Wednesday, November 10, 2010
Obituary tells a story!
What prompted me to delve into this path of thought was the discovery of an obituary of a former patient of mine. Now I am not an obituary reader, though I am told many people my age are. But I just happened to find this one and low and behold it was for a patient whom I remembered well. M. P. had been in my practice for many years. She really didn't have too many of the chronic diseases that plague most older women. I recall a little bit of diabetes which really didn't require any meds and some high blood pressure that was controlled on 1 med. I know she developed an underactive thyroid while in my care and I had started her on daily thyroid hormone replacement. She had a lot of difficulty whenever she received any kind of diagnosis, and she was very concerned about having to take any kind of medication. Since the thyroid condition would require her to take meds every day for the rest of her life and to occasionally to have blood tests to check on the correct dosage, she was very down about this. She would whine in the office about, "how was she going to do this? How could this have happened to her?" etc. etc. She was also often going on about various family problems that seemed too much for her. Sometimes she would go into the family issues a little and they were usually stories about inter personal relations of some sort. She really didn't have family members who were abusive, or in trouble with the law or anything like that. But the interpersonal problems often were a burden for her. So I recall looking at my schedule and seeing her on the schedule and knowing that I would have to gear up my cheerfulness to get her through the visit and also to get me through the visit.
So I was quite surprised to see this sentence in the obit that I found: First her many friends and relatives were listed. Then, "M and her husband of 60 years had many close friends before and during their mariage that they maintained over 60+ years. Described by many as a "true lady", M was known for her friendliness, charitable spirit and insistence on putting the needs of others before her own. Her kindness and generosity will never be forgotten." This did not seem to be the woman who I saw in some ways whining to me during every visit in the medical office. Which is the correct picture? Or are both views true?
I began to review my own recent medical visits to my own doctors from my view and then how they might seem from the doctor's side of the visit. The doctor sees the patient for a very short time, especially now adays. He/she doesn't know anything about the patient from anywhere else in the outside community. The patient feels the pressure of time of that office visit and has to quickly and emphatically get across to the doctor what is bothering them. There often is not enough time to put these complaints into perspective. I know the difficulty I was having with arm pain after my melanoma surgery and I had to convince my doctors of the degree of this discomfort if I wanted to achieve any success in the treatment of these problems. I particularly felt this need when I returned to my plastic surgeon with these complaints. I felt he was not giving credence to the problems. I guess I did whine a little more than I am used to, but he felt I was under the care of a physical therapist and the therapist reported I was improving so the surgeon felt he didn't need to do anything further. Yet he was the one who had started the pain, obviously, so I felt a strong need to get my suffering across to him against the time pressure that I also felt as the patient.
So if there is such a vast difference between who people are in everyday life and who they have to be when they go to the doctor, how can the relationship between patient and doctor resolve itself? An excellent question! I think that the oness is on the doctor. He/she must realize that this paradox exists. And the doctor must create sensitivity and listening and observation skills that can detect the patient's needs and make the patient's communication more efficient. And patients must ask questions and not be shy with the doctor. It turns out that the visit to the doctor's office is one of the most important interpersonal communications that take place in our later life. Each participant needs to understand this and realize how easy it is for this communication to go wrong. I just know that I don't want to be misinterpreted in my visits like I misinterpreted poor M. P. Lets hope that all of you feel comfortable enough with your physician to bring up your concerns and let's hope you have a skillful physician who appreciates the complexities of these interactions.
Note: At the beginning of this post, I used the caduceus, a universal symbol for the field of medicine. I plan to use this symbol in the future also when the topic is medical. It is familiar to most everyone as an apparent snake, or sometimes two snakes entwined around a pole. The origin of this symbol is quite interesting. Check upcoming posts and I will explain its origin. You may be surprised.