Small, Everyday Steps

Hello everyone,

So this week I’d like to start by telling you about an exchange I had with a patient and the thoughts that have been swirling around in my head since then.

So as usual, the majority of my week was taken up to find patients in the hospital, and then go talk to them and figure out their entire story. Why they’re in hospital, how they’re feeling, even just their general life story if they want to talk about it. The more they talk the better. Now we do have access to their medical records at any time so we could do some pre-reading before we walk in to the room but I personally like to avoid reading the records until after I am done chatting with the patients and walk in, maybe just checking to see they aren’t a violent schizophrenic before I walk in.

This system led me to interview a quite frail and elderly patient who was a little confused, hard of hearing but still fiercely determined to regain their independence. Obviously as a lowly medical student I am not in a position to get the patient up and back to their own, but they did make a simple request that did get through to me. As part of their desire to be independent the patient took pride in knowing all their medications and what they were for (a considerable feat for an elderly patient with some memory issues on over 8 separate medications). A few months ago this patient had been admitted to hospital and every single medication had been switched around and noone had bothered to explain to the poor patient their new therapeutic regime.

Asking someone to explain the new medications to the patient is absolutely something I can (and did) do, although the question that stuck to me was: Why did I have to do it at all? Medical school drills into us the importance of patient understanding and making them an active participant in their care. Particularly in this case the solution to the problem was such an easy fix that it boggles my mind that noone had addressed it in the 5 or 6 months the patient has been on these new medications. It didn’t even have to be a doctor; a pharmacist, or the district nurse that comes to visit this patient all could have answered the basic answer “This pill is for your blood pressure, this pill is for…” and so on.

So next a potential explanation occurs to me: is it that this sort of patient awareness is a relatively new feature of medical education and so none of the treating doctors were simply trained to think about the patient’s desire to know their medications? Following hot on it’s heels though comes my response, there are many younger doctors involved with patient care that have also been trained in the same course as I have, they could have seen this issue and taken a step to fix it.

But then after another minute comes the more disturbing possibility: perhaps every doctor and healthcare professional was aware and didn’t have the time to do anything about it. I mean, it is not beyond belief everyone knows how busy doctors are, so maybe it isn’t so much of leap to think none of them had time to talk to the patient for an extra 30 seconds. This gives me a fairly plausible explanation for what I experienced although it leaves me with a chilling foreboding that perhaps in a few short years and with some added responsibilities to silence the primal human inner voice that called out when I was speaking to the patient. No, not simply to silence the voice but to never even hear the outcry in the first place.

So now where to from here? Is it enough to simply sit here being conscious of the issue and pretending like that will inoculate me against the personality warping effects of my future job? No, that doesn’t feel like enough of a step. Now I must confess that I am a big believer in solving major problems through small steps. I have attended talks by doctors who spend their lives working in 9 months of the year in Nigeria to combat the outbreaks of tropical disease there, or the people that work for a decade to fund new water distribution centres in rural villages. These people are heroes, but there is not one issue that I could find myself dedicating my time to to the exclusion of all others, at least for now. So I am a huge proponent of tiny everyday steps that every person (or physician in some cases) can do to help the problem along. Not as sexy as air lifting tonnes of medical equipment to the far corners of the world but some of the most significant advances in medical care come from the same basis: simply by asking a patient’s name before we give them a dose of medication apparently cuts down on the massive number of incorrect doses that are handed out in hospitals. So the take away from this event is just another question on the long list that I am supposed to ask every patient I see. Not even a new question, one that perhaps we all ask with the same lazy expectation of asking “How was your weekend?” every Monday morning. It’s not like we really expect a long answer, we just ask it because we are supposed. In the same vein, we ask this and don’t really pay attention to the answer but I now find myself more avidly paying attention to how the patient answers. The question?

“Is there anything else I can do for you?”

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