All of us
were told in medical school, at one time, to treat patients like family members.
We lose this mentality very quickly as the daily battles become a war of us
versus them. The popular novel usually assigned to the budding medical student,
“House of God” by Samuel Shem, portrays this adversarial approach in two
mantras that are repeated by the well-read scholar: “GOMERs go to ground” and
“the longer you stay, the longer you stay” – phrases that refer to the patients
who they would prefer to Get Out of My E.R. and the fact that patients always
make our days longer. We deliberately depersonalize patients in a way that is
meant to provide a more objective but cynical means of coping with the daily
tragedies of medicine and the frustration with not ever being done with your
work. Instead of reveling in the world of patient advocacy and diagnostic discovery,
we get sucked into the grind of hospital rounding or the outpatient clinic, respectively
trying to figure out how to get a patient off our list on the wards or another
person out of the examination room and back to the checkout area. The folly of
this mindset is that a new name will only replace the old name on your list
regardless of how soon or late you discharge the patient from the hospital. In
the same way, the clinic world is always running behind with good intentions at
the start of the day and a frazzled staff (and sometimes disgruntled patients)
by the end of the day.
The goal of treating
patients like family members is that we offer the caring, helping hand that is
meant to comfort in times of need. We reach out to our fellow human beings and
see their concerns through the lens of their world, not ours. “The Doctor” was
a powerful movie back in the early 90’s that portrayed a renowned and successful
surgeon who was diagnosed with cancer at the peak of his career. He quickly turned the tables on his medical school colleagues and students by forcing them
to learn what it is like to be a patient, not a practitioner. Following his
recovery, the previously pompous doctor dressed them in hospital gowns and
forced them to view the delivery of medicine from the other side of the
stethoscope. As a technique, I will have my own family member-style discussions
with patients to encourage them to go a direction I strongly feel or discourage
them from going down a path that is not in their best interests by channeling
this approach. A well-placed comment that I am only recommending something that
I would make for my own family member is often well-received. I can only do so
as long as I am being honest and forthright with my own convictions and their
respective position and values as well.
The final
warning to us is not to flip the roles and treat family members like patients.
I have learned this problem the hard way by ignoring issues that family members
have had or hindering the good work that colleagues were doing with my loved
ones. I have to trust that my fellow medical community members have the same
level of caring that they would want for their own family members as well. If I
inject my own subjective feelings or motivations into the more objective
viewpoint of a third party practitioner, I am no longer acting as the supportive
husband, father, son or relative that I should be; I am, in fact, compromising
their treatment course by getting in the way of the better care they would
receive from someone else with a more objective lens. You have to love them so
much that you can set them free, removing yourself from the clinical role and
embracing the supportive family member that you should be.
SECRET
WORD/PHRASE: "Family member treatment" (BREVITY WORDS) OR "What would you recommend (medication/test/procedure) for one of
your family members?”
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