Tuesday, 16 December 2014

Compliments

WARNING: I WILL BE SHAMELESSLY RISKING SPRAINING MY SHOULDER BY PATTING MYSELF ON THE BACK IN THIS POST.  

Admittedly this blog is dedicated to idiots and stupidity, and as I've said numerous times my favourite idiot remains me.  So having told several stories where I am the goat, I think I've disparaged myself enough to have earned myself a complimentary update.

If you want more idiot stories, you'll have to wait.  Probably not very long.

Since finishing my training I have spent very little time around other doctors in clinical situations, so I therefore have no idea how my colleagues speak to patients.  I don't know what kind of terminology they use, if they have prepared speeches for certain situations, or how they treat patients in general.  I have a fairly well-established bedside manner, and it seems to serve me very well in the vast majority of situations.  Though my demeanor rarely changes much, every now and then I have to tailor it for certain types of patient (those who are very difficult, very drunk, very upset, very young, very old, etc).  Some people need a bit more care, some need a stern talking-to, others need massive doses of sedatives to shut them up.

Kidding, kidding.  Sort of.

Generally speaking, my philosophy is this: If you're nice to me, I'll be nice to you.  Because of this ideology, every so often patients tell me (compliment warning) that I make them feel better just by sitting with them for a few minutes, talking with them, and explaining everything in excruciating detail, probably more detail than they want or need.

Apparently this is not the norm for surgeons.

Nathaniel (not his real name©) was the unfortunate driver of a petrol (gasoline) tanker truck.  In the wee hours of the morning Nathaniel swerved to avoid another driver, and his truck lost control and flipped on its side.  Incidentally, I hate the term "wee hours".  "Small hours" is no better.  I don't know why it bothers me so much.  Non sequitur over.  Anyway, sparks began to fly from the now-exposed underside of the truck, and despite debilitating pain in his chest, Nathaniel wisely decided not to be anywhere near his truck when those sparks interacted with the several thousand gallons of highly-explosive fuel he had been hauling, and he ran.

When he was brought to me about 30 minutes later, he was clearly agitated, clutching his chest and having trouble breathing.  When I pushed lightly on his chest, he grunted and looked at me as if I were Satan.  His chest felt unstable to me, and an X-ray confirmed that he had 4 fractured ribs.  Fortunately his lung had not collapsed, he had no bleeding in his chest, and he had no other serious injuries.  I explained that his injuries were painful but not life-threatening and that the only treatment was pain medicine and time.  That seemed to calm him somewhat.

Over the next several days, I quickly assessed that he would be a patient who required a bit more TLC than my typical patients.  My daily rounds with him, which should have taken no more than 3 minutes to press on and listen to his chest, assess his pain, and go over his X-ray, took at least 15 minutes while I sat with him, listened to him describe his pain, and reassured him that he would heal, but it would simply take time.

A few days later his pain had improved to the point where he could walk without difficulty, and he no longer needed IV narcotics.  I discharged him, telling him he could continue his recovery at home, though it would be several more weeks until he felt completely better.

As I was sitting in my office about a week later, I got a call from Nathaniel, asking if he could transfer his care to me.  Confused, I told him I was already his doctor, so I asked him what he meant.  "Well, I really liked the way you cared for me in the hospital.  You were so patient with me and you really listened to me, so I want you to be my primary doctor."

I told him that while I don't do primary care, I was truly honoured by the request, and that simple question was one of the best compliments a surgeon could get.  I gave him the phone number for an internist whose philosophy is very similar to mine - be direct and honest, and above all else listen to the patient.

To the medical students reading this, I hope you take this vignette to heart and learn a valuable lesson that DadBastard and GrandpaBastard taught me a long time ago.  Ultimately all patients want the same thing: to be treated like a human being.  What I did isn't difficult, it isn't special, and it isn't unique.

All I did was treat Nathaniel like I treat everyone - with respect.

23 comments:

  1. one of the rules of thumb I teach rookies for hazardous materials incidents is "If you see the driver running, try to keep up."

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    1. This comment made my day. I needed this kind of humor today!

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    2. thanks. I stole it from another instructor who stole it from an action movie.

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    3. This sounds like an excellent survival strategy.

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    4. my department has had only one line of duty death in over 70 years, and that was a heart attack. we didn't get that record by being reckless. dead firefighters make great headlines, but usually don't save any lives in the process.

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    5. I did a pool lifeguard course many years ago and one of the first things they said was: "Be careful; if you're drowning, you're not helping anyone". I'm sure the same logic applies to being on fire!

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    6. yep. if you have an accident you become part of the problem.

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  2. This is why for a very long time I've preferred to see NP's. They're trained from the beginning from a different perspective than MD's have been. Recently, this hasn't been so true as I've been to 3 different NP's that are....I don't know what to call it but I'm done with those 3.

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    1. I've had about a 50/50 success rate with NPs. when I see an NP instead of a GP, it's generally equivalent, sometimes better, but on the occasion that I've had to see an NP instead of my gyno because of a scheduling conflict, it was definitely a lesser experience.

