DISQUS

ArkieRN · 1 year ago

Well said.

Midwife with a Knife · 1 year ago

I agree. I posted a recent post (It's not your fault, except when it is), where I talked about conselling non-compliant diabetic patients. I was surprised at the number of people who said, basically, "well, you don't know what this person's life is like...". I'm working on a response to that, but briefly I feel that in a sense, that may be true, but also at some point, people just have to friggen take responsibility for their own lives, and if they're not willing to do that, nothing I can do as a doctor will help them.

I'm not even talking about the really hard stuff like loosing weight (difficult to continue over a long period of time) or stopping smoking. I'm just talking about an effort here. Anyway...

Rogerswife · 1 year ago

I've been reading your blog for a little while now, and as a first year med student this is the first one that I felt I have anything to add to. The attitude of the anonymous poster is one that is pervasive in my school, and one that is highly encouraged by the administration: be all things to your patients. I have never prescribed to this idea for the simple fact that it is impossible. To me, the most important thing a physician can do is give their patient the best MEDICAL advice available that is evidence based. That's it. To assume that it's our fault if a patient is noncompliant is to take the power out of the patient's hands, to infantilize him and say "You're just not capable of caring for yourself properly." A patient met with this statement up front would almost certainly be insulted, yet it seems implicit in the way we decide that we must "handle" our patients. Seems to me you're going to get a lot of physician burnout of docs who are trying to be mother, priest & babysitter to every one of their patients.

Anonymous · 1 year ago

"The secret of the care of the patient is in caring for the patient". Francis Peabody, MD 1925

"It is not my role as a physician to give a crap". The Happy Hospitalist, 2008

"well, die then, bitch". Michele on Happy Hospitalist Blog, 2008

Which one of these physicians would you like to have taking care of your parents, your grandparents or yourselves? Which of these physicians elevates the practice of medicine and which simply suck it dry? I know your type Hospitalist. Your the one who calls patients GOMERS and admissions "Hits". And you are perfectly in love with yourself - anything that the Happy Hospitalist thinks must be true because he thought it. You are a hospitalist because the only way you could ever get patients to work on (rather than work with) is to have them foisted unknowingly upon you. No patient would choose you if they had a choice. Also, I don't believe that because you don't give a crap that makes you a better doctor - although I bet you think it does.

To paraphrase Barak Obama, words matter. How you talk and how you act are inextricably linked.

To the first year medical student, caring for the patient does not mean be all things to all patients. It only means care for the patient. You have a lot to learn.

R Alanko MD · 1 year ago

Ahh, but P4P assumes the DOCTOR is responsible for the PATIENT'S life decisions. Or at least fire the patient who makes the 'wrong' one. Now do I need to lose sleep over those decisions as well?

I want my patients to do well, and I am genuinely pleased when they change the misbegotten ways leading to their predicament. I even flatter myself, that perhaps my dazzling explaination of pathophysiology actually made any impact.

I can care for my patients without stealing the responsibility for the decisions from them.

And anonymous, I have been sucked down that road and manipulated by those who prey on helpers. There is a proper balance. I am not required to mourn a patient's (to me) bad decision.

The Happy Hospitalist · 1 year ago

anon 0309:

My, how you are so mistakenly misguided. I did not say I don't care FOR patients.

in fact I care very much FOR my patients. That is my job.

If I was a patient, I would much rather the doctors spend all their time caring FOR me and leave my family and friends caring ABOUT me.

There is a huge difference. And my separation of caring FOR patients and letting others care ABOUT them allows me to more clearly separate my job from the noise.

I would hope if I was ever on the receiving end of a major illness that my doctors spend all their time caring for me and not about me. I would never expect a doctor to care about me on an emotional level. That clouds the mind of objective decisions.

As far as your insults towards me personally, I am above that. It's easy to pull words out of context and extrapolate irrational thought. So, if doing so makes you feel better about yourself, consider it my free therapy to you.

You must be new to my blog as well. Spend a little time looking around and you will see how misguided you really are about my views. I'll leave that on your shoulders to burden.

