Wednesday, March 3, 2010

Medicine ... a mystery ??

It's scary, but it's a fact. The general public has no clue as to what doctors actually do. Add the mysterious element of "going to theatre" and Confusious would be put to shame. I can't figure why anyone in their right mind would consent to anything without understanding exactly whats going on, or at least having some basic idea! I have quit counting how many times patients reply I don't know, when asked what procedure they are having!! This usually as they are being wheeled into theatre! It really disturbs me ...

I get paid to eliminate pain, anxiety and all coherent thought, in as safe a manner as possible. Therefore, I feel it is unethical to unsettle patients pre-operatively. Can't have them all worked up and jumping off the table, so in these situations I basically choke on my tongue. But contrary to popular belief, I too am human, and therefore I sometimes fail.
Didn't you ask the surgeon what he is going to do to you? Yes I did. Did he tell you? Yes he did. Did you understand what he said? Not really. Did you ask him to explain it again? No I didn't. Why ever not??? Don't know ............... Did you sign consent? Yes .... Go figure ..............( of course when the shit goes flying, it's the doctor's fault).
Add to that the audacity to refuse the anaesthetic until they see their doctor, and all I can do is shake my head. I know that people think dopers aren't really doctors, and that we quickly go shopping or something while we wait for the surgeon to finish, but little do they know that the gas fairy is about as much quality control as they're gonna get.

Just the other day we did a total hip replacement. We offered the lady a morphine spinal combined with a GA. The spinal was turned down due to a fear of permanent paralysis, and a general was accepted on condition that her throat not be manipulated in anyway. No pipes please dear... She also requested a 22G paediatric jelco....
After a twenty minute negotiation session, I wrote a report summerising the situation and asked her to sign it. She read it carefully, realised that my ass was neatly covered, and was then ready to hear me out. I once again explained everything ad nauseum. The procedure was successful, but the next day she spoilt it all by asking me why we use the throat pipe ......!!!!!!!!!!!!!!!!!

It's about as bad as the patient that passes his pre-op interview with flying colours. You know the one that has no medical problems? Then you lift his pajama top ... Oh that old scar?? Yes yes, I had a triple bypass a few years ago ... Or, ok now show me your pills, is this not warfarin?? Oh yes, forgot about that, my blood is thick so been taking it for a while ... Or, is this not angised?
Yes I use it about twice per day, but other than that I have no problems ...
It annoys me, but I take full responsibility for these situations. Wish I could get it into my thick skull that, Do you have any medical problems, or anything that I should know about
, has a different meaning to me, and a different meaning to the patient. Wish I would remember to always ask all the questions one by one.

Then of course there is the influence from the media.
Today, our patient was having her varicose veins done. In the institution where I earn my living, this is done under mild sedation, using an endovenous laser technique. So I often end up chatting to the patient intermittently.
Today was no different, except that I quickly realised what calibre of patient we were dealing with. (And secretly wished that I could give her a general anaesthetic) Out of habit I confirmed that she was nil per mouth? Her tone was a little condescending as she replied that the LASER was not really an operation. She heard it on TV the other day. Also the doctor told her she was going to be just a little sleepy, so she had breakfast. Okey dokey.
After a few similar questions and answers, I took the cowardly route and pretended to be very busy writing notes. I seriously couldn't handle any further conversation.
Half way through the procedure she asked if haemorrhoids could be done with the laser. I rolled my eyes as the surgeon asked why. Well I'm here now so you can just do the piles too. They really bother me you know. And I really like the laser. Laser, laser, laser!!! The vascular surgeon was a bit offended I believe and told her to see a general surgeon for her secondary problem.
She proceeded to make it very clear that in her opinion all surgeons were equal and that she was very outraged by his rejection.
I thought it wise to administer a touch of propofol at this point ....

Ok so the medical profession needs to revamp its communication skills, but as with everything in life ... it takes two to tango ...

3 comments:

  1. mmm try it from the patient's side.
    I'm 3 days post-op bloke in white coat strolls up and says he wants to take my blood. Okay I say but why am I having blood taken every day. He pretty well throws a tantrum and hisses back at me "Well you don't have to have it done you know - no one's forcing you are they? I'm just doing my job" and starts to pack up his stuff!. I talk him down he takes blood and goes away. Next day different person, same question, clear explanation. Guess everyone has a bad day :)

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  2. I had one of those surprise CABG scars the other day to. Irritating as hell. Like, you didn't think this was important?

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  3. Hi Inky, I always try to put myself in a patients shoes and treat everyone with respect. Also I feel it is imperative to put a patient at ease before any procedure. But sometimes in the name of self-preservation, it's best to just shut up??
    Doc-ZZZ, someone told me that I'm totally over-reacting cause after a CABG one is technically normal again. tried to explain that its still part of a patients history and something I need to know....

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