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  3. I have narcolepsy, chronic migraines, and endometriosis, so I mostly see a neurologist (for the first two) and a gyno (for the latter), who have a similar amazing bedside manner, and who I can tell truly listen. it probably has something to do with being a specialist, but they never prescribe simply to get you out of the room, they schedule long enough appointments, and they remember details of my life that have nothing to do with my medical history. they make me feel like a person, not a patient.
    my gyno has done 4 of my 6 surgeries (I've had 4 for endo, one appendectomy, and one gall bladder-ectomy); she is by far the best, most considerate doctor in terms of listening to me and telling me exactly what she's going to do.
    whenever I have to see a GP, I'm entirely lost, and I never have nearly as good an experience as I do when I see my neurologist or OB/gyn. I have actually seen my neurologist on one occasion for sinus infection, simply because I didn't want to deal with a GP.

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  4. That is great! It really does make a huge difference when you find a doc that cares and you know they're not going to be laughing at you behind your back.
    I was super nervous when we were moving from MI to TX over the summer and having to replace all of my daughter's specialists but we hit the jackpot out here and found an AMAZING Ped and the rest of her "team" (read...rare genetic syndrome with a bunch of other unknown crap thrown in...) It really does help. a LOT. and yikes on the truck driver!! he is one lucky man! My husband is a Safety director for a large trucking co here in TX and we just had a tanker roll over late Friday night and had they made even one slip up while trying to set this truck up right the whole dang block would have gone up. (including my husband) Glad he is ok! Good job Doc B!!

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  5. listening works so well! my previous GP just never listened or did anything. every time I saw him he would give me the exact same prescription: lose weight and exercise. he wouldn't listen to me when I said I was in too much pain to exercise. he didn't listen when I told him that I'm so exhausted that some days just taking a shower feels like running a marathon.

    I got fed up with him and found a new GP. new GP is terrific and since seeing him we've figured out I have fibromyalgia, GORD and (up until recently) chronic sub acute appendicitis. I'm taking medications for the GORD and fibro, my appendix has gone bye bye and guess what? now I'm exercising more because I'm not in so much pain and because my pain is under control I'm feeling less exhausted! it's amazing what a simple thing like listening will do!


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  6. I was a nurse in a busy day surgery unit. My job was to get the patient ready for surgery. I picked up the next chart and read the note taped to the front. This patient was terrified of red exit signs. OK.
    The elderly man's family left the room (yay!) and I started my assessment.
    What should have taken 15 minutes lasted about an hour.
    My patient started talking. This elderly farmer from a very rural area was on a ship that was bombed in WW2. He was on a lower level. After the ship was hit the only hope to make it out was to follow the red exit signs. When he passed the severely wounded all he could do was inject them with morphine from a medical kit that he had with him and keep going. He told me about a lot of things. All I could do was listen.
    After I finished, I mentioned to his family that it took so long because he wanted to talk about the war. They told me that he had never spoken about the war to anyone.
    My co workers were furious because I took so much time with one patient.

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    1. I'd be disturbed by red exit signs too, if that was my most prominent memory of the war.

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    2. You can just imagine that seeing those signs must bring back memories of being stuck on a sinking ship surrounded by people you know who are about to die and you are unable to help. That's enough to make anyone panic!

      The fact that he wanted to tell someone before he went into surgery makes me wonder whether he feared for the outcome. Hope it all went well.

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    3. This happened almost 20 years ago. I don't remember what procedure he was having done and I didn't see him again but that is one 'get ready' I'll never forget.

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  7. Bedside manner goes a long way in getting a patient to open up. How can some Docs not realize that? Incidentally - I thought of you, DB, and this blog - at 2:00 am as I was taking my husband into the ER with chest complaints. It had to be 2:00, NOT 2:00 PM! LOL! He's a post-bypass patient, and a tough guy who rarely admits to symptoms, much less consent to go to the ER. He checked out fine, with the basic tests, but has a follow-up with his cardiologist this afternoon. So was he one of your patients who shouldn't have been in your ER, or do you say better safe than sorry? Thank you! : )

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    1. I can't speak for DocB but unless he makes a habit of going despite it consistently being nothing, I feel it is still better safe than sorry. (we have had people who consistently called for an ambulance for symptoms of minor problems.)

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    2. I'm not a medic but it would be a very unprofessional doctor who was put out by seeing a post-operative cardiac patient with chest complaints. Especially, as Ken says, if they don't make a habit of kicking up a fuss about nothing.

      Hope the follow-up revealed nothing amiss.

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    3. I work in an interventional cardiology practice and I would have advised you to do exactly what was done had I taken a call from you or your husband that he was having chest pain. It is not worth the risk that it 'might be nothing' for a patient with a cardiac history, let alone history of CABG. I hope all is well.

      As Ken alluded to we have a fair number of 'nervous nellies' as well that show up in the ER or walk-up at the clinic for minor things.
      -AnonRN

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  8. Thoroughly enjoy reading your blog, keep it up.

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  9. The feeling you described here is the way that I feel about my ENT.
    I mean, I'm also so enamoured with the man that I could marry him, but I think most of it stems from the fact that he's the first doctor in 5 years who listened to me and validated my problem.

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  10. No, SERIOUSLY. You have no idea, from a patient standpoint, how incredibly rare it is to find a doctor that treats you as a rational human being, listens, explains, etc. It's good to know you're out there, however rare.

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