Wednesday, February 13, 2008

Letter #18

Dear Future Physician,

Congratulations on your success this far – I applaud you on your noble career choice and wish you the best of luck with your future endeavors. You are entering the medical profession at a time of great need. While there may be plenty of physicians to go around quantitatively speaking, through my experiences as a patient I've found that the quality of doctors can vary in a number of ways. I wish I could say every MD I've encountered was phenomenal, but the fact of the matter is that there is only so much one can be taught during medical school – good doctoring is about the patient, not just the disease, and that part comes when you are out in the real world.

As a formally perfectly health sixteen year old, finding myself in the hospital for the first time ever was beyond frightening. Basic tests showed nothing wrong and my first doctors only looked at the tests, not at me, and thought they were being comforting by saying "I promise it's not your heart" when my (obviously GI) pain was in the epigastric area. It took over a month of traveling to different hospitals, evenly highly respected ones such as the Mayo Clinic, before I even had some semblance of a diagnosis, and that's because one doctor truly looked at ME and not just my CT/MRI/endoscopy/labs/you-name-the-test. Just because you can't find an obvious abnormality on a lab or diagnostic test doesn't mean there's nothing wrong, and it most certainly doesn't mean it's "all in my head." After my "godsend" doctor took the time to treat me as a person, we quickly received the correct diagnosis: Chronic Pancreatitis. Ironically I was treated completely different after that diagnosis popped up on my chart. And six months later when my ICP was 330 there was no question that I truly had a "headache behind my eye" – we got the diagnosis of Pseudotumor Cerebri while I was still in the ER and I had shunt surgery a year later. Basically what I'm saying is to trust your patient – you know the anatomy, pathophysiology and differential diagnoses… they know their body, and certainly know when something isn't right.

As my main treating hospital is a prominent teaching hospital, I've encountered more than my share of residents and medical students. Some were great, and I let them know that. Some I shuddered when they walked in my room. While in the end the most important part is what is coming out of the physician's mouth, there is so much more to communication, which I believe to be the essence of a successful patient-doctor relationship. It's been proven that about 7% of meaning is transmitted by words, while 38% is by vocal cues and 55% by body cues. Please keep in mind that whether you like it or not, you are being judged from the moment you walk in a patient's room. Your body stance and opening remarks set the tone for the entire visit. It was the doctors that first asked about me and not about my disease that I developed a deep sense of respect for. And it's not just your communication with your patients that matter. Whether intentionally or not, we see the impression you have made on our nurse, and since she sees every combination of medical talent and personality, we tend to respect her opinions. If your patient is in pain at 3am and you're on call, please don't complain when you're woken up… you signed up for it! I say that half-jokingly… as a nursing student, I know that nurses don't enjoy having to call and wake you up in the middle of the night just as much as you don't like being woken up. They are just doing their jobs as patient advocates – please respect them! If you haven't figured it out by now, nurses can be your best friend or worst enemy!

Patients understand that it's impossible for one person to be an expert in everything, hence the reason we have sub-specialties. However, nothing bothers me more than a doctor who has too much pride to admit he's out of his realm of knowledge. "I don't know" is not an acceptable answer to any question, big or small… the answer is "I don't know, but I will find out" and you should follow through! Big egos are perhaps the biggest turnoff in doctors – even if you are world-renowned, you are still a person just like the rest of us. You may be superior to your patient in medical knowledge, but chances are they know more about another topic than you do. On that note, while patients are more knowledgeable on their own conditions than ever before thanks to the internet, please explain things in words your patient can comprehend. A sentence full of "medical lingo" just adds anxiety to an already anxious patient. In school they tell you that "the only dumb question is the one you didn't ask" – same goes for patients. It may be something you think is as obvious as the fact that the sky is blue, but if your patient brought it up to you, it's important to them, and therefore should be important to you.

In a similar vein, there is a huge difference between delivering a new diagnosis, poor prognosis, or other difficult news realistically versus bluntly. The former shows respect while the latter indicates that you don't care, even if that's not what you intend to communicate. And in times like those, a little compassion can go a long way. It's the little things that matter – that extra minute you stayed to assure a frightened parent… to play a game of cards with a child receiving chemo… to hear a terminal patient's reflections on life… those are the moments we remember as patients. And frankly, I think you will remember them too, as they are the essence of the wonderful "helping" profession you have chosen.

Above all else, please remember each day as you enter the hospital or office why you went to medical school in the first place. Think of the older woman who is hard of hearing and needs everything repeated as your mother, the annoying, impatient little boy as your future son, and the young woman distraught over her new diagnosis of breast cancer as your sister. Just remember that you are treating people, not specimens, and everything else will fall into place.

Best of luck!


Age 20, Chronic pancreatitis (dx 4/05), Pseudotumor Cerebri (dx 8/05), VP shunt (7/06)

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