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 !
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