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medpundit |
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Friday, February 20, 2004The first thing was the phone-in diagnosis -- yeah, it's malignant. ``You need to call your surgeon.'' The doctor's 2-year-old was screaming in the background. Sorry about that, the doc told Sheri over the phone. But, to Sheri while she gripped the receiver in disbelief, there was no disguising the doctor's distraction or, profoundly, her indifference. Sheri had just been told she had breast cancer. We can't make the diagnosis of malignancy or of breast cancer by any other means than a biopsy. So, how is it that Sheri finds out she has breast cancer before she's ever contacted her surgeon? The column goes on to explain how Sherri had to fight for respect: But you may not guess the whole person matters when a dreaded diagnosis plunges you willy-nilly into the multibillion-dollar cancer industry, which is often clueless about how to deliver qualities as simple as compassion and respect. For that, patients have to fend for themselves. As a "bad patient," Sheri did so doggedly, without embarrassment. And often enough she found it. As she went into surgery, for instance, she implored her doctors to operate with love, and one of them said, "We're the two loviest guys in the hospital.'' Going into a relationship - any relationship - expecting the worst of the other person, is a set up for disappointment. Expect someone to be misogynistic, and you'll find it in almost everything he says. Expect someone to be racist and you'll likely find it in his every word and action. Expect your doctor to be cold and heartless and he likely will seem that way. It may not be the reality, but in such emotionally laden geography, perception is everything. And unfortunately, expectations have a way of warping perception. Sheri was fortunate that one of her surgeons had a well-developed sense of humor and was able to diffuse a tense situation. This reassuring conversation took place in the pre-surgery prep room, soon after Sheri had argued with the anesthesiologist. Sheri, a musician and health-care professional, had programmed two CDs for her surgery -- Mahler (sad, heavy strings) for the mastectomy, and James Taylor for the reconstructive surgery that would be done immediately afterward. And she had wanted her friend, an allergist and doctor, to be in the operating room to work the CD player. The two surgeons had no problem with the arrangement, but the anesthesiologist smelled irregularity and nixed the plan, refusing to consider Sheri's point of view or even look her in the eye. ...In the end, there was a compromise -- one of the surgeons agreed to work the CD. But after she took her stand (while lying prone on the gurney), she told me, ``His students were standing there with big grins on their faces because they couldn't talk to him the way I could.'' Or maybe they were grinning because they knew no one was going to be operating that CD player, and she would never know it. Now, there are definitely times when patients need to be their own advocate. If a patient feels that his doctor isn't listening or providing the care he needs, then he should find a new doctor. But, this story just sounds like the story of a difficult person. Chances are, she's just as difficult for waiters and store clerks as she is for doctors. ADDENDUM: Bard Parker reminds me that there is a way to get biopsy results without ever seeing a surgeon: Concerning your question about a biopsy sans surgeon, if the patient had a lesion on her mammogram a stereotactic biopsy may have been performed by a radiologist. A practice I am not in favor of, by the way. I had forgotten that radiologists do those. (In my practice, I send them to the surgeons.) UPDATE: And another physician reader has this observation: Oh brother. "Difficult" is a charitable assessment of this patient. I have no argument with a patient carefully selecting which doctor and which hospital she wants to go to, or which therapy among the available and appropriate choices she may want. But to insist on what kind of music (maybe the surgeon, who is the one doing the work here after all, would prefer not to have music playing while he is doing his work) would be played while in surgery is going a little too far. The writer, who seems a little fuzzy-headed with his pop-science reportage, implies that the operating room environment is just one more venue for the self-involved to tailor to their tastes, all under the wooly cover of compassionate care. It doesn't occur to him that there may be valid safety reasons for the anaesthesiologist wanting to set limits on CD playing. He should get a clue; this is the OR, not a garden party or a dance club. UPDATE II: Another point of view: I offer a polite disagreement with your assessment of the 'difficult patient'. I don't deny that there are patients who are difficult -- demanding attention far beyond the norm. No one likes them -- not the doctor, not the staff, not even the people cringing in their chairs in the waiting room as they listen to her vocal demands. Yet there are two reasons why that attitude should be understandable -- not desirable, not easily acceptable, but understandable. First, most simply, she's a consumer. Someone has informed her of a major change to her life plans. She has a right to wring every iota of useful attention and information from them, whether it's convenient for them or not. Second, she's in a tough position, and feels that she isn't getting the level of attention that that tough position deserves. Should she be a good patient and sit quietly? No more than she should meekly accept the word of the auto mechanic who's just blithely informed her 'that sound means you need a new transmission, lady'. Neither of these gives her to right to be pushy or arrogant, demanding more than her service provider can reasonably give. Was she? Did she? Yes, I think so. Any professional relationship demands a level of civility and balance that was exceeded here. She was wrong to act in that way. But she wasn't wrong to believe that she needed extra attention, and to act on that belief. posted by Sydney on 2/20/2004 08:29:00 AM 0 comments 0 Comments: |
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