[Dr. Suzanne] Mitchell says Dick taught her the difference between medical treatment and medical care.
“To be willing to follow your patient to where they want to go is an uncomfortable journey, and it changed me forever,” she says.
She’s no longer afraid, she adds, “to allow my patients to take me on their journey. Whatever expertise we have, the patient holds the wisdom of their life. And we need to be with our patients ”” really be with them.”
Mitchell often tells the story to medical students and young doctors in training. Sometimes they say, “How will we have time to get to know our patients?”
Her response is: “How can you afford not to? How can you afford not to connect to your patient before anything else happens?”
One of my favorite stories of the week; I quoted it in this morning’s sermon.
Beautiful, Kendall! Too often, the “medical establishment” stays focused on the cure, not the care.
All too often the medical community treats instead of cares. Bless this doctor for caring. This is one good reason for having a variety of health care providers: I believe that nurse practitioners are educated to care while medical doctors have traditionally been educated to bring about a cure. It is great to see a medical doctor who has decided to care.
I reacted differently to the story. Her encouraging the patient to be hospitalized was a pretty obvious error, which she, herself, realized afterwards and had a hard time reversing. Ordering tests, doing biopsies, hospitalizations etc., sets one on a path that one needs to ask at the beginning if that path is desirable.
[blockquote] “How will we have time to get to know our patients?”
Her response is: “How can you afford not to? How can you afford not to connect to your patient before anything else happens?” [/blockquote]
Medical students know the reality. The question is certainly valid and the response is haughty and snarky. Time pressures are increasing, especially in primary care. Primary care docs are becoming physician extender managers, leading a team of PA’s or NP’s. Good physician extenders know when something is fishy and needs a second pair of eyes to look it over more closely. They will alert the physician who needs to do more than pop in to the exam room and say, “Hi, we talked about you and I agree with the plan of the PA or NP, bye.” So the correct response is that the days of hour appointment slots is over and “getting to know” the patients will indeed be less and less possible except for perhaps physicians in academia that are shielded from the real world.
A somewhat associated aside. Just at the time when the services of nurse practitioners will be ramping up, the national organization is pushing a proposal a method to curtail supply. There is a movement afoot to require new nurse practitioners to have a “doctorate of nursing” (with the old NP’s being grandfathered in, of course). They will backfire, I believe, because practices will simply hire PA’s.
Disclaimer: I have worked with many fabulous PA’s and NP’s and they are absolutely essential to move forward with (true) healthcare reform.
Frankly, I found the piece irritating.
NB:
“And the hectic pace of her patient-care practice left her wondering every day, “What am I doing here?” To give herself time to take stock, she took a part-time job with an elder services agency in Gloucester, Mass., an old fishing port north of Boston. She saw her first patient at home”
So, this lady is NOT in regular, fee for service family/acute care medicine. She is on salary for an elder services agency, and has the luxury of being paid for making home visits.
She who was being PAID to spend time with somebody at home who was clearly not going to do well in a hospital insisted on hospitalizing the poor guy instead of doing her JOB with she was PAID to do, to manage him AT HOME. Obviously that was an error. Then, after all the tests have been done by the busy medical staff, she gets to be the “hero” who brings him home and lets him “die in peace”.
Where was she when she shoved the care of somebody she was PAID to CARE FOR AT HOME, onto the busy hospital staff who, unlike her, worked in the clinic full time, took call every other night (or more often) and had a dozen sick consults to see during the day?
Then she has the arrogance to make snotty comments to medical students.
5. Clueless wrote:
“Frankly, I found the piece irritating.”
I’m with Clueless here. Physicians and PAs are all over the map, and frankly, some of it is to be expected.
1. Surgeons are a bit freaky to me. People who make their life work cutting open, sawing, and drilling into other people are weird. I don’t expect or need a surgeon to be nice. The nice one put my wife’s wrist back together wrong, and six weeks later had to take it apart and re-set it all over again. The arrogant one did a really great job removing the fascia material that had grown uncontrolled, into, and around the tendons controlling my fingers. He explained to me in great detail how much he enjoyed doing this particular procedure. The only thing was, he said, he had to make sure he had enough blades on hand because he went through a pile of them – the cutting, scraping, and peeling really dulled them out fast. TMI.
2. My eye doctor is an observant christian firmly in the Reformed tradition. He has lots of questions for me about Catholic teaching on the Sacraments. He says he covets my prayers on Tuesday mornings when he does surgery. I like him a lot, we have prayed for each other in the consulting room. This guy is warm, personable, caring and a Christian. And I am very grateful he did a good job on my wife’s cataract. He’s the exception.
3. My psychiatrist doesn’t listen to me – not really. He’s looking for signs of depression. He once told me “nobody thinks he’s got a better grasp of reality than a depressed person.” Unfortunately, a cold view of reality can turn morose pretty quickly. He does a 20 minute medication review with a eye toward evaluating my mood level, and he’s not that interested in the details of my life. He’s pretty acerbic. We’re not friends. I do rely on his good judgment though.
I could go on. These people have work to do. Some of it involves personal interaction. Yes, it would be better if the general practitioners were friendly and got to know their patients, but the medical field has gotten so specialized I would rather they all were skilled at their jobs. I can deal with people who can’t make good eye contact – I would have a lot more trouble with permanent nerve damage to my right hand.