Tuesday, March 01, 2011

bedside manner

if nothing else, this previous post illustrates that surgeons are not that great with the whole bedside manner thing. i would like to think i'm an exception...but i still am a surgeon.

i make a point of communication with my patient. obviously if he is a child, i use the same measure of effort in communicating with the parents. but few things irritate me more than some or other family member that insists on forcing their way into the fairly personal interaction between patient and the guy that in all likelihood is going to carve him up in the very near future. i refer to the person who insists on answering my questions directed at the patient as if they know better. i mean if i ask what the pain is like and, before the poor patient can express himself, his well meaning irritating wife or mother begins to describe to me what he is feeling as if she is feeling it too. i often want to tell them to get sick themselves before i give a dam what they feel or think. i'm usually at least slightly more diplomatic.

i was a senior registrar. a private consultant friend of mine asked me if i could look after his patients while he was on leave for two weeks. apparently he did not trust the other private surgeon working in that hospital. to be frank neither did i (but we'll keep that story for another post, shall we). we went on a sort of handover round together and i got a feel for what was going on. after rounds he mentioned to me that there was still one more patient coming in from a general practitioner that apparently had a bowel obstruction due to a previous operation as a child. the patient was apparently going to be admitted via x-rays. i could evaluate him and operate if i felt it was indicated. all seemed well. he would be my first ever private patient.

the patient arrived and i was called to evaluate him. i walked into the room and took in the scene before me. the patient, a young man that i estimated must be about 26 years old, was lying in bed and what had to be his father was standing next to him. i greeted them both and introduced myself. i then turned to the patient.

"what seems to be the problem?" i asked, looking at him. the father answered before the patient even had a chance to open his mouth.

"well doctor, he started with..." i cut him short right there.

"uhmm, excuse me, but i did not ask you. i asked him." i said. then turning towards the patient with possibly too much of an ostentatious flick of my head i started again.

"what seems to be the problem?" the moment the patient opened his mouth was the moment i became acutely aware that he was mentally retarded. he very nearly could not string a sentence together and certainly couldn't express himself in terms above that of about a five year old boy. i felt like a total idiot and could feel my cheeks flush in embarrassment, but what could i do? i just had to soldier on. i mean i could hardly now turn to the father and admit that after careful consideration i did want to hear from him what sort of pain the patient was experiencing, especially seeing that i had just brushed him aside rather unceremoniously.

the entire interview and examination was painful (i think the patient also experienced a bit of pain) but i just kept on slugging through it. i then looked at the x-rays. it was a clear case and i knew i needed to operate. for the consent i fortunately could turn to the father. it was clear the patient didn't have the mental faculties to sign his own consent, if he even could write at all.

fortunately the operation and the post operative phase went well and quite soon i discharged the patient into the care of his parents.

just over a week later i followed the patient up. luckily everything was in order and i informed him and his father that all was well and they could go in peace. they left the consultation rooms, but then the father turned back to me. i had been expecting something like this from the first moment i had realized the patient was mentally retarded. i was just surprised it had taken so long in coming.

"doctor, i'd just like to have a word with you in private." oh, well, i thought. it's not as if i don't deserve some backlash for my unintentional indiscretion at our first meeting. i braced myself for the worst.

"doctor, at our first meeting, from that first moment when you refused to hear from me what was wrong with my son, but instead insisted on speaking only to him," i cringed. "well from that moment i knew we were with the right doctor. thank you so much for all you have done for him and for the respect you showed him. we as a family will forever remember everything you have done."

i didn't see that coming. i decided to just keep quiet about the fact that i hadn't realized the child was mentally retarded. we all went our separate ways, me with my pride and hide intact and the family chuffed at how i had treated them. i was relieved.


rnraquel said...

That turned out to be quite a lovely story. You just never know :)

rlbates said...

Sometimes we "bumbling" surgeons actually do the right thing unknowingly. :)

Anonymous said...

I often see the opposite -- when someone with a speech impediment or some such issue is assumed by the staff to be mentally incapable of providing a history and the caregiver in question ends up being the one doing the talking... I feel bad for people who could otherwise advocate for themselves if they could only be heard in the first place.

I am rather pleased that this turned out the way it did for you!

Eutopia said...

How awesome is that?!! :-)
Well done for plugging on even when you realized you had made a mistake by assuming he was "normal" (I put that in parentheses because honestly - who is?!) - a lesser person would've turned to the father and simply ignored the patient.
Being a parent, I can well imagine how the dad must've felt!!

Anonymous said...

I let the guardian speak for a moment because it does no good to interrupt, and, I do need them. Then, I kindly and casually strike up a conversation or interact with the patient. I do it in a way that there is no mistaking my attempts to assess and relationship build. I have never been interrupted by family in this. I also most often can get verbal/nonverbal information from the patient that guides me. Even dementia patients, somehow.


Natalie said...

Seriously, this is really inspiring. I'm considering neurosurgery in the future, and I've heard so many stories that are polar opposite to what you've just told. Props to you for sticking to your guns. Keep it up!

Allette said...

This is so uplifting. I am studying for my MD soon and plan on entering surgery for this exact reason, bedside manner. I am so glad I found your blog. Thanks for sharing!

Shanda said...

Great story. My 12 year old daughter was diagnosed with cancer 5 years ago...(she is fine now) but I really appreciated the doctors who talked directly to her instead of going through me!
Love your blog!

Free truths said...

I just found your blog through 'blogs of note' congrats! I feel like I should apologise for not finding it earlier. It actually made me laugh out loud! Whilst trying not to make light of the plight that most patients are in, I must say I found this story hilarious. I can't believe how much catching up I have to do now! :)

Unknown said...

lovely story and great job covering your blunders. I could learn a lot from you. SNORT!

Unknown said...

Oh, P.S. Love the use of Gregory House as your photo. He IS the posterboy for bedside manner. Love Him!

Sparkles! said...

And that actually turned out great in the end! I think that bedside manners are very important and unfortunately many doctors tend to forget that as I have often witnessed in the wards

Wreckless Euroafrican said...

Brilliant! i Love your stuff. It's sad that this small (erroneous) act from your side was such a big thing for a family. It is so sad that too often people treat the mentally challenged as complete retards. The fact that you made the effort to 'soldier" your way through the entire pre op interview gave that boy, and his parents a view of you that says "He treats his patient - like a patient, and not like a vegetable! Well done!