Tuesday, 2 May 2017

Doctors And Patients Alike Can Be Guilty Of Dangerous Assumptions

Today's short post from kevinmd.com (see link below) is a timely reminder that the relationship between doctor and patient is always a fragile one, influenced by suppositions and assumptions, on both sides. With a disease like neuropathy, where the boundaries are vague and diagnoses and treatments less than 100% reliable, it's vital that there's mutual give and take. Far too often doctors send nerve damage patients home with the cliched; 'You'll have to learn to live with it', leading to frustration and anger and unresolved medical issues. In that case, the doctor is wrong and deserves to be called on his/her bedside manner. However, patients are equally guilty when they self-diagnose, or demand certain treatments, or come to the surgery without a coherent story. The point is that there's room for a little humility and 'counting to ten' on both sides. This article illustrates that perfectly and is a lesson for both doctor and patient. In the case of neuropathy, there's often no right and no wrong but the middle ground must be found in order to provide the best possible treatment for the patient. That demands a preparedness for the long haul...on both sides, with patience and respect as prerequisites on the side. Well worth a read.

You think the patient is difficult? Maybe it’s you.
Jordan Grumet, MD | Physician | April 28, 2017

I have come to believe that humility is an essential component of wisdom. Never have I found this truer than in the practice of medicine. In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble.

Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact, the label “difficult” assumes the problem lies within the patient and not the technique being utilized by the care provider. Already, blame is turned outward and personal responsibility abandoned.

A few years ago, when I was in a group practice, one of the senior partners had a particularly needy patient that somehow showed up on all our schedules from time to time. Her aged joints carried her into the exam room to in a particularly hobbled rhythm. She paused before each sentence, her voice barely above a whisper.

Her litany of issues was long and nonsensical. And this was always the precise moment when humility left the room. We all became convinced that her complaints were psychosomatic. And we were right. It still amazes me at how cavalier I can be when I think a solution is either simple or nonphysiologic.

It was only after several visits that the need for a thorough exam became apparent. I tapped my feet and waited outside the door for what seemed like an eternity as she undressed and climbed into the gown. My stethoscope stumbled over the heart as if its mighty muscle had not thumped hundreds of thousands of beats. I auscultated the lungs absentmindedly untouched by the unmeasurable volumes that glanced the porous surface.

My hands fumbled over the fibrosed joints that absorbed the shock of a child’s prance, a young athlete’s stride and,now, an ancient shuffle.

My conceit, however, unshakable as it was, was shattered by the faded serial number tattooed on her forearm.

And my humility, once again, was restored to a respectable level.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.


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