Monday, February 12, 2007
I consider surgery -- yes, even surgery -- to be grounded in science. Positing an idea, subjecting it to testing and peer scrutiny, healthy skepticism, constant re-evaluation: all those things, we do. Doctors are heirs to those who invented transistors, calculated moon-shots, figured out DNA. Still, it's not as if we're pure as snow, scientifically. I'm not, anyway. My gut -- which has metaphorically and metabolically grown over my career -- still plays a role. Here's one example, and I'd bet other surgeons (and to the extent that the concept applies to other docs, they too) would agree with this: you can tell who's going to do well as soon as you meet them. I doubt it's testable. For that matter, it may not even be true. But I'm saying there's a vibe about some people, good or bad, that can fill a room -- signaling strength or portending problems, making me light on my feet or feeling doomed. Demi-doomed, anyway. Wish I'd been able to bottle the good stuff.
We're talking gut here, so I'm not sure I can elucidate. It's not about particulars, although surely there are some at play: eye contact, family interactions, general health. Attitude. Practicality. Not fear, per se: everyone's afraid. How and where the fear fits, how it's broadcasted. What questions are asked: about pain, side-effects vs. how soon can I get back to work. Humor. (Especially, appreciating mine!) And you know who's predictably among the best? Little old ladies. Let's hear it for little old ladies. Maybe it's because they've seen it all; perhaps it's because they are innately trusting. It's not, certainly, because they're worn out or don't understand. They just know they can handle it, is all, because they've already handled so much. Yeah, maybe that's it.
It's widely held, I'd say, that positive attitude improves outcomes; optimism helps to cure cancer. At least one study says otherwise. As squishy a thing to measure as is "attitude," I'm sure the study is subject to criticism. Still, the result doesn't surprise me. Stress maybe. Attitude? I'd question it. But I have no doubt (just don't ask me to prove it) that how you feel going into an operation has much to do with how you come out of it. Even little things, in my self-regarded opinion, make a difference. Here's one: in the recovery room, when patients are just struggling awake, most nurses ask them "are you in pain?" When I'm there, I ask "are you comfortable?"
If, as studies tell us, a more happy patient isn't necessarily a more cured patient, nevertheless you'll never convince me (until a study is done) that a happier patient isn't a quicker-recovered one. I'm a hand-holder, a sitter-on-the-bed, a patter-on-the-knee. I'm a cracker of jokes, a looker-for-the-lipstick-sign.* And my patients, mostly, got home happy from surgery, PDQ. For that, I do have data. And the ones that didn't? Well, I just knew it.
*Positive lipstick sign: when a lady makes the effort to put on lipstick after surgery, you know she's on the home stretch.