Thursday, August 16, 2007

Physician patient relationships

Joan died eight years ago. She was my patient for at least ten years prior to her death. As with many of my patients Joan taught me a great deal.

The first time I saw Joan, she had recently undergone a mastectomy for a fairly aggressive breast cancer. She was not the type of person to go to the doctor until it was absolutely necessary so a breast lump went undiagnosed for several months. She was suspicious of the medical community as a whole and she told me point blank how much she disliked doctors at our first meeting. The surgeon who was treating her for her breast cancer insisted that more doctors be involved and Joan had a fierce desire to beat the cancer so she did as the surgeon ask.

I immediately like her. Joan had a quick smile and it punctuated our entire discussion of her medical history, even when she was telling me why she did not go to the doctor often. By the time I had finished the examination and talked to her a bit more about my plan of treatment, I knew that we had a relationship. Not just a relationship as the law would define it in the Medical Practice Act but a relationship because of a mutual respect.

I saw Joan at least every three months for several years. My kids were born and hers grew to be teenagers. We never saw each other outside my office but she knew the names of my kids and had seen their pictures. I knew the names of her children and her husband and had even met them on various visits. She never failed to ask about my family nor I hers. She enlisted me for all kinds of referrals for family members.

And we listen to each other. Really listened. She saw the bone tired working parent of an infant and a toddler. I heard the worry in her voice as she discussed the latest escapades of her teenagers. At each visit we had a few moments to be friends. When she was free of disease we celebrated together. When the cancer recurred we gave each other strength to continue the fight.

When no more treatments worked, Joan asked me to talk with her husband about hospice even though I was not the primary doctor treating her cancer. She felt that I knew her weariness. Two days later she was admitted to hospice care. I made a house call three weeks before she died. We had talked several times on the phone but I decided one last visit in person was necessary - for me. I needed to tell her what a wonderful patient she had been and what a privilege it was to be her physician.

I have had several such opportunities now with patients who are near the end of life. Much of what we know as physicians is learned from our patients. Just as Joan was honest with me from the beginning, she taught me that it was acceptable, no expected, to be honest even in the end.

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1 comment:

Anonymous said...

Thank you Doc. You are indeed a physician who practices medicine as an art and with an eye for Shalom.