Friday, December 16, 2005

Why we don't care about you

Horrible little story I heard a few weeks back that just popped into my mind.

Seems a few years back a patient came in to Florey ED. She didn't look that sick. She had had a little niggling pain in her back for a few weeks, a kind of "slept funny" pain, and hadn't got around to seeing the doctor about it, and then that morning had noticed some blood in her urine. So, just to get things checked out she turned up to the ED, a glorious, quiet spring morning, and was being seen by bright, bubbly Dr Lues, who ordered the appropriate blood tests and CT scan.

"I'm ever so glad to be here, you know" said Mrs Rose. "Florey has treated me very well."

"That's good to hear" said Dr Lues. "Why do you say that?"

"I had such a lovely time the last time. I came in quite unwell, and the doctor who saw me sat down and listened, and he did and xray and found out what was wrong, and all the other doctors said he'd saved my life. He was such a darling. If he was here now, I'd love to speak to him."

"Of course. What was his name?"

And Dr Scurvy was soon tracked down and a very pleasant reunion took place, with many heartwarming expressions of mutual regard. It turned out that Mrs Rose and Dr Lues had come from the same part of England. Both shared a similar regard for Dr Scurvy, and an interest in keeping birds, and conversation sparkled between them over the next hour in such a way that they went from being complete strangers to what would have appeared to a passer by as close friends.

And all went well until the intern poked her head in the cubicle and said the CT scan had come back. Dr Lues said "Be right back" and trotted to the screen to look at it, and found the huge cancer on Mrs Rose's kidney - which turned out to be aggressive, malignant, and which killed her within the year.

Everyone, except possibly the stoic and courteous Mrs Rose, took this reasonably poorly. Dr Lues didnt see many people for the rest of the shift, and actually took the next day off. Dr Scurvy, who was older, attended the funeral, something that some of the old-school doctors seem to do more than the rest of us. Mrs Rose's daughters spoke highly of him, and also asked for their regards to be passed on to the absent Dr Lues. They said that Florey had treated their mother very well.

Anyway, said Dr Lues, who was telling me the story, there's a moral in that, and it's pretty plain to see.

And what would you say it was? I said.

You can't care, said Dr Lues. You can't go through that every day, ten times a day. You notice something - I don't aask anymore. About personal things. I don't ask if they keep birds, or what their daughters do, or what town they come from. I don't want to know. Because if I want to do my job right, I have to treat the patients as patients. I can't care.

So. I don't know. I have considerable difficulty with Dr Lues' conclusion. I don't know that what she says is true, and I doubt that it is true for all patients all the time. i don't know that I can yet ring up my friends and relatives in other parts of Australia when they go into hospital, and say "Well, I hope your doctor doesn't care at all"

Thanks for listening,


Blogger Foilwoman said...

Didn't they take care of her better because they did care for her? It sounds to me as though she received good care, and with a real personal touch, which would be very important when you hear those dreadful words "There is a mass on you [insert vital organ here]." My older sister (dreadful medical history) always does better with doctors who connect with her. And she's hard to connect with (not a lot of processing power left in her heavily medicated, over-injured, schizo-affective disorder-afflicted brain), but does better when someone makes the effort. She's on blood thinners now (due to blood clot), so she doesn't have to have the surgery for her spinal stenosis (caused by three prior spinal surgeries), and I'm glad because the surgeon has the bedside manner of a hired assassin, which is a true sign that she will do poorly.

8:23 AM  
Blogger Chade said...

I have found in my time that there are basically four types of Doctor: Those that care (Really Good), Those that Don't care but want to do the right thing (Good), and those that are apathetic to the whole experience (Bad), and last but not least and gladly falling by the wayside - The Chop Shopper! (Incredibly, appalingly bad.)
I have had experiences with all of the above at one time and I actively seek out the Doctors that have a soul. It sometimes appears to me to be like a Joss Whedon story where all but a few are soulless vampires.
An experience to prove the point, perhaps.
Two decades ago I befell a rather nasty accident involving seawater, a rusted and mince-bladed beercan, and a foot. Needless to say it was a serious injury. The first Doctor we came across in Emergency kept me waiting for three hours as I slowly bled out and screamed till hoarse. The next took a look at the wound and in my delerium I'm sure I heard him say, "It's only superficial; minor nerve damage. We'll staple it up and that should see him right. Nurse can you organise a local for this boy." The third I came across said, "Sweet Jesus, What is going on in here? I want this kid sedated, get him some blood, and call that micro-surgeon in Adelaide. This is going to be some fucked up night."
The surgery went rather well, besides my waking up, although it did go for something like six or seven hours.
I never heard of the first doctor again, but the second one was in the papers a few years back. He was being sued for malpractice (23 counts) and had his licence revoked. I also found out that in his younger days his solution to almost any problem was 'Cut it out, that (insert body part) isn't necessary.'
So now, I seek out the first two types of Doctor. And I'm very thankful when I hear them curse regarding the severity or complexity of an injury. It shows they're paying attention and that maybe they're there to do their best.

8:57 AM  
Blogger Bronze John said...

Thanks for the comments. I feel that Dr Lues was wrong, and the thing is her actions do not accord with her words - she is actually a very caring doctor. She probably spoke more out of concern about burnout than anything else.

Anyway, I don't believe caring is somethign you can just turn on and off.


BTW, my verification word is "biqxqwuj", which would win any scrabble game in history.

2:28 AM  

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