I wonder how one teaches common sense. I don't know if it's a generation gap or if it reflects a real degeneration of the medical ethos, but it seems like the doctors running around seem to be increasingly devoid of any common sense.
A lady recently went to an A&E because of lower abdominal pain. The usual tests and examinations were done and she was diagnosed as having late stage ovarian cancer. Nothing really wrong here. But what was really screwy was the way the young doctor informed the lady of her diagnosis....pretty much along the lines of ..."The nurse said you were asking what was wrong. Well...you've have extensive cancer of the ovaries. We can't do anything here because we don't have a gynaecology unit here, so we must refer you to KKH." Just like that.
Being alone in the clinic at that time, she freaked out on receiving the news. Understandably so, I think. Surely common sense dictates that if you have such potentially distressing information to convey to the patient, you should try and ensure that the patient has some emotional help nearby,in the form of a relative or next of kin.
So how do you teach common sense?
Subscribe to:
Post Comments (Atom)
13 comments:
Sad, considering the med school curriculum placing so much emphasis on patient communication modules.
Then again, there're senior doctors from various specialties who exhibit anti-social personality disorders, yelling at and insulting their patients ( even the paying ones ).
I encourage all my students to watch House...
Not sure about lack of common sense. Maybe a lack in empathy ? The doctor just didnt care ? However this is a societal phenomenon isnt it ? Singaporeans in general are quite cold and unfeeling. Sometimes rude and insensitive. Not surprised that there are doctors like that around.
However must take into account that docs in S'pore do have to face a pretty nasty bunch of patients. Two weeks on an attachment in S'pore and was tearing my hair out at some of the absurd patients.
Since a diagnosis requires a medical history (including family history) to help the doctors create a list of possible causes then has to be developed and narrowed down by further tests to eliminate or support specific possibilities...it makes sense to make a patient comfortable enough to be open about their history...this will allow the attending doctor to make the fastest diagnosis.
I believe good bedside manners not only improve interactions with patients and progresses their healing process, it will allow for a more holistic diagnosis and treatment of the patient's problem.
A wise doctor once said..."A good physician talks to the patient and not at the patient....and...A good physician searches at all times for new clues to confirm or refute an initial clinical diagnosis.”
While i agree that if the incident is as what you have described, that then the junior doctor lacks basic common sense, it is far too simplistic to generalise that junior doctors are worse behaved. I believe that there are as many rude unfeeling senior doctors around, just like there are many patient and conscientious young doctors.
You are of course right. I have known badly behaved, insensitive doctors of all ages. It just seemed to me that it's getting more prevalent. That's why I queried if this was perhaps a generational bias in my perception.
Btw, I also do know of a number of really great young'uns as well. A credit to the profession.
I posted about this recently on my personal blog.
While there's always the possibility of a "grandmother syndrome" at play, I concur with your observations about the younger generation.
This paradigm shift occurred during my MO days, when I began encountering a disproportionate number of HOs not responding to pages. This occurred during night calls and also during office hours.
I find this sort of behaviour unforgivable, because it clearly compromises patient safety, never mind the poor reflection of the HO's devil-may-care attitude.
I remember one night where I spent an hour searching call rooms across 6 floors hunting down a notorious HO who was covering the MICU with me. He was nowhere to be found, and I ended up doing his changes as frantic nurses paged me from midnight till 6am, after which he magically materialized in the ward and got an earful from me.
A credit to the medical profession he was not - and probably still isn't.
Thanks Spacefan. But grandmother I am not. :)
I had this incident when the patient's wife came crying to me and told me that her husband had given up and wanted to die. (Btw, I am no doctor)Husband was suffering from lung cancer.
I therefore asked why did the patient wanted to die cuz he was doing well (emotionally) for the past few days.
Can you believe what the wife said?
The wife said the radiologist told the patient that "you are going to die soon. no amount of treatment is going to save you. you would be better off preparing your funeral."
Patient confirmed subsequently with me that such incident did took place.
If what the radiologist said was factually correct, and the patient did not know of that before, then I think the radiologist did him a favour.
hmmmm....often it's not the content the manner in which it is said. As in the example in my post....factually correct but insensitive. No common sense?
Not exactly the same, gig.
I wasn't going to nitpick (because I assumed you changed the actual circumstances of your story) but I don't think it is the place of an A&E doctor to reveal a diagnosis of cancer, because he cannot make that diagnosis with sufficient confidence. If the guy was my charge he would get an earful from me.
Now the radiologist did not make or reveal the diagnosis of cancer. He merely made two predictions based on clinical knowledge, and gave one piece of advice.
What I am curious about is what prompted a radiologist, by no means the primary physician to a cancer patient, to say what he said.
My guess is that the patient voiced overly-optimistic, unrealistic views about his own prognosis. Yes, he might have been in denial. Kubler-Ross and all that.
Or maybe he expressed uncertainty over his prognosis.
If I were the radiologist, my options would have been to keep quiet ('not my patient, not my business'), said nice but probably false things ('yes, I think you will be alright too'), or told him the truth based on what I know.
I know which option I would have chosen: I'm not in the business of selling hope; I'm in the business of selling knowledge.
Which option would you have chosen?
Did what the radiologist say tip him into depression? Well, maybe, but then it's part of Kubler-Ross too, isn't it?
And finally, to be really insensitive: if he really was going to die soon from lung cancer, why shouldn't he be depressed and suicidal? Why shouldn't he be *allowed* to feel depressed and suicidal? Why should he live up to his wife's (and lyx's) expectation to 'do well emotionally'?
Come to think of it, if he really believed he was going to die from cancer soon, why would he want to commit suicide?
Chances are he was using the encounter as an excuse to allow himself to show his emotions to his wife.
People who are sick or dying feel they have to 'do well emotionally' for their family's sake, when really what they need is the permission to cry.
Cancer sucks. Dying sucks. Being optimistic doesn't improve your prognosis (yes, there is a paper on that). Deal with it. Make your funeral arrangements.
May not be common sense, but 'common' isn't always right.
Post a Comment