Thursday, July 28, 2011

Patients as Diseases

Yesterday I had a sudden strange epiphany: we tend to treat patients as diseases. The people who've come into the hospitals have "become" their diseases. We're more likely to say something like, "my diabetic patient" as opposed to "my patient with diabetes." Subtle difference perhaps, but a difference nonetheless.

It just hit me. Outside of their diseases - there sole reason for coming into the hospital - I knew next to nothing about my patients. I didn't know that my HIV patient was once a baker and a tanner (it said so in his chart). I didn't know that my DVT patient lives with his son and grandchildren (he randomly told me one day). I didn't know my patients as people, only as pathologies. It suddenly didn't sit particularly well with me.

On the one hand, by focusing on their pathologies, I can do my job more efficiently and figure out what's wrong and how to (hopefully) fix it. But on the other hand, there's so much more to the patient than their diseases and there's an element of humanity that's somewhat missing. I mentioned this to one of my friends who's on the same rotation track as me, and he says, "Welcome to the real world."

Yesterday my attending and I were rounding one of our patients with diabetes. She'll likely need her toe amputated because it's basically dead and rotting. And she started crying. My attending says to her (paraphrased), "You have become your disease. You have to get your life back and control this, don't let your disease control you. Knowing what it is is half the battle. The hard part is what you do, and I know it's not easy. But you must not let your disease control you."

We're all so wrapped up in the medicine, in the problems, that we fail to see the bigger picture of the world we live in. I don't know if knowing my patients as people would contribute to better patient care. Maybe it would help me understand how and why one of my patients became so obese that she could no longer sit up, roll on her side, or walk. And maybe, just maybe, it'd give me that small window of opportunity to help my patient manage her health once she leaves so that I never see her again.


fan of casey said...

Aek: The best doctors I've had usually take a personal interest in me as patient and as a person. I'd rather have someone who has a good bedside manner, so you are insightful to think about your approach to patients. Too clinical is no good, nor is being too familiar since you still have to remain objective. Find the sweet spot that works for you.

My brother is a surgeon and I attribute part of his success to his empathy and connection with his patients.

rj said...

It's good point you realize that. Not every medicine student learns bedside manner through their clinical practice. :)

I'll share this insight with my classmates

Biki said...

Its a fine line to walk to be sure, but I think finding it increases patient compliance. To know that your doctor cares for you as a person, and not as your disease lessens the feeling of "oh why bother". One doesnt want to let friends down, and while you wont technically be a friend, if you are friendly, sometimes thats enough.

And your extremely overweight patient? The people i know that are hugely overweight seem to be horrifyingly depressed and are running from something they cant deal with. I've watched my sister in law gain 100 lbs in less than 10 years. She also hoards trash. Finally after years of depression she is seeking help, I just hope it works.

Ron said...

I think with me is that I think about them as people and not as pathologies enough.

And so when the consultant asks me for details on pathophysiology of certain clinical problems I go:


. said...

Hey Aek...well written...if you see your patients as people you and they should both see the human side of medicine...and that you care enough to see them as people first and foremost.