Cast & Curious

Tag: sickness

  • A doctor in the family

    I too believe that having a physician member of the  in the family offers some distinct advantages. The best example of course is the relatively access to healthcare professionals. Medical information, drug prescriptions, when needed are easily obtainable. With a physician relative, navigating through the maze of complex healthcare system seem a bit more bearable for the average patient.

    Such advantages though isn’t without compounding problems.  Complex family dynamics often interfere (sometimes negatively) with physician’s ability to be objective medically. Thus, it has been a norm among physicians to hand over treatment of sick family members to their colleagues. In this situation, that physician family member is often relegated to a healthcare facilitator. [pullquote] A healthcare facilitator, by virtue of his knowledge about the ins and outs of the prevailing healthcare system efficiently facilitate the carrying out of different medical procedures for his or her sick family member.[/pullquote]He or she also acts as the official medical information person for the family and translates these medical information into something understandable by the family members. In the bureaucratic parlance, a “fixer”. Not the best of titles for someone with lots of suffixes in their name, but yes that’s what we do, when a member of our family gets sick.

    A physician may chooses to manage his or her sick family member, despite this potential bias.  It will never be easy though and may sometimes take a toll on the personal life of that physician.

    I squirm at the sight of my mom being stung by needles. If she winces in pain, I wince in pain too. I feel terrible whenever she complains swallowing several pills even if it is exactly what she needed. When she asks me “are you going to cut me again?”, my heart melts. In these moments, I hate to be the doctor in the family. Nobody likes to inflict pain on your patients in the promise of them getting well. Try telling that to my mom.

    Is it easier then for physicians to manage a sick member of the family? Again, the simple answer is NO, IT ISN’T.

    I don’t find talking about medical illness to our family less painful either. Simplifying a medical information is a bit challenging too. Despite aiming for a shared decision making, you ultimately end up  making the decision yourself, being the “more medically informed” in the family. Ergo, a bigger responsibility. Sadly, you cannot make a “no decision”.

    There is an inescapable reality that families with doctor are exempted from the problems besetting an average Filipino family. The costly health care system, the complex Filipino family dynamics and other multitude of problems, does not discriminate whether you have a doctor in the family or not.  The power of the stethoscope doesn’t discriminate patients, family or not.

    The hardest part I think is taking responsibilities should medical knowledge fail to address a medical condition of a family member. I have yet to meet a physician who boasts that he or she “healed” a family member from sickness, but I can practically name a few who took on their lives for “failing” to even ease out the pain his or her relative feel from sickbed.

    Would you call it then an advantage, having a physician in the family?  I, a physician and a son, ultimately don’t think so.

    (Let me hear what you think)

     

  • Close call on rehabilitation

    In the past, I work closely with rehabilitation physician in the course of treating my patients.  Since I went into private practice  in the province though the lack of a Rehab physician in my area pushed me to learn and give rehabilitation regimens to my post op patients. What i discovered first was not really about the nitty gritty of giving exact instructions on physical rehab regimens. The necessity to communicate clearly and cultural sensitivity plays an important role and could save you from embarrassment or worst, the barking look of your own patient.

    Mrs. Cruz (not her real name) is a 56 year old soon to be retiring school teacher I operated on after she sustained an bi malleolar ankle fracture from a vehicular accident. She was a stern looking bespectacled woman, barely smiling but very sharp with her unending probing questions. She claimed to know me when I was still an elementary grade pupil (although, I couldn’t remember exactly if she was one of my teacher), but I suspect she isn’t the type of teacher you and your nasty classmates could play jokes on. Anyhow, I operated on her uneventfully and she is on her first week of follow up post op. Time for rehab I said.

    She was accompanied by her equally stern looking husband, a former military man from the looks of his eyes when she came in my clinic.One of her son was waiting outside the clinic and was I guess an added “assist” should the need arises. I just came from two succeeding ORs, barely had any sleep and was pretty tired from whole day of running around the hospital seeing patients. I am in my usual cool emphatic composure, but it was 4PM and my energy is almost spent since 7 am that day.

    “Good morning Mrs. Cruz,.. Sir!” I said. Greetings which was met by a querying look from both persons. “Hows your operative wound madam?” “Have you been dressing this daily?” I continued. “Yes” she said. I went through the routine of checking her post op wounds, examining it and then removing the sutures after seeing the wounds are all healed already. I then checked her ankle joint’s range of motion. It was a bit stiff even if I did one good operative job and has checked the range of motion intra op to be “full”.

    Time for a “rehab” I said nonchalantly to Mrs. Cruz.

    I was skimming her chart and fumbling on my phonebook at the same time for the cell number of our in house physical therapist. I noticed the couple looked stunned and was looking at me squarely liked I said something really awful.

    “Rehab, doc?”. Mrs Cruz didn’t blink to ask me again. Half stunned, half in disbelief.

    “Yes, Rehab” I replied a bit annoyed and spent.

    Then Mr. Cruz, face red in embarrassment, looking more serious and agitated now,  butted in “Doc, my wife is a teacher, she doen’t have any vice at all, at this age, I really find it hard to believe she is using any drugs!!!” in Tagalog.

