A colleague recently remarked that being the (self opined “best”) expert that he was in his field, there was no one else he could discussed his cases with anymore. It is true that in this day and age you may end up as the only expert in your area (even internationally) especially if you sub (x n) specialize. However, whilst one might think one is the crème de la crème or the king of the hill, as a doctor, he must never assume that he can no longer learn from anyone. One can obviously turn to literature, research and international expert meetings but in truth, although background noise is aplenty, there are only that many substantial findings worth committing to memory, barring special breakthroughs. But when the science of medicine stagnates, it may be time for us to hone the art. Personally I find that I have learnt much from two groups of people.
It is an unfortunate (hard) truth that most doctors are narcissistic to begin with or will become one in the course of their training. It is already a daunting task to ask to experts to listen to one another much less to their undifferentiated juniors. However, this is silly as young bloods often have new ideas and have fresh eyes to some of the clinical problems we face. They are not burdened by the prejudices accumulated together with the years of experience and do not have preconceived notions. I often hear good ideas from MOs and Registrars and even if I may not agree with their ideas, it always good to listen to what opinions they have to offer when it comes to a difficult clinical scenario. Also, there are many junior Drs who may be extremely well liked by patients, receiving good comments (as well as cards and gifts) from them. I would observe (and learn from), albeit quietly, their mannerisms and attributes which endears them to their patients. The rapport that a doctor has with his patient often would make or break the management of the case and such soft skills had often been ignored by hardcore physicians and might not be the forte of many a senior Dr.
It may also come as a surprise that we often (consciously or unconsciously) learn from our patients. It does not matter how familiar you are with the literature, nothing beats having a firsthand account of the effects or side effects of a medication from a patient. We continue to learn about signs and symptoms presented in their many varied forms and often distorted in many ways by cultural overlays.
To illustrate, I had an elderly lady who came late for her appointment and complained of anxiety and itchiness in her womb. As she had been late and I was in a hurry to end my clinic, I was quick to dismiss her. My dismissive attitude continued for a few visits and I felt rather irritable with her persistent complaints of itchiness in the womb which I knew to be anatomically impossible. During one of her visits, my clinic was unusually empty and perhaps as I was less flustered that day, I chatted with her for an extended period of time. She told me that after her husband passed away, she had single handedly brought up her two children doing odd jobs. She had since retired as her children have all grown up and she was staying with her son, a successful engineer. Unfortunately, her daughter-in-law and her grandchildren found her uncouth and her son without putting in much thought was negotiating for her to move in her daughter. However, her daughter was not willing to take her in either due to space constraints. She was immensely disappointed and had worries that she would be abandoned. It became clear from her account was developing the anxiety due to the recent turmoil in her life particularly to the fear of being abandoned by her children. I felt ashamed of myself for having ignored this lady previously because she was late. Given her lack of education, she would have had difficulties maneuvering around our rather complicated hospital system to have made it to see me, thereby being late. More importantly, her accounts made me reflect on my own relationship with my parents.
It is important to sometimes slow down to look (at), listen (to) and feel (with) the people around our clinical practice. We may learn powerful lessons from the most unlikely person in the most unlikely place. For it may take ten years for one to become a fully accredited specialist but it will take a lifetime for us to master the art of medicine.
Dr BL Og
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11 comments:
"It is important to sometimes slow down to look (at), listen (to) and feel (with) the people around our clinical practice. Sometimes, we may learn powerful lessons from the most unlikely person in the most unlikely place. For it may take ten years for one to become a fully accredited specialist but it will take a lifetime for us to master the art of medicine."
Can't but feel that the above is especially apt for our politicians.
Your colleague would do well to take a leaf from a certain vascular surgeon from SGH's book - he maintains that he can always learn something, from anyone.
Your colleague is turning himself from a doctor into a technician, just so that he can feel good about himself.
To become narcissitic is to risk stagnation; and to forfeit humility is to lose the essence of medicine.
As an aside, is there a reason why the Minister of Health never seems to be a medical doctor?
I completely agree with Re-minisce...
