Your patient has an abnormal mammogram. You schedule a surgical follow up appointment and she doesn't go in to get a biopsy. You talk to her, and she says she'll be there at the next one, so you set it up again. She doesn't show, no follow ups. One doesn't want to assume, but worst case, it probably is cancer, so its important that the patient gets it sorted out before it gets worse. After some time you finally get ahold of her and find that she believes the medical intervention isn't necessary, that she feels healed through her church and prayer, and so she sees no need to continue with you or the surgeon...
As her doctor, what would you do in this situation?
After my second day with this program I and roughly 10 other med students were asked this question. This was an actual scenario that the Dean who was leading the discussion experienced. We shared our thoughts and avenues for working with the patient, and then she told us what she did and how she managed to work it out, see the patient get a biopsy, which lead to a successful surgery to remove the cancer.
That course started to get us thinking about the theory behind how to work with patients, but when it comes to actual skill or applicable knowledge, we know close to nothing. I don't know about pathologies, how to treat patients, or what to do when I see a patient, which is why I'm terrified for next Tuesday. A small group of us will be going to the Sharewood Clinic and most likely see patients. Talking with other students in the program, we have a limited idea of what to expect, or what we are supposed to do. Needless to say we're a bit scared (Apart from being incredibly excited. It will be our first chance to put some of the skills we learn in class into practice, and learn from other medical professionals). However, I do find comfort when realizing that this situation echoes the first time a college student mentor goes out to Seattle high schools to work with students on their college applications for the first time. You worry, wondering, what if I don't know how to help them, what if I say the wrong thing or give them bad information? Some how, even after all the pre-visit anxiety, the college student leaves feeling great and excited to go back and work with their students. I'm going to assume that this is how it will work out for me next week, because I remember, this program wants us to succeed and do well. They will support us so that the patient receives the best care possible.
If you're like me, you're watching the show Boston Med. No, none of the hospitals my school is affiliated with is on that show, they are all Harvard hospitals. 24 hours after discussing patient-doctor relationships and how to communicate, be empathetic, listen, and help the patient on their path towards better health, I watched a surgical intern on Boston Med have the sort of interaction with a patient that resembled the bickering with one of my siblings back in grade school... I'm simply amazed at how he didn't appropriately handle the situation. With an "I know what's best attitude," he did not listen, acknowledge the patient's feelings, or what the patient's daughter was saying, he started leaving the room while the patient was still talking, he was simply rude. Forget empathy, or compassion, he acted rude. It's not a mystery as to why so many frustrating stories come out of the health care system. If he manages to keep going the way he's going, he has a much higher chance of being sued. The evidence shows that professionalism and the way you treat patients is one of the strongest indicators of malpractice lawsuits. That doesn't mean professional and caring physicians don't get sued, but it means that they experience a lawsuit less often.
On an unrelated note, I have a home. I'll be out of the dorms and moving in with two second-years at the start of August. Wicked awesome. Yep, imagine me saying that in a Boston accent... I was practicing it last night out at the bars. Anyway, I lucked out, because the student I contacted about playing soccer needed a third roommate, and after playing a couple games of pick up with him and a bunch of other Bostonians, I landed the apartment.
Time to get ready to watch the consolation match for the world cup!
Cheers
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