Friday, September 14, 2007

Remembering The Patient's Role In All Of This

Today, many medical students are asked to spend a day in the hospital as a mock patient in order to understand what the experience is like from the patient's point of view.

For aspiring doctors who are used to being surrounded by the latest technology, supported by trained healthcare professionals, and able to manage a medical crisis, the sudden feeling of powerlessness -- of being totally out of control-- is a rude shock to the ego. They get awakened from sleep to take a pill, get sent for all sorts of tests, receive enemas from total strangers, and undergo a brutally dehumanizing treatment protocol in the hope that it will increase their emotional sensitivity as physicians.

Today's doctors are even being urged to take acting classes on the assumption that, even if they're not too concerned about a patient's needs and cares, they can at least do a reasonably good job of faking their responses. The problem is: Whether you're faking sincerity with a patient or faking an orgasm with a sexual partner, you're still
faking it. And when your patients are dealing with these kinds of stressors, oftentimes there is very little you can do to help.

Sometimes even a physician needs a rude shock to jolt him out of a doctor's dulled, conditioned responses to life and to his life's work.

When my father was nearing the end of his life, an eager young internal medicine specialist (who had been called in to consult on the case) attempted to order a series of laboratory studies. My mother adamantly refused to give her permission for the tests to be performed. The young specialist was at a loss to understand why my mother would not cooperate with his orders until she explained the situation to him as succinctly as possible:

  • My father was dying.

  • He knew he was dying and looked forward to dying.

  • We all knew he was dying.
So if a choice had to be made between (a) making my father suffer through a bunch of unnecessary tests or (b) letting the hospital's income suffer by not billing an insurance company for procedures which would have been covered by the patient's policy, then the family's choice was that my father die in peace and the hospital have less income.
Having lost more than 1,000 friends to AIDS, I can tell you that my father was extremely lucky at the time of his death. His wish to avoid a long and debilitating terminal illness was granted. He expired in his recliner while taking his afternoon nap.

"He even got lunch!" my mother laughed.

A great deal of credit for President Clinton's victory in the 1992 election goes to his political strategist, James Carville. Knowing that Clinton's opponents would use every possible weapon to derail his candidate's bid for the presidency, Carville made sure that campaign workers understood the importance of keeping their efforts focused on one short and simple message to voters:
"It's the economy, stupid!"

Greed and ego are key motivators in any profession. The field of medicine is hardly immune to their influence. Taking Carville's strategy to heart, let's concentrate, once and for all, on the real reason for creating good, solid medical records.
Here's what it is not about for the medical transcriptionist:
  • It's not about how fast you can type.

  • It's not about how many lines you can bill out.

  • It's not about your problems with carpal tunnel syndrome.

  • It's not about your family, friends, love life, or any lack thereof.

  • It's not about the side effects of professional burnout.

Here's what it is not about for the dictating physician:

  • It's not about how fast you can dictate.

  • It's not about how many patients you can examine in an hour.

  • It's not about sheltering your income to avoid taxes.

  • It's not about your family, friends, love life, or any lack thereof.

  • It's not about the side effects of professional burnout.

Here's what it is all about:

It's about the patient!

[Consciousness Raising Exercise #19]

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