The other week when I was making rounds with my residents, we were discussing a patient who was the victim of a vehicular accident.
Prognosis was poor. Complications post surgery were multiple. Financial resources were scarce. What do patients or their relatives expect from their doctors? When faced with this dilemma, how do we arrive at a holistic approach at addressing this matter?
In medical school, we are taught the essentials of diagnosis and treatment. While bioethics is part of the theoretical considerations taught to us, placing this into practice is often forgotten. Until we are faced in real life with the dilemma in patient care.
As healers, we need to remember that it’s not only providing treatment to patients that are important. I tell my residents:
1. The patients expenses should always be taken into consideration. After all, it is not your money. And you have no right to spend it any way you want. Make sure that you approach the work-up based on the working diagnosis. Do a good history taking. Be sensitive to the needs of the patient and their family.
2. As medical students or those in training, don’t treat patients as training materials. Empathy, sympathy and genuine concern are the cornerstones of the good doctor. Remember: we are not god. Learn to touch their hearts more than their hands.
3. Sit down with them and discuss their illness. Everyone – whether they pay or are charity patients – deserve equal care and attention. Before prescribing, make sure that the patients need the medicine. If natural treatment is available (bed rest, water, fresh air, change in lifestyle), don’t prescribe medicines that are not superior to these.
4. Break it to them gently. Especially for those where the bad news will need comprehension and a bit more time to process, make sure you use terms that are understandable. Pause in between explanations and ask them if they understood and if they have additional questions.
5. Reassure them that you are with them in their road to recovery. Constantly update them on day-to-day changes. If you need to add tests, tell them why. Don’t be trigger happy requesting for unnecessary tests. Think before requesting. It’s not your money to spend. Imagine yourself as the patient. Always. How would you want your doctor to approach your illness?
6. During end of life issues, gather the family and explain in a language and words that they will understand. Provide them with clear options on both BENEFITS and RISKS on outcome. Place yourselves in their shoes and ask yourself, how will I want to hear the bad news?
7. And in our daily prayers, don’t forget the people we care for. Pray with them and for them. Adding a layer of faith by asking for spiritual guidance and enlightenment during these difficult times lighten the burden, and buys a cup of hope.
I get the point when patients or their relatives are taken aback when an unlikely diagnosis is heard. After all, no one is ready to look at death straight in the eyes.
Medicine after all provides every day with the possibility of a miracle.
Hippocrates said that
Wherever the art of medicine is loved, there is also a love of humanity.
Incidentally, the patient from the vehicular accident passed away. The family who was poor from the get go now has a mounting debt to settle. The party responsible for the “reckless imprudence” stopped providing funds to the victim.
We need to learn to let go…
because even at the throngs of death, there is dignity…