The other side

Having recently been ensconced in hospital as an inpatient for seven days, I have been “released” with a new perspective on life as a patient. The clinical care I received was second to none, and I am interminably grateful to all of the healthcare professionals involved. But as the days passed, I began to understand why patients can become so upset, disillusioned, and even aggressive during their hospital stay.

Lying in a hospital bed gives you time to think, and think, and think. You think about what’s wrong with you; you think about what’s not wrong with you; you worry about the tests you have to have and the treatment you may face. The highlight and focus of your day becomes the doctor’s ward round. It is the few minutes out of each 24 hour period that you feel are productive: when you manage to find out what the plan is (usually), what your test results are (sometimes), and what’s wrong with you (infrequently). Imagine what it feels like when those few minutes are rushed and information is poorly communicated. Imagine how I felt when the doctor popped his head round the door and said, “No change? Keep going,” and then left.

As a doctor, I could understand the general ward chat, and I cringed when I was referred to as “side room 5” or “the abdominal pain.” I winced when yet another doctor jumped to incorrect conclusions about my history, and I cried when a member of staff barged into the room during an intimate examination.

How many times have I been that rushed, busy doctor who hasn’t had time to explain things slowly and fully to patients? How many times have I popped my head into a side room with a medically stable patient who is waiting for social arrangements to be made before discharge, and just said hello and goodbye? Countless times; I’m as guilty as my colleagues.

Being a patient is a tiring, emotional experience, and we doctors have a duty to help our patients through this difficult time, not just with regard to their clinical management but, perhaps even more importantly, also their feelings and anxieties.

I hope I never forget this invaluable lesson.

First published in the BMJ, 2009;338:a966

How can we best choose future doctors?

The Biomedical Admissions Test (BMAT) results are out; medical school applications are in and mostly processed; the interview season is well under way. I am bug eyed from reading personal statements, all of which seem to begin with “From an early age I have been fascinated by the workings of the human body.”

I have shaken hands with more outstandingly gifted youngsters than I have ever met outside the medical school application process. I have read how characters were honed in tropical jungles or by scaling Himalayan peaks. I have underlined examinations passed without dropping a mark and quirky arts subjects studied in parallel with hard sciences. I have noted exceptional social or material circumstances pointed out by teachers anxious to maximise number of offers from the Russell Group of top UK research universities for their school’s annual report.

I have been told so many times that the future of medicine is contiguous with that of the embryonic stem cell that I now believe this statement. I have also learnt that good leadership is about telling the nurses clearly and in simple terms what they should do. I have ticked “accept” on some forms and “reject” or “waiting list” on others.

In parallel with all this I have been a patient. I presented with a symptom that alarmed and distressed me. Uncomfortable and undignified investigations to exclude a malignancy were conducted with the utmost professionalism. The junior doctor who clerked me in for my operation took care to ensure that my record was flagged with a key allergy. He later reappeared with a large felt pen, apologising good naturedly for initially forgetting to mark the site of the operation. I was anaesthetised by someone who understood how terrified some people are by general anaesthetics. The cause of my symptoms was removed with great skill. When I developed what I believed (correctly, as it turned out) to be a postoperative complication, I was taken seriously and seen promptly.

If I live out my predicted life expectancy and follow the typical pattern of decline in industrialised countries (that is, if I don’t get really sick until within a year of my death), my serious illnesses will be diagnosed and managed by GPs and consultants who are being admitted to medical school around now. Most importantly, these men and women will be in charge of my terminal care.

Talented all rounders they may be, but will selecting for the litany of accomplishments towards which they are all groomed give us the doctors who will care most effectively and humanely for us in our dotage?

First published in the BMJ (2008;337:a2963, doi:10.1136/bmj.a2963).

   

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