That's What I Should Have Said!
Every now and then, when the medical field isn't making us read thousands of pages on the pathophysiology and treatment of a zebra disease like pheochromocytoma, they try to make a point about how one appropriately relates to the patient. Apparently some of us have forgotten how to relate to people, but this advice is well appreciated - stuff like, "Always remain at eye level with the patient" and "Let the patient address you by your first name." All of this is to dispel the illusion of there being some hierarchy in the doctor-patient relationship, which is important, because we try to promote the team aspect of achieving the best results in the patient's health.
Another thing they tell you is to be non-judgmental with the patient. There are so many different cultures and alternative lifestyles out there, it's in both your interests not to come off as condescending. Reasonable. I haven't had a problem with that, as I can be pretty stoic to begin with. Sometimes, though, you struggle to search for the right words because total honesty would be, well, bad.
Let me explain with the following examples:
Patient 1: A 30-something year old woman comes into the voice because she has felt sinus pain and pressure for the past two days. She is a smoker, and her last bout with sinusitis was treated with a course of antibiotics. After taking the appropriate history and performing the relevant physical exam, I present my assessment and plan to the patient. I think she has sinusitis caused by a cold virus. A two-day history of symptoms is really not the time to be prescribing antibiotics, so I tell her we'll probably treat her symptoms - vitamin C, zinc lozenges, honey lemon tea, maybe some echinacea. "WHAT ARE YOU TALKING ABOUT?" she sneers at me. "I'm a pharmacist! I know about drugs! I want something so I can function."
What I say: Okay, that's something we can talk about. You are a smoker, and you have had prior bacterial sinus infections, so a course of antibiotics may be appropriate for you.
Translation: Oh, you're a Pharmacist, huh? Then you must realize that these antibiotics will probably do nothing for you, they'll make you feel like crap for a couple of days, and I'll bet you're back here in 10 days begging for more antibiotics. Add to that the fact that the more you use antibiotics, the more you depend on them and not your own immune system to fight off the buggers. Why people get addicted to feeling nauseous and willingly give themselves a bout of diarrhea is beyond me. And no - acute bacterial sinusitis doesn't require antibiotics if you only have mild to moderate symptoms - but I'm sure you Pharmacists work from better guidelines than I do.
Get my drift? Here's another one.
Patient 2 is an elderly gentleman with chronic obstructive pulmonary disease (COPD). Management of COPD is geared more towards making the patient comfortable and preventing further damage to the patient's lungs. He's in the office for a follow-up visit to see how he's doing on his medication regimen, and - he's clinging to this clipboard. Perhaps it's his list of medications (always a good idea to have on hand when you visit the doctor, folks). Anyway, I start off the interview with the standard: "Hello, Mr. Smith, I'm Mikey, a student at Suchandsuch University, how are you feeling today?"
Mr. Smith has no complaints, except for the fact that he's concerned that Massachusetts is going to become known as the "Gay State" and he's getting as many signatures as he can to prevent that from happening.
What I say: Well, that's certainly interesting. It's always nice to have a cause to feel passionate about. But let's get back to how your breathing is doing. Are the inhalers working for you? Do you need any refills?
Translation: Mr. Smith, you have a serious lung disease. You will be living the rest of your life gasping for breath, and that's when it's pretty well controlled. You're more prone to other diseases such as lung cancer and heart failure. You'll likely be visiting us often for respiratory infections over and over again. And your dying breath is going to sound something like Ricardo Montalban in Star Trek II: Wrath of Khan - "From Hell's heart, I stab at thee. For hate's sake, I spit my last breath at thee." Nice.
And this next one is my favorite, so far.
Patient 3: A 16-year old girl has just given birth to a baby girl. She would rather bottlefeed the baby, because, well, breastfeeding is "icky."
What I say: Certainly there are plenty of options in providing your new baby daughter with the proper nourishment. I'll have the breastfeeding nurse come in to talk to you about all of these in detail, okay?
