Wednesday, September 19, 2007
It's considered a truism: if you have a doctor or nurse for a patient, it's gonna be a horror show. I'm not convinced, but to the extent that it could be true, the fault -- as Shakespeare probably said -- is in ourselves. The problem is the nearly irresistible pull to treat doctors and nurses differently than we do the rest of our patients: to abbreviate explanations, to avoid recommending things that are inconvenient, to bypass the ordinary steps taken to get from encounter to conclusion.
In the formative days of this blog, I posted about operating on my partner when I was a very young pup. Any way you could look at it, it was a horrible experience; after removing a section of his bowel, he had a problem I'd never seen before, nor have ever again. Without question, had I closed his mesentery the way I'd always done (and still would do) instead of the way he liked to do it (I figured he'd be happy when I told him), I'm certain it never would have happened. By the time it was over (and before he made a complete and full recovery!) I was ready to push him out a window and jump after him. Amazingly, within a day of his much-delayed discharge, I was asked to see another fellow physician in need of bowel surgery. OK, I thought. You fall off a horse...
Fortunately, he was a pediatrician, which meant I could treat him like a person who hadn't a clue about surgery. Close as you can come, really, to operating on a civilian. (Kidding. I'm kidding. But I do admit to telling that to myself at the time, given my closeness to never operating on anyone again, let alone a doctor.) He did fine. Whether it played a role or not, I treated him exactly as I did my "usual" patients: explained in the same detail, using the same understandable terminology, saying the same things to him on rounds, in the same way, as I would have had I not known him at all. During surgery, I simply put who he was out of my head. Operating on "Doug" early in my practice, horrible as it was, may have been a good thing: it taught me to wipe away any assumptions and treat everyone the same. (It must also be said: many doctors and nurses have an expectation of and/or try to wheedle their way to exceptional treatment. Myself included. I'm not opposed to giving and receiving certain perks -- fitting in a visit, removing a lump or bump off the clock, off the record. It's the big stuff that needs discipline.)
Until I saw the mystifying choices some of them made, I used to consider it a compliment whenever a nurse or doctor came to see me or sent a family member. OK, maybe it was. Still, I'm not sure -- with the exception of people who actually worked in the OR -- what they really knew about me. (I'll never forget my shock at hearing an excellent recovery-room nurse mention who her OB/Gyn was: a guy constantly under scrutiny for poor decisions and outcomes, who was -- happily -- at the time only weeks from his eventual banishment from the staff.) For whatever reason, I did operate many times on colleagues, co-workers, and their families. And notwithstanding that early horror, it never again bothered me. When red flags flew, it was for the same reasons they unfurled for "regular" patients: co-morbidities, unpleasant personality, weird behavior. Not, in other words, because they were medical folk. But after my ugly initiation, I did make it a point always to eschew short-cuts or shorthand, speaking and behaving in my usual manner, drawing the same simple diagrams. Some even made it a point to thank me for it. The ones that lived.