Monday, August 17, 2015

Patient or Person

The patient was wheeled into the amphitheater classroom in front of 125 medical students.  Francis Wood Sr, the graying Chief of Medicine was holding forth for us that day.  “Students today I’m going to show you a very interesting case.”

Then he paused as if collecting his thoughts. “Now I’ve just made two mistakes in introducing Mrs. Ellison.  What were they?

We sat there not having any idea what he was talking about.  We had been immersed in pathology, disease, physical exams, and seeing patients.  Dr. Wood said, “Well, first of all I introduced Mrs. Ellison as a case.  What’s wrong with that?  I don’t think she wants to be a ‘case’ but really thinks of herself as a person.  We need to respect the fact she’s a person with a disease – not just a disease we happen to be interested in.  Secondly, when I identified her as ‘interesting’, I wasn’t really talking about her, but about her disease.  In a sense I was allying myself with the disease against the patient!”

Dr. Wood was the person who led me to choose Internal Medicine for residency training.  I hoped to learn about people, the human condition and what can go right or wrong in the spans of our lives. My Dad was my other mentor.  An old-style GP he had a small office, delivered babies, gave ether anesthesia, did minor surgery, etc.  He knew families and they knew him.  He knew he was aging when he was delivering the next generation of babies.  “Jim, get to know the families, what they do, what they value, and try to gain their trust.”

But something’s happened in our rush to modernize care with new “efficiencies.”  For example: every Tuesday, in  “hospital X” your doctor changes – a new Hospitalist takes over.  They review the records as they inherit 12-15 new patients.  Their job is to speedily move you through the hospital and off to Skilled Nursing or home or some other venue such as an Adult Family Home.  There’s a name for this:  “Transfer Trauma”.  We have more technology, but less continuity.  We must ask, “does anyone really know me, know my family, understand my fears and hopes?”  Perhaps some can afford a “concierge doctor” as a bridge, but it’s no solution for most folks.  Hopefully, we will have loved ones to be strong advocates and fill in some of the gaps.  We need to be a person, not an “interesting case.”

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