Translation: Icky? ICKY? Do you remember what you did to make this baby in the first place? I call 'Bullsh*t.' You probably did worse to your boyfriend. And you think breastfeeding is ICKY???
What I'm listening to now: Five Tango Sensations, Astor Piazzolla and Kronos Quartet
Another thing they tell you is to be non-judgmental with the patient. There are so many different cultures and alternative lifestyles out there, it's in both your interests not to come off as condescending. Reasonable. I haven't had a problem with that, as I can be pretty stoic to begin with. Sometimes, though, you struggle to search for the right words because total honesty would be, well, bad.
Let me explain with the following examples:
Patient 1: A 30-something year old woman comes into the voice because she has felt sinus pain and pressure for the past two days. She is a smoker, and her last bout with sinusitis was treated with a course of antibiotics. After taking the appropriate history and performing the relevant physical exam, I present my assessment and plan to the patient. I think she has sinusitis caused by a cold virus. A two-day history of symptoms is really not the time to be prescribing antibiotics, so I tell her we'll probably treat her symptoms - vitamin C, zinc lozenges, honey lemon tea, maybe some echinacea. "WHAT ARE YOU TALKING ABOUT?" she sneers at me. "I'm a pharmacist! I know about drugs! I want something so I can function."
What I say: Okay, that's something we can talk about. You are a smoker, and you have had prior bacterial sinus infections, so a course of antibiotics may be appropriate for you.
Translation: Oh, you're a Pharmacist, huh? Then you must realize that these antibiotics will probably do nothing for you, they'll make you feel like crap for a couple of days, and I'll bet you're back here in 10 days begging for more antibiotics. Add to that the fact that the more you use antibiotics, the more you depend on them and not your own immune system to fight off the buggers. Why people get addicted to feeling nauseous and willingly give themselves a bout of diarrhea is beyond me. And no - acute bacterial sinusitis doesn't require antibiotics if you only have mild to moderate symptoms - but I'm sure you Pharmacists work from better guidelines than I do.
*******
Get my drift? Here's another one.
Patient 2 is an elderly gentleman with chronic obstructive pulmonary disease (COPD). Management of COPD is geared more towards making the patient comfortable and preventing further damage to the patient's lungs. He's in the office for a follow-up visit to see how he's doing on his medication regimen, and - he's clinging to this clipboard. Perhaps it's his list of medications (always a good idea to have on hand when you visit the doctor, folks). Anyway, I start off the interview with the standard: "Hello, Mr. Smith, I'm Mikey, a student at Suchandsuch University, how are you feeling today?"
Mr. Smith has no complaints, except for the fact that he's concerned that Massachusetts is going to become known as the "Gay State" and he's getting as many signatures as he can to prevent that from happening.
What I say: Well, that's certainly interesting. It's always nice to have a cause to feel passionate about. But let's get back to how your breathing is doing. Are the inhalers working for you? Do you need any refills?
Translation: Mr. Smith, you have a serious lung disease. You will be living the rest of your life gasping for breath, and that's when it's pretty well controlled. You're more prone to other diseases such as lung cancer and heart failure. You'll likely be visiting us often for respiratory infections over and over again. And your dying breath is going to sound something like Ricardo Montalban in Star Trek II: Wrath of Khan - "From Hell's heart, I stab at thee. For hate's sake, I spit my last breath at thee." Nice.
*******
And this next one is my favorite, so far.
Patient 3: A 16-year old girl has just given birth to a baby girl. She would rather bottlefeed the baby, because, well, breastfeeding is "icky."
What I say: Certainly there are plenty of options in providing your new baby daughter with the proper nourishment. I'll have the breastfeeding nurse come in to talk to you about all of these in detail, okay?
Translation: Icky? ICKY? Do you remember what you did to make this baby in the first place? I call 'Bullsh*t.' You probably did worse to your boyfriend. And you think breastfeeding is ICKY???
*******
What I'm listening to now: Five Tango Sensations, Astor Piazzolla and Kronos Quartet
posted by Mikey at 9:12 PM
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