I met a resident who advocated that all medical students should become patients and have the same procedures that they order for their patients performed on them à la the movie “The Doctor.” While I agree that being a patient offers perspective, I don’t agree that I need to have tertiary syphilis to understand how to interact with a patient facing the illness.
We act as health care providers and now view the world in this light, but we must never forget how the patient perceives the information we provide.
We walk into a patient’s room with our crisply ironed (or wrinkled) white coat from which a badge proudly hangs. We immediately present ourselves as the authoritative figure, and it’s even more intimidating if we arrive with a flock of white coats. We stand while the patient is lying in the hospital bed—again emphasizing the difference. The patient stares at a group of strangers and must decide how much personal information to divulge.
Everyone on the team needs to be identified so the patient knows that everyone in the room is involved in his or her health care. It’s helpful if you can sit at eye level with the patient. Rounds can sometimes be speedy, so it’s a good idea to return later in the day and spend more time with the patient explaining and answering all of his or her questions.
You will encounter patients from all walks of life. They will often times be at a different educational level than you, and thus you need to explain things in their terms. You can tailor your explanations depending on their respective occupations and highest levels of education—now you understand why we ask all those questions in the history and physical. For example, a woman with high school level education will probably require a different explanation of her breast cancer than a breast cancer researcher.
Attempt to do everything in your power to help the patient understand. Page the translator, ask family to assist you, draw a picture, use an interactive display on the iPad or talk through the pamphlet together. A patient should have resources readily available for them so they can contemplate the information.
No matter how kind and caring you are, you will encounter rude, obnoxious and ungrateful patients. Even if seeing Mrs. Sanderson is an absolute delight but Mr. Green makes your blood boil, you still have to treat each equally. Don’t forget that being diagnosed with a chronic illness, taking pain medication, having a surgery or simply being in the hospital changes a person’s mood. On top of that, the patient is in pain, scared, irritated, confused, depressed and worried—all of which must be addressed.
Patients will usually have family and friends there, all of whom are anxiously waiting to hear what the doctor says. If the patient is okay with it, keep family and friends informed. They don’t want to be left in the dark and want to be ensured that their loved one is getting the best possible health care.
Remember: the patient is number one. Even if you love cutting people open or trying new drugs on them, you still must keep the patient’s best interest in mind.
Ask yourself: why am I ordering this test? What will I do with the results? If you don’t know the answer, then reconsider the test. What will the patient gain from this procedure? Will it help them in the recovery process? If the answer is no, then look for alternatives. Don’t put a patient through unnecessary testing or procedures; it’s a burden for them physically, emotionally and financially.
The patient has a voice (but not “The Voice”). It is the patient’s body, and the patient makes the final decision. You may feel strongly about a particular drug or procedure, but you must still present the benefits and risks. A patient can refuse, and you must honor that no matter how much you disagree.
On the other hand, some patients may not be able to make their own decisions, and making the decisions may actually fall on you. Act in their best interests, and do what is right.
Patients are often debilitated and are certainly vulnerable. Do not take advantage of their respective conditions. Offer empathy, support and guidance to all your patients—this is my pledge, my pledge to all of my patients.