February 22 – March 27, 2015
Weeks 32 – 36
I sincerely apologize for my absence. All I can say is that the end of block III to the beginning of block IV was an intense whirlwind filled with massive cramming, brain emptying and then teach-yo’-self cardiology-Abraham-Lincoln style (He wasn’t a cardiologist, but I read somewhere that he taught himself how to read). Biochemistry (thank God), GI are behind me (sort of until boards studying) and now its on to renal, pulmonary, and cardiology! I have also started working in my new lab more regularly and that has eaten up some of my blogging time. I used to worry about not posting as much, but now I think that have longer absences in between posts gives me more time to reflect on what is going on in my life before sharing it with all of you.
Quick summary of my life in the past few weeks:
- SPRING BREAK!
- Cooked lots with my older sister, celebrated my brother’s 30th birthday and my nephew’s 3rd
- Went to Hyde Park to visit friends
- Anti-climatic Barbra Streisand Movie: Yentl
Before Mulan, Motorcrossed, She’s the Man and most cross-dressing “girl power” movies, there was Yentl. This one is probably more realistic than the others and also super unsatisfying.
- Went to the Cleveland Orchestra again!
- Celebrated more birthdays! YAY Louisa!
- Learned A LOT about cars (battery died, wheels weren’t aligned well, and had to get body work done)
- Observed my first Match Day! (Match Day is the day fourth year medical students find out where they are going to do their residency. It is a surprise and is so exciting!)
- As a Pediatrics Interest Group Leader, I put together our first event (Peds Match Panel) with my fellow PIG leaders!
- For my SCD research, I started going to the adult clinic to collect blood samples. In the process, I noted the differences between how adult hematologists talk about their patients and how pediatric hematologists discuss their patients.
But let’s talk about my title: Wait, Am I Sympathizing with Doctors Now?
To sympathize is not to condone behavior.
I have always thought that doctors could do better in how they communicate with their patients, think about their patients and their profession. I have had some negative experiences with arrogant physicians of all sorts and people with just not great bedside manner. On the flip side, I have also seen wonderful clinicians and people serving their patients with intelligence and kindness. But, recently, I have begun sympathize with physicians when they deal with the complex nature of medicine.
Doctors are supposed to fix things, but people are really broken.
This Tuesday, we heard a very powerful story about a 57 year old woman who was illiterate in many ways. She could not read or write until very recently, and she also had poor health literacy. Her parents could not read or write either even though she attended school until 9th grade. She progressed from grade-to-grade with Fs on her transcript and the inability to read. Even read short words or names like, “Edward” could not be deciphered on a sheet of paper.
When she was 19, she realized that her abdomen was getting bigger. She went to the doctor to investigate, and the doctor told her she was pregnant.
“Ok,” the patient said.
She came back a few months later to complain about the growing size of her stomach.
“You’re pregnant,” the doctor said, “You have a baby inside of you.”
Then she got it.
How could the doctor assume that this woman did not understand that? She did not understand what “pregnant” meant? How could she know that the patient did not even know how to read?
Most people in the United States cannot read above an 8th grade level. Illiteracy is more prevalent than I had ever imagined. There are 5 levels of literacy according to national literacy standards. 1 in the lowest. Experts say that to function today you need to be at at least level 3. People at this level can read o bus schedule or write a simple letter. In Cleveland 65% of people have a level 1 or 2 reading level. In East Cleveland it is 78%.
Physicians are supposed to be careful observers. Realizing a patient does not understand something takes time and attention. Unfortunately, many doctors do not spend enough time with their patients, and as the 57 year old woman told us that she has felt that doctors have left her, “before even coming through the door.”
How do we get this way? Being a doctor does give people financial security, but it is not as lucrative of a profession as it once was, and it takes forever and takes a lot of money. Most of the people who become doctors do so because they think they will like the work. They like science, and they want to help people. But, why do we become this way?
While the amazing patient (who can now read and write thanks to her 10 year old grandson convincing her to go back to school) told her story, I wondered: who is to blame for her once illiterate life?
Her parents for not being literate? The education system for passing her even though she couldn’t read? The other doctors who did not notice before she came into the clinic? The health care system for making 15 minute patient-interactions the status quo?
I don’t know.
But, all of her life, no one outside her family was truly looking at her.
Perhaps *we* are all to blame.
It’s hard not being cute anymore. I am not referring to myself, (although my cuteness is up for debate), but now I am talking about adult patients with SCD. The sense I have gotten in my short time in the adult clinic, is that many health providers find these patients difficult. The disease is the same as with the little kids, but in peds, the doctors do not blame the patient for their behavior. With adults, they or more apt to. Beyond behavior problems, grown-ups acquire additional co-morbidities and face different issues. Difficult patients demanding more pain meds. Difficult patients smoking marijuana outside the hospital. Difficult patients being combative or angry.
It must be hard for physicians who are treating a complex disease and complex people who come in with baggage they have to deal with.
One nurse practitioner said, “This is why we need cognitive behavior therapy. Pain-killers can only do so much.”
Here’s what I have learned:
Doctors have legitimate reasons to feel frustrated and overwhelmed–to feel limited in what they can do for their patients. I am beginning to get it. There are certainly limits. A hematologist cannot feel the pain of a sickle cell crisis. They cannot fully understand how that specific patient internalizes pain and what pain means to them. An OB/GYN will not have time to teach their patient how to read.
So what can be done? I am not sure.
Here is what I know: there is so much more to this job than taking away a disease. We must look for the ailments that are not necessarily in the chief complaint.
In the future will I ask myself, “How do I help this person?” or will I ask, “How do I get rid of their problem?”
Will I see my patient as a problem? The problem?
How do I get rid of THIS problem?
How do I get rid of them?