I'm going to be a little nondescript here.
The other day I saw a patient in the hospital. I was covering for a partner. The patient was gravely ill. There were many decisions to be made, surgeries to be planned, and antibiotics to be given. Of the fourteen days in the oncology unit, I may have be the rounding doc once or twice.
As the situation worsened, the relationship between the patient, family, and medical staff had begun to decline. Although I assessed the patient and wrote my billable note in the morning, I couldn't help but feel that there was much more to be done. Decisions were being left open ended, and many of the realities of diagnosis and prognosis were ignored like that annoying friend that one never acknowledges in public.
As luck would have it, a number of cancellations in my schedule left my afternoon completely free. So I made a few phone calls and gathered the family. I walked into the room and sat down comfortably on a chair, and looked up at all those anxious faces.
Tell me about it.
I didn't move for nearly two hours. I waited patiently on phone calls, bathroom breaks, and pillow adjustments. When I emerged from the room, the plan was completely different. Surgeries were cancelled, antibiotics stopped, and a modicum of peace was restored to an otherwise hectic situation.
The patient/family didn't need more medical care. They didn't require an xray or a brain scan. They needed an ear to listen, and an experienced voice to help guide them.
This type of interaction takes time. It also saves the healthcare system a boat load of money.
Healthcare reform, meaningful use, quality reporting, etc, etc...what could possibly go wrong?
Well, how long has it been since you spent quality time with your doctor?
Ah , YOU listened .
ReplyDeleteThe doctors I have now listen, but there were many along the way that didn't. I'm glad you had time--and the thoughtfulness--to make a difference. That patient and that family will never forget you.
ReplyDeleteSigh. I don't suppose your practice extends to the Middle East. Not one of the (unfortunately) many doctors treating me has ever listened to, let alone solicited, my feelings or long-term desires and goals with regard to my terminal illness.
ReplyDeleteA profoundly important two hours for that patient and family, Dr. G!
ReplyDeleteThe reality, however, is that had it not been for "a number of cancellations" that left your afternoon completely free (and how often does that happen?!) this conversation never would have taken place, and your patient would have likely headed off to surgery as planned.
Those cancelled appointments were such a gift to that patient, to the family, and to you as a physician. Since the luxury of a completely free afternoon like this is rare, allowing the same type (if not length) of open communication must be woven into the time-restricted nature of doctor-patient relationships.
You may not have two hours with every patient (in fact you most certainly won't!) but even an extra two minutes of compassionate listening would make a big difference to ever patient you touch.
Shouldn't the hospital have a end of life person/counselor to bring the reality to the family? My family was told that he should recover but in retrospect we all knew better. He spent the last 4 months in a bed dying instead of taking his natural departure. That was hard on the family, hard on the staff and hard on him. Thank you for taking/having the time to talk. Action is the key to change...
ReplyDeleteMy trips to the hospital usually last about 10 minutes, once every few years. So I haven't spent that long with the doctors.
ReplyDelete