Wednesday, March 02, 2005

Routine for us, not for them

I appreciate the lengths that Orac went through to treat this patient. I especially appreciate his comment:
Thinking about this case, it occurs to me that we doctors too often become rather blasé about cancer. As mysterious and implacable a foe it is to us, we nonetheless treat it as fairly routine. We have to, particularly if it's our business to treat it. However, to the patient it is most definitely not routine.
I often have to remind myself that this is also true of my ER patients. I suppose it applies to all of our patients. When we are faced with disease, death and dying, we remind ourselves that "the patient is the one with the disease." I know that I will go home OK at the end of my shift.

But for the patient, the experience is unique. I have worked so many hours in this ER that I am familiar with every routine, every corner and every sound. For my patients, every sight and sound is new and potentially frightening.

Ordering a lab test, for me, is a matter of circling something on a form. For the patient, it usually involves a needle stick and some degree of discomfort. Add to this the uncertainty regarding what is being ordered and for what reason. The patient must wonder what is going to happen to them (not for them, as I would think) as a result of that test.

We will occasionally get a complaint from a patient regarding laughter at the nurses station. We get defensive and say, "Just because they are miserable, why do they expect that we should work in a restrictive environment. They should realize that this is our workplace and our comrades, and we may laugh as they may at their wrokplace with their comrades." However, there are few workplaces where the customer is as depersonalized as in this one.

We strip the patient naked, place them in an uncomfortable bed, poke them with needles; strangers come in and look at personal places that even family members haven't seen; we take them down halls to other departments without adequate explanations.

Thank you, Orac, for reminding me of the scared PERSON who I am treating, instead of the PATIENT who I all too often depersonalize.