    “Ugh!Oh no, no..that’s not what I meant! Her ankle needs physical therapy so she can walk painlessly again on that foot!”

    The rest of this story brought back the adrenaline in me that day. I was totally insensitive, perhaps because I was so spent with toxicity. In a provincial community where I practice, social stigma for drug addicts and sensitivity towards implying one is using any addictive substance may cost you your life. In this part of the country (and in some other parts too), “Rehabilitation” means drug rehabilitation. Many believe its derogatory and I guess, I learned my lessons that day.

    Perhaps clarifying things out, being socially sensitive and a bit more of patience, will save you from your own “close calls” with ‘rehabilitation”.

  • Why you should not be your parent’s (or any other relative of yours) physician

    Ugh! (photo from here)

    It’s hilariously difficult to even get an IV line inserted. “Jesus, are you going to pin prick me to death?“

    Or get a good symptomatic history. ” I had my stomach pains and vomiting since 10:30 but I could handle it till 1:00am so you can bring me to ER” She was dehydrated by then.

    They have their own diagnosis. ” I only ate small amounts of pancit…maybe its my UTI!” Maybe. But her blood sugar is also 290. With some signs of dehydration..

    And their treatment : “ I’ll just lessen what I eat so as not to perk up my sugar“

    And discharge plans: “I’ll go home tomorrow, where are you?“

    They also can be your chief of clinics :”When are you going to see me? Who is my doctor, what time will he be here??“..

    Ugh, well. I just resigned my job and endorsed my patient! I’d rather just be, “the Son”. Good luck doctor!

  • Notes to the knife II: The opposite of humility

    Again? Yes. Again and against.  I will write about humility in knife wielders until this amazement transforms into a virtue. In the professions of demigods, any opportunity to get enlightened on humility doesn’t come by so easily .  So when it knocks, one should not wait for two or three knocks before opening the door.  The great student doesn’t need the winds to howl before opening his heart to learning. Humility, I should say, comes right into your face before you even knew it did. Like what happened to me recently. When I took the role of patient..

    My mortal lessons
    Notes to the Knife II

    It probably was just a viral infection but before the lab result got out and the diagnosis made, I took the role of the patient religiously and found time to interest myself with observing people around me. A physician admitted in room 204 is something a phenomena to everyone else. Including myself. Not the fondest role any physician would want, but certainly the most engaging. Of course, not until some real patients ask you about this ‘anomaly’.

    Being the patient, in the reversal of roles, is it really that easy for you? You know, relative to us, real patients, you (the actor patient) have almost everything you needed within your reach.(Unlike us patients, where we often cry for help on this and that..)- real patient X.

    Hell, NO.

    When this  knife wielding body go awry for one infinitesimal  reason, our chaotic hordes of Hippocratic knowledge put more distress on thyself than any other patient could ever think. Let me exaggerate. A hundredth decimal change in our body temperature would trigger a bazillion neuro impulses on our cerebrum that would then, extrapolate a gazillion more differential diagnosis that are rarely confirmed that is true. In short, we have more worries because we knew a bit more. Yes, my dear patient, sometimes, ignorance is bliss. Knowing something worse than just cold, flu or skin allergy as a differential diagnosis is no fun! It burns our distress horns more than you can imagine.

    Knife wielders are good actors. But we are not that good as a patient. We are the worst patient a doctor can get. Of course we really wanted to act like we’re patients when we are the patient. But it ain’t easy when you know for example, that a skin test is more painful than a deep laceration. I for one would rather sew myself up  than have someone stick a needle into my arm. There’s too much pain when you know whats coming right into your skin.

    IV bottle
    Opposite of humility

    Okay you try to act like the patient, but does your doctor treat you like your the patient?The nurses?The x-ray man?How many times did you peek at your own chart? In fact, most physicians of physician-turned-patients never mutter a single piece of conjecture to this patient until he or she is 101% sure about the diagnosis. The convoluted fear of the so many possibilities is staggering.   Easy patient huh?

    Last, and probably the most interesting phenomena I’ve noticed- when the knife wielder gets sick,  other people  would then say “he’s got it!he’s got it! We’ll get it too!’ This ‘when-doctors-get-sick, its going to be doomsday-on-us’ charade is very annoying. Exaggerated? Maybe. Got something related to the profession’s supposed infallibility. But then again, is it really that way?

    Where does humility stand in all of these?I’d say below your humility our dear patients. Doctor turned patients swallow a large chunk of their infallibility grid to be treated adequately. It takes humility to accept diagnosis a mile away from what you knew. It takes a hundred more strength just to keep shut your mouth instead of whining in pain  receiving a cut not from your own knife. It takes humility to be just a patient for even one second. It takes more humility than just humility.

    Bottom line is this. When doctors get sick, the implications creates waves more than what a regular patient will. Sort of a celebrity thing but more than that. The ripples are often beyond entertainment. Some even wreck havoc on some patients perception of their health. So maybe this is why some knife wielders need to be good actors and actresses whenever they exchange roles with their patients. Celebrity easy?!Obviously not.