of questions; then I was off to the next room. I had no difficult patient issues today.

The last room I visited was the room of my new consult. I pulled the chart and reviewed the admission note (that I could barely read); I looked at all of the xrays, MRIs, CTs, PET scans, and bones scans. I reviewed the previous operative notes and pathology reports. Needless to say, this patient had been through a lot in his short life. The next step was to examine the patient.

I walked into the room. There was mom, dad, sister, cousin, and friend. I introduced myself to them all and discussed the reason why I was asked to see him. I talked with mom (who is in the medical field) and dad for a bit to get a sense of what had been done previous and what recently gotten him to this hospital stay. Then I sat down and talked to the patient. I began by talking to him about school, girls, if his sister was nice, about his new PSP (which is FFT). We talked about some of the things he liked about school and what his aspirations where in life. I then began to talk to him about his symptoms and how things had changed. I did a quick exam of the areas of concern. Then we discussed what I would propose to do. I think I spent may be 20 minutes in the room. Everyone was on board with the plan. I contacted my colleague and scheduled the surgery for the next day.

The next day we preformed the procedure. Afterwards, I went to talk to the family and informed them of the outcome and the future plans. At the end, the mother says to me how appreciative her son was of how I treated him. She informed me that I had been the first person to sit down and speak to him in a language he could understand. She actually began tearing up. I said thank you. I checked on my patient in recovery room. When saw me, he began to cry and began thanking me for taking care of him.

As much as we complain about number of hours in the hospital, poor reimbursements, bad hospital administration, insurance dictating care, and increase in malpractice cases, one of the things that is sometimes lost is the care of the patient. We are taught both in medical school and residency to take care of diseases that patients have and not how to take care of people. Sometimes we get so caught up in our own issues and forget that the patient is not a disease s/he is a human being.

Not everyone will like you. This is something that you will encounter throughout your training and careers. Your purpose should not be to have the patient like you but be to provide good overall care of the patient (person) and family. In this particular instance, I did not do anything different than I normally do, nor do I think what I did was extraordinary. I treat these kids as if they were my own. I try my best to treat the patient as much as I do the disease. This day I succeeded in remaining human. We will see how I do in the coming days.

“To become truly great, one has to stand with people, not above them.”
~Charles de Montesquieu


Brent said...

You keep this up and I'm going to become a pediatric orthopod!

Xavier Emmanuelle said...

I think I'm going to print out this post and read it on days when I'm fed up with studying --- this post reminds me all over again why I'm going to do medicine.