Patience

This has been a very clinically oriented week for me: I spent four hours working an “observational shift” in an emergency room, four hours shadowing an intervention cardiologist at a private hospital, and four hours working at a weekly clinic in a halfway house for former drug users. It has been, simultaneously, both empowering and humbling: I have repeatedly become very aware of how little I know at this stage of my training as my instructors in the clinic have asked me questions to probe my knowledge base, and yet I also have felt, for the first time, partly responsible for the care of patients and their future outcomes of the care provided at these institutions. Through all of these experiences, I have found that patience is a valuable asset that is often abandoned, yet it is such an integral part of being a physician and a caregiver.

On this subject, I have three anecdotes:

Broken Trust

In the ER, one young mother brought in her 2-year-old child who had previously spiked with a fever of 106 degrees and had a bad cough. According to one physician I know, these two symptoms together “are pneumonia unless proven otherwise.” All of the signs were pointing to either bronchitis (non-lethal) or pneumonia (considerably worse and may be lethal), and a chest x-ray was ordered to determine whether or not the condition was pneumonia (which typically presents with pleural effusion, the accumulation of fluid around the lungs). However, the mother did not want to wait for the chest x-ray: she had been at the ER all day with her daughter, and she didn’t want to wait any longer. The attending physician came to speak to her and try and convince her not to leave: she spoke quite sternly to the young mother, and mentioned that any other doctor would have called the Child Protection Agency in this situation (in which the mother would leave with her daughter Against Medical Advice [AMA]). This seemed to convince the young mother to stay, but I could tell that she was not happy about this accusation and seeming threat. Later, when the chest x-ray returned and was showed no sign of pneumonia, the attending spoke to the young mother again and prescribed antibiotics for the little girl’s condition which was likely bronchitis. However, when the attending left, the mother still had questions. To my surprise, she turned to me and asked me to help clear the confusion. Though my knowledge base was limited, I did know enough to help her understand the difference in severity between bronchitis and pneumonia, the difference between bronchitis and allergies, and also the reasoning for using antibiotics for bronchitis. After I explained this to her, her edge seemed to be softened, and although she wasn’t happy about her experience at the ER, she seemed to be slightly more confident about being able to care for her daughter. Hopefully, the extra minute I took to explain these differences to her will help her make the right decisions about her daughter’s health. In this case, both the patient and the doctor weren’t as patient as they could have been with one another, and it took a third party (me) to help diffuse the situation.

Someone to Listen

When I shadowed the interventional cardiologist, one of the patients he saw had previously seen one of his colleagues the previous day for a checkup after having not seen a cardiologist for some time. Notably, she was quite upset about that patient-doctor interaction: the physician simply did not seem to take the time to hear  what she had to say. However, this intervention cardiologist, without needing to put any effort into using charisma or charm, listened to her story and her concerns, and she left feeling much happier and better taken care of now that a doctor was willing to hear her out and take her words seriously.

Generosity

At the halfway house, I saw one patient – my first real patient (and a new admit) for whom I took a full history and did a full physical examination. I definitely wasn’t prepared for this experience, however, as I have only thus far had limited training in physical examinations and had only interviewed Standardized Patients. However, I had the excellent guidance of a fourth-year student as well as something that surprised me in a good way: the patience of the patient. He was very proactive and motivated to manage his health condition (HIV/AIDS and syphilis), and he was very patient with my inexperience. Although I was initially hesitant and apprehensive about asking him questions about his drug use and sexual history, he took the issues in stride: he wasn’t ashamed, shy, or cynical in his interaction with me. Instead, he was quite mellow and composed, and his manner made me much more comfortable and more motivated and confident to do a better, more in-depth job in taking his history and with his physical examination. Physicians always talk about being patient with patients, but I rarely hear about the value of patience among patients with their physicians and the health care system: a mixture of assertiveness and patience can go a long way to improving your health care experience and possibly even your health outcomes.

These combined experiences have, for the first time, made me feel like a doctor – not a good doctor because I still have a long way to go in developing my knowledge base, honing my skills, and improving my interpersonal approach. Nonetheless, I’ve been in the saddle now, and I’m excited to do more. As tiring as these twelve hours have been, this has also been a rejuvenating experience – it has reminded me why I wanted to be a doctor in the first place. I’ve always been a patient person, but now I realize how important a quality this is. Humans are inherently social creatures, and it is so difficult to interact with one another without being patient with one another in the face of language barriers, misunderstanding, and miscommunication.

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