Monday, February 13, 2012

The Importance of Caring

Several days ago I came across this article, The foundation of medicine is care. Like many words in healthcare, "care" has become overused (right up there with "professionalism"). What does it even mean anymore?

We adhere to standards of care - the set of questions, actions, labs, imaging, etc that we do to diagnose a patient's problems and provide adequate treatment. We provide care to patients, to help them when they request it of us. None of this necessitates that we care about our patients. As the article argues (and I agree), this last kind of care is the most important.

Today, a distraught parent explained her daughter's "history of present illness" to the physician I am working with this week. In trying to get an accurate picture of her daughter's current illness, he asked the mom question after question to make sure he had the story right. The mom got frustrated because she's had to explain the whole thing for who knows how many times and she felt like he wasn't listening - such is the perils of an academic teaching hospital, you must tell the same story at least 3 times (and often more). The mom became so frustrated that she broke down. She was the first person I met who said how horrible this hospital was, how no one seemed to care enough to get the story right or talk to each other so that everyone's on the same page. She's not entirely wrong. Our hospital system is set up in a rather fragmented way. We provide the same standard of care (if not better) than most other hospitals, we provide good care for our patients. But we, as a system, didn't care about the patient.

Inpatient medicine is very different from outpatient medicine. In the outpatient setting, I felt that every physician actually cared for his/her patients on a personal level. I had a . . . heated discussion with my roommate about a month back. He asked me why I cared so much, why I get so worked up over a patient encounter. Really, I couldn't help it. By actually caring about my patients, not just for them, I feel like I am able to do more and am willing to try harder for them.

He didn't share my same views. For him, once he met the standard of care, he need not go further. If he couldn't get a patient to comply, then he is perfectly satisfied to give up and walk away from the situation. While in some scenarios this is indeed the correct course of action, I felt that it would be a disservice to our patients if we gave up every time they gave us even the slightest hint of grief.

Anyway, just some thoughts.


fan of casey said...

Aek: You have to find that balance between caring about your patients as an objective professional, advocating for them without lettung it get too personal for you because you just cannot get sucked in too deep emotionally with every case. Your roommate on the other hand could learn so additional beside manners from you, because he sounds too detached. Try to find that happy balance.

fan of casey said...

Ooo, typo -- it should say "some additional" not "so"

fan of casey said...

Aek: You probably read a lot of medical journals and such -- but here's a "health" piece from a general news source that made me think of you. And like so many interesting posts, the comments tend to generate a great deal of followup insight (when you dismiss the crackpots comments):