By HANS DUVEFELT
Today a patient told me a cancer doctor had told her husband that he only had a year to live. She was angry, because she felt that statement robbed her husband of hope and she knew well enough that doctors don’t always know a patient’s prognosis in such detail.
“Would you want to know if you only had a year to live”, she asked me.
I thought for a moment and then answered that I probably would want to know. I explained that I would want to make decisions and provisions because I live alone and am responsible for my animals. As I told her, I am well aware that if I dropped dead right now, things would be pretty chaotic for a while.
Two and a half years ago, I wrote a post titled Be the Doctor Each Patient Needs. In it I presumptuously coined the phrase I later put right on top of the sidebar of this blog:
Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.
I still believe we need to be incredibly sensitive to all the verbal and nonverbal clues our patients give us about what they need. In my 2018 post, I used the analogy of being like a chameleon. That’s not the same as being dishonest. It is a matter of knowing that your education and title give you an authority, an opportunity and an obligation to use your position of trust in your patient’s life to say things they need to hear in order to carry on or perhaps to take the first step in a new direction. We all wear the mantle of a superhero in a sense, and we can use this symbol for good. But that carries a responsibility to use our powers wisely.
We must strive to know our patients well enough to know what they need. Those things are seldom apparent from the medical record. They are subtle, subjective and often in some degree of flux through time and the course of life and disease.
The other day, a colleague who was scheduled to see a patient of mine I couldn’t accommodate in my schedule asked me if there was anything she should know before seeing this patient. What I did, in less than two minutes, was explain this person’s track record of resourcefulness, comprehension and follow-through.
Those qualities or capabilities in a patient must determine our behavior and care planning. I sometimes have a very full schedule because I think I know when I need to monitor each step in some patients’ treatment or they will get lost in terms of what to do and maybe even lost to followup entirely.
When I think about medicine being an art, I see the art in reading people and the art in applying basic treatment principles in an individualized way. This takes time to learn and hone, and it sometimes requires extra time in the patient encounter. My aim and my desire in practice is to automate and delegate the many mandated aspects of healthcare so I can focus on what only a treating physician can do: Pull together all the objective and subjective data, develop a treatment plan that makes sense for the patient and help them see the direction and steps needed to put that plan into action.
Another phrase I coined, perhaps equally presumptuous as the first one I quoted, and which I tried out on my boss a while ago (I can’t quite read the reaction I got) was “I’m an artist, not a bookkeeper”. I do believe that is what my patients need and are looking for.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.