An Explanation: The #1 tool in your physician’s toolkit

Cross-posting from the heenastat blog.


 

It was almost a formality, me rounding on that patient that day.

The obstruction had resolved. The nasogastric tube was out.   If the diet advanced as expected he could be discharged to continue his chemotherapy. He was not even my primary patient. He was on the heme-onc service so I wasn’t even responsible for the paperwork.

Yes, he was dying of cancer. That was not news to him. Nor was the nausea and vomiting that he had come to expect in the wake of periodic infusions of poison. That which was intended to kill the cancer cells also killed a little bit of his insides with every dose. But the distention and obstipation was new. He had not felt right 4 days ago and he had rightfully come to the ER.

His diagnosis was small bowel obstruction. However, one could not tell from the CT scan if it was due to adhesions from his cancer surgery some years ago or due to new tumors scattered in his pelvis which had in recent months made him the unfortunate bearer of the “stage 4 cancer” moniker. As if the side effects of chemo for his cancer recurrence were not enough, now he had to suffer through this. But he was better by the time I met him as the new attending on a consulting service.

My exam confirmed the residents’ optimism that the obstruction had resolved. It was likely adhesions given the swift improvement and I noted how the nasogastric tube works to relieve such obstructions to the patient and his wife. But I explained that we were not sure, based on the original CT scan, if the cancer was playing a role in impeding the flow of GI contents. Either way, as long as he was able to tolerate oral feeds he could resume his cancer treatment with the hopes that the same symptoms would not recur. He did not need an operation in the immediate future. The patient and his wife were relieved.

As I concluded my visit, I asked (as I always do) if there were any other questions.

“No,” replied the patient’s wife. “But thank you so much. In all our time here, no one has explained what was really happening. Thanks for making it so clear. We really appreciate it.”

________________________________________________________________

I know I have written about this before-about the power of clarity in the medical encounter.

But seriously, I was at least the 4th attending physician to meet the patient not to mention the countless 1st through 6th post-graduate year trainees who had cared for the patient before I met him. Yet no one had taken the few minutes it would take to explain why the patient felt so miserable and how an uncomfortable tube down his nose might help.

Understanding the disease process is pathophysiology 101. Explaining it to the patient is doctoring 101. Sure, doctoring 201 is the art of explaining it in a way that caters to a patient’s educational and verbal capacity without instilling fear; but that no one had even tried just made me sad as a physician and as an educator. Once again, I took solace in the fact that there was a resident with me to both observe the explanation and to witness the words of gratitude. Hopefully, that’s my way of paying it forward just a little bit.

So at the risk of sounding too preachy let me leave you with this: If you take care of patients, remember they and those who love them are humans in a state of crisis. Amidst the pain, the fear, and the uncertainty of what’s to come, taking a moment to offer an explanation for the suffering can go so much further than any medication or procedure. Consider it the #1 tool in your physician’s toolkit.

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5 thoughts on “An Explanation: The #1 tool in your physician’s toolkit

    • Qualities such as spending time with patients, explaining ,comforting, truly caring are appreciated by patients but not the corporations we often work for. I have been in practice 30 years and was just fired. I am a good doctor (ego intact) . I am pleasant get along well with others. I have never been sued. I am slower now. I don’t see as many patients. I am not good with technology ie EHR but eventually all gets completed. My patients appreciate me but not my former employer. I am not quite ready to retire but hard to look for a job when the qualities I think are important are not appreciated.

  1. It seems like common sense for those of us who understand how to translate from clinical jargon into lay language, but I get this all the time, too, and I’m the Infectious Disease specialist. “Doc, you’re the first one to explain to us what is going on.”

  2. I have long believed, and tried to live, that one of our main jobs is to teach. Teach the patient and his family, explain in terms they can understand what is happening. We physicians, myself included, spend too much time at the keyboard and not enough at the bedside.

  3. Absolutely! In order to really have cared for the patient, good communication, explanations, and education play a part. It’s never just about treating the body. Thanks for the great post!

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