Personally I won't want a Dr to be our Minister... feel that Drs tekan Drs the most...
Tekan good what. If it makes the system better... why not? :) Gives us (and the sheep) less cause to bitch...
The problem is, while many physical complaints may have a psyschological component, the challenge is being able to draw out the latter in history-taking, which takes time and is often impossible in busy clinics and emergency departments.
It's always easier to order investigations and pick on the smallest derangement, than to ask about the patient's job, home and financial situations.
Even finding out if a patient has been compliant with medications / diet or fluid restrictions is deemed irrelevant by many doctors.
It isn't just about what the patients can teach us. Sometimes, it boils down to systemic limitations, and the physician's own mindset.
I agree. Even if you manage to find out that the patient's symptoms may have arisen out of "problems of living", it still doesn't solve those problems for her, does it? What is achieved here other than a sense of satisfaction over how 'good' a doctor you are?
What is more important here is actually to make sure that the patient does not actually have any organic disorder. Just because patients choose to medicalise their problems (consciously or otherwise) doesn't mean it then falls onto the medical profession to solve those problems for her - in this case, what does one expect the doctor to do? Wouldn't a community leader, trusted friend or a relative be of more help? If people think to avail themselves of other social support instead of thinking that doctors/pills are the cure for all their problems, then we will see a lot less misuse of medical resources.
Of course, how you relate to your patients depends on your discipline.Can't expect forensic pathologist to be empathic... but then again...
unfortunately, pts often do not have any insights into their problems. which is the reason they may use medical services indiscriminately as they are jus looking for help. if we can understand their problems, we can
1) solve it - refer to MSW, psychiatrists, FSCs if we can't do it ourselves.
2) support them - be nice and not b frustrated over why they keep coming back. problems may resolve by itself.
The case that i illustrated, she eventually accepted that her children would not take her in and she decided to live with her sister. having accepted the situation, her symptoms resovled.
Again, in places like the A and E this may not be possible.
"As patients self-diagnose and tap on the same reservoir of information available to physicians, these tools are transforming the doctor's role from omniscient purveyor of solutions to emphatic advisor on options... these developments are changing the emphasis of many medical practices - away from routine, analytical, and information-based work and toward empathy, narrative medicine, and holistic care." Daniel Pink
at the risk of sounding like a bad person... if a patient comes in somatising a psychological / social ailment is the onus really on us to try to sift through unfamiliar territory to identify the root cause of the problem? Of course it would make us feel good if we could, and we just *might* be able to help the patient. But with another 20 patients to see in the next two hours... are you doing them a disservice by prolonging this consult?
I don't think we will ever be able to get the patient queues to shrink, so really what we should do is move for (much) better social workers, who have the time to listen and the resources And ability to actually DO something about the patients' problems. This unfortunately needs spending, and at the risk of annoying angrydoc - I think the healthcare budget needs a closer look.
So yes, sadly the onus is on us to exclude an organic problem - as quickly as we can - and then turf them away to a specialist in psychosocial problems. (unless of coure you're in private practice...)
"This unfortunately needs spending, and at the risk of annoying angrydoc - I think the healthcare budget needs a closer look."
Yes, Remi, you did annoy me with your comment. Now if the patient's problem is NOT medical, why should the solution be increasing healthcare budget?
The problem is that current thinking makes "medical" the socially acceptable gateway to seeking help for what is a personal, non-medical problem. By saying that we will continue to place the onus of solving social problem being presented as medical problems onto healthcare workers, we are encouraging people to continue to do so.
"The case that i illustrated, she eventually accepted that her children would not take her in and she decided to live with her sister. having accepted the situation, her symptoms resovled."
So to paraphrase, Og, she wasted your time, and you didn't actually do anything to help her. Nice.
(soothingly) Because, angrydoc, that is the model we have to work with, and because their only other recourse is to go whinging to their minister, who will in all probability not know what to do if they live in a certain GRC. :)
"Because, angrydoc, that is the model we have to work with..."
If "that's the way it is" is going to be our answer for everything we find is wrong with the world, then... why should I even bother finishing this sentece?
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