Tina · 1 year ago

I think you make the right distinction between caring FOR and caring ABOUT.
This is one of the little traps of the English language, where we tend to associate the word CARE with NURTURE, like a mother would her child.
If we tried to replace the word CARE in the medical sense with PROVIDE TREATMENT, this would help, don't you think?

by: PM, SN · 1 year ago

Bravo!

I've seen similar issues in Nursing. Providing care at the bedside for people who have more or less intentionally made themselves ill can be very frustrating for people and challenging to their beliefs.

I think the people who are most successful at their jobs, however, provide the best possible care regardless of their personal feelings about their conditions. Even in Nursing, in which a great deal of importance is placed on "caring", providing competant care and a therapeutic relationship is -not- predicated on being emotionally involved in that patient's outcome. In fact, I'd say this can potentially be a major obstacle to the provision of competant and ethical care.

What can you do for the 50 year-old with bilateral knee replacements who refuses to do weight bearing exersizes and drinks nothing but diet pepsi? There are two options, basically. You can do your job, or you can fail to do so. In this scenario, my job was to execute interventions that would provide teaching, ensure safety, and optimize the health outcome. I couldn't get her out of bed, no matter what I did. I calmly, patiently and supportively explained that she was putting her shiney new $10k appliances in danger. I inwardly laughed at the rediculousness of the situation and marvelled at how difficult it is to change the health behaviors of adults, but I remained professional and did my job as well as I could, and left knowing that whatever happens to her next is -her- problem, not mine.

Here's another example. The Nurses at the LDRP unit I rotated through needed a little redirection because they were "guilting" mothers into choosing breast-feeding instead of formulas. Because they cared too much ABOUT their issue, they abandoned professionalism and integrity, and failed to serve their patients by doing so.

Another example: During that same LDRP rotation, I had four patients in two rooms. Room A was a 16 year old hispanic woman who just had twins, her second and third. Some of the other students in our cohort made snide comments and snickered, but in caring for that mother and her twins, I saw a knowledgable, responsible mother, a large, supportive, loving family, and all of the componants of a positive outcome. In room B there was a dour mid-20s primagrav with incompetant cervix, who refused to manage her diabetes (she had a SC pump), participate in treatments or comply with her mobility restrictions.

The two rooms just provided two different challenges, that's all.

michele · 1 year ago

For anyone who cares, I'm an RN, not a doc. I've been one for 17 years now. And I go to work and do the best job I can do. When a patient refuses to do all those nursie things, ambulate, say, or TCDB, I explain to him why it's in his best interest. If he continues to refuse I document that and move on to the next patient. My other patients shouldn't be neglected because I've spent an half an hour persuading a 450 lb woman admitted for a wrist fracture that she needed to sit in the chair for 15 minutes(this really happened).

Anonymous, my question was not a rhetorical one, and I challenge you to answer it, preferably without insults or misquotes - if a patient does not care about his health, why should I lose any sleep over him?

Anonymous · 1 year ago

I was also a chemistry degree person who worked many years on the bench. You are absolutely right about people who pace themself and then get angry at you for working to hard. I use to hear about this all the time from co-workers. "Slow, down...You're working to hard...You make us look bad" Its all BS and it also gets you down after a while. Although i did make significantly more than 8.00 per hour. That would really suck.

Matt H · 1 year ago

Well said. I have a condition (dysplasia) caused by a structural abnormality that is (essentially) surgically not correctible. I was taught by a very good physician how to use medication etc to reduce the problems caused by this, and it's worked very well.

And re effort in == effort out (note the double ==...C programming will do that): After earning a couple of degrees, I found myself in a situation similar to yours (e.g., boring position with no long-term future). I decided to focus on one small area and be the best I could be at it, and am now a CIO for a tech company. Effort in *does* equal effort out. Luck doesn't hurt but ultimately effort and skill win out.

Spook, RN · 1 year ago

It truly is a fine line to walk. A lot of BS is foisted upon us in nursing school about "caring for the patient". All too often, too many nurses (mostly the new grads that I saw) took it very LITERALLY.

Responsibility is sorely lacking in our society - it's not just in hospitals. It's everywhere. People don't plain give a crap about the consequences of their actions.