As I have alluded to before, most physicians do not practice medicine because we love people and hate money. After endless years of training, we spend countless hours working for the best possible outcomes for our patients because we crave approval. First we sought the approval of our parents, then our teachers, and now it is the approval of our patients. "Thank you!" sincerely spoken goes along way with most of us. A note or a card will likely be kept in a special place for years.
Perhaps you can imagine how devastating it is to have a patient who is dissatisfied. Three days ago I took a young woman to surgery after she had a Cesarean section at another hospital. On arrival to our emergency room she was hemorrhaging internally as well as vaginally and also out of her abdominal skin incision. Only her first baby, I was afraid I would have to do a hysterectomy to save her life.
Now that we are three days out from this crisis and the patient is getting better, with the aid of surgery, blood transfusions, and IV antibiotics, I am more optimistic. And, I was hoping for a grateful patient. Alas, she is tired, sore, and angry. Some of this is to be expected. The father of the baby is miles away, driving his truck. Her family consists of an 18 year old male cousin, who tells me he needs to learn about babies because his girlfriend is pregnant. He has been sleeping in her room because the hospital requires a responsible party be present to care for the baby.
Continuing to do the best that I can to provide good medical care, I am reminding myself that healing of my patient is reward enough.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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