Saturday 8 August 2015

The Doctor-Patient Relationship.



             Having spent the major part of my professional life training medical students and family physicians, I am embarrassed when stories illustrate a deficiency of the principles of basic courteous human communication.  This, of course, is the quintessential ingredient of all doctor patient relationships, that we have emphasized in recent years.  Here is the story of one needless breakdown in such relationships.

            I belong to a club that meets every Saturday morning at a popular London Coffee Pub.   Being a retired physician and educator, I  encourage club members to ventilate their complaints with the Health Care System in general and physicians in particular.   Rob, a well-educated, laid-back guy with a great sense of humor, and a number of health problems including a previous myocardial infarct, was unequivocal in his praise of the cardiac rehab program that he had been involved in and the support he had received from the people he met in the medical community.     What  disturbed him was not the medical care he had received or the subsequent rehabilitation program, it was what happened following a  stress test after the cardio rehab program.   While waiting in the consulting room, a young physician, and he stressed it was a physician not a medical student, came in to discuss his results.  Rob has been a teacher all of his life, and recognizes the difference between students and physicians..  The doctor informed him that he had done well in the stress test but the blood test indicated a liver problem..

            “You have done well on your treadmill and  blood tests … with one exception; you have to cut down on your drinking.  You should quit drinking  because it is causing serious problems, ones that will be more serious if you carry on.  It is affecting your liver and your kidneys, which are being weakened by the daily drinking."

            Rob was taken aback by these comments because he did not drink very much and wanted to know exactly what suggested that he might have a drinking problem.

            He said, “She told me that the blood tests indicated that I had a problem with alcohol, drinking at an alcoholic’s level, and the problem was serious enough that it was causing problems for the heart and liver.  The tests indicated kidney damage as well.  Taken aback I informed  her that I didn't drink daily and often not even weekly.  We, my wife and I, my 32-year-old daughter and her husband, might share a couple of bottles of wine a month and that I purchased maybe three cases of beer a year for the household.  I admitted to having a little more beer during the summer when at the cottage on a hot day, but that was not a monthly occurrence and we spent only about a month at the cottage each year.  Since I didn't think that fit her conclusions, I  suggested to her that perhaps she should know of what she was accusing patients, because she made it clear she didn't believe me.  When no apology  or explanation was offered  I asked for more specific information. At that point she said “thank you” and left the room.  Expecting her to return with some information, I waited.  About five to ten minutes later the nurse came in asking what I was waiting for.  I explained that I was expecting the doctor's return.  The nurse said she was not returning, she was now doing a stress test with another patient.  The nurse apologized for any inconvenience caused and I  went home.

         When visiting my own doctor a day or so later I related the incident to her, as a result of being very concerned about the condition of my liver and  heart problems. She was furious.  She had another set of blood tests done and her report, a few days later, was that they indicated no such thing and showed only a minor abnormality of the liver enzymes and wondered if the doctor had asked if  I was on Dilantin, a medication commonly used for various purposes. She was sure that was what was responsible.  I answered that I had not been asked that question specifically, but that the doctor had a list of all of the medications I was taking.  She mumbled something that sounded to me like, ‘dummy,.” and went on to tell  me the  blood abnormalities were due to the Dilantin I was  on.

         Rob went on to elaborate further..  He told me that following a repeat stress test  three months later he was told that his triglycerides and liver enzymes  were elevated.  It was again suggested to him that he may be drinking excessively.  Bearing in mind the previous episode, and anxious not to repeat the whole incident, he asked the doctor why he thought that he was drinking excessively.  The answer, ‘the tests show that you are.  It has to be alcohol because we know you are involved in a fitness program and you did so well on the stress test, it cannot be because of your physical conditioning, it has to be the result of drinking too much alcohol.’

      Rob went on, “I told him that I had nothing to  drink since the previous tests  three months earlier and explained in detail exactly how much I drink.  Somewhat taken aback this physician then went to the computer looking up the most recent blood test results.  The triglycerides were 0.09. (Well within the normal range).  I suggested to him that he look into this further.  This he did and subsequently came to the conclusion that the abnormalities were due to the Dilantin .


“I have no objection if this doctor or any other tells me that a social habit, whatever it may be, or however much it may be, is a factor that perhaps could be contributing to a medical problem.  If I drank one bottle of beer a week, or a month and that was a contributing factor to a medical condition, then it would be my responsibility to consider  dealing with it by eliminating that problem altogether.  However, virtually  accusing me of being an alcoholic, and that was part of the first doctor's message, is not only unwarranted and incorrect, it is downright unscientific and unprofessional.”

      When Rob told me that his cardiologist, who was the preceptor of the first physician in this narrative, responded by laughing when he heard the story and stating that his resident had at times, an unfortunate bedside manner,  Rob was certainly not amused!

      No wonder  that our sensitivity is questioned on occasion !








No comments:

Post a Comment