Dear Jessie,
Can you believe your first semester of medical school is behind you?
Wow. I still remember the thrill of learning about the body, even though it was over 30 years ago. (Yes, I know: Most of what you are learning wasn't discovered yet when I was a student.)
In the months since you began your studies, memories of my early days in medicine have been resurfacing. (Sigh) If only I knew then what I know now, which takes me to my reason for this letter.
Since New Year's, alongside my usual vows to cut down on junk food and work out harder at the gym, resolutions to help improve patient care have been rattling around in my head. Since I can't put these ideas to use myself, I'm passing them on to you.
As always: No pressure. Read this at your leisure, and use it whatever way might be helpful.
Put Blame Where It Belongs
When procedures don't go smoothly, be careful not to blame your patients for their anatomy or physiology that ramps up the difficulty for you.
For example, if you miss a needle stick, avoid blaming the patient by saying, "Your veins are scarred" or "You have rolling veins." Many patients are already burdened with self-doubt. Even when they know their veins are not their fault, their sense of vulnerability can make your statement sound like an accusation.
Obviously you don't want to say, "Dang. My technique sucks." Unless your patients are comatose, they probably won't give you a second chance.
I suggest stating the situation and giving patients some control. For instance, "I need to re-stick you, using a different vein this time. Would you like a few seconds' break before I begin?"
When I worked on the wards where help was always available, after missing a stick I reassured my patient, "I should get the IV in this time. If I don't, I'll get someone else to start your IV today."
Along this vein (Sorry, Jess, I couldn't resist!!), the blame-phrase that irks me most is "These patients failed their treatments."
Excuse me? These patients kept up their half of the bargain. They came for their treatments, right? And they dealt with the side effects, inconveniences, and expense. Even when you are talking among your colleagues and out of earshot of patients, I think it's wrong-un-healing-to say "these patients failed" their treatments. If anything, "the treatments failed" these patients.
Refer to Reliable Resources
I'm ashamed to admit this, but it was only after I became a patient that I learned about local and national disease-specific resources for patients. I seriously regret all the lost opportunities to connect my patients to first-rate info-and-support services.
Jessie, in a few years you will have your "MD," and your words will carry great weight. Anytime you recommend something as a physician-even a Web site or a support service-your patients will be more likely to follow up.
I have an offer you can't refuse: When you go into practice, I'll help you create handouts that list the top five resources for each of the most common diseases you treat. It won't take us long.
Once you have the handouts, in two seconds you can say to your patients, "I want you to review this sheet and check out some of the resources." With this tiny effort alone, along with providing the information, you'll:
* Encourage your patients to learn about their disease and treatment.
* Acknowledge the emotional side of your patients' illnesses.
* Steer patients to excellent resources and away from unreliable (and dangerous) ones.
Learn about Patients' Hopes and Dreams
One of the most challenging aspects of being a clinician is having way too much to do in too little time. Here's a tip that can help you become more efficient: Find out about your patients' hobbies and hopes. When evaluating medical problems, ask them what activities used to bring joy, but that no longer do.
Wait!! Hear me out before you roll your eyes.
Let's say I ask my patient, "Ms. Smith, how's your back pain doing?" She might answer, "Fine, doctor."
So what do I conclude? Her back pain is under control.
But if I ask her to name an activity that used to bring joy but no longer does, she might tell me she hasn't gone to her book club in months.
"Why?" I'd ask.
"Because, Doctor, I can't sit longer than 20 minutes. My back throbs and my right foot feels numb."
Now you have a more accurate picture of this patient's condition. In many settings, discussing patients' hobbies and hopes can help you in your evaluation of patients by:
* Clueing you in to previously unrecognized symptoms.
* Clarifying the severity and impact of known symptoms.
* Providing useful insight into the patient's resiliency and emotional adjustment.
Understanding your patients' hobbies and hopes may lead to better patient compliance, too. A shared goal of "controlled blood pressure" is fine and good. But your patient (and I suspect you) will likely feel more invested if the goal is "fishing, caring for grandchildren, attending book club, playing golf, traveling, and so on." When blood pressure control is a means to an end (and not an end in itself), your patients will better understand the "why" behind all the "what" you prescribe.
If nothing else, Jessie, caring about patients' hobbies and hopes nourishes healing clinician-patient bonds, because happiness has nothing to do with anatomy and physiology, and everything to do with the person in the hospital gown.
Enough for one letter. Enjoy school. Love, Mom