May 26, 2010

Hurting My Patients

An email to Doctor D:

What does it feel like to cause pain or disfigurement to a patient? Is it troubling or do doctors not let it affect them?
Believe it or not, most doctors are not sadists.

Hurting patients is distasteful to those of us who went to medical school because we wanted to "help people."

But the fact is that the really cool gadget that Dr. McCoy waves over sick people to fix them hasn't been invented yet. "Dammit Jim, I'm a doctor not a butcher!" Unfortunately, for the foreseeable future even high-tech medicine will involve some butchering.

People come to Doctor D feeling rotten and I sometimes stick them with needles, electrodes, blades, and tubes which at least in the short run makes them feel worse.

Sorry, I know, it sucks.

Doctor D fully realized the cruelty of his profession as an intern when he was performing a lumbar puncture on a squirming, screaming 2 year old with meningitis. The terrified kid couldn't understand why sticking a needle into his spine was required. He just thought we were torturing him. It sucked. That day D wished he had chosen another profession.

But young Doctor D got over the trauma he caused. The fact was that the lumbar puncture helped save the kid's life. Many of the painful things we do save lives, so we grin and bear it.

After a while we get used to hurting you:
It doesn't help patients for doctors to get emotionally distraught every time we cause pain. You want me thinking clearly so I can do procedures quickly and efficiently, with as little pain as possible. The doctor who hesitates to do an urgent painful procedure can be dangerous to patients.

Empathy must kept in check by necessity.

But occasionally the doctor gets too hard... forgetting your pain altogether and focusing only on the job.

Or even worse, we enjoy hurting you. It's easy to feel for a helpless toddler we have to hurt, but a whiny grown up who asks to be "knocked out" just to get an IV and has more tattoos than skin is a lot harder to feel for. Patients who thrash around can be dangerous to work on because needles and scalpels get knocked all over the place. "STFU and be still!" We sometimes even fantasize about performing painful procedures on belligerent patients.

Our work in proximity to so much suffering has a natural hardening effect. Doctors must constantly be wary lest we become cruel.
I believe that we can find a middle ground in which we perform the difficult task of hurting to heal without losing our compassion.
If I must cause pain adding kindness and understanding can sometimes be more therapeutic than morphine.
Doctor D always enjoys hearing your stories and perspectives in the comments.

What are your experiences with doctors causing pain? What was done well? What was handled wrong? Have you ever felt a doctor was being intentionally cruel in a painful procedure?

May 20, 2010

A Voice In The Wilderness

So you're probably wondering why there hasn't been a post this week.

Doctor D is visiting primitive relatives who still live in the wilderness beyond the world wide web. He only briefly escaped to connected civilization to send out this message.

Next week he will return with a new answer to your questions.

May 11, 2010

Spreading The Love!

The Last Post of How To Thank A Doctor.

Okay we've almost beaten this topic to death. You asked Doctor D and you received! You now know every nuance of the physician psyche in the realm of gratitude. Your thanks should now reduce MDs to putty in your hands!

But one last pearl of wisdom to take home:
If you thank a doctor and then treat the staff like crap, you just come across an insincere ass.

This should be totally obvious, but you wouldn't believe how many people do it.

"Oh, thank you so much Doctor D for diagnosing my UTI. You are awesome!" Then they go disrespect the nurse who had to crawl under their panus to get the in-and-out cath. Not cool and not really grateful.

The truth is that doctors get thanked too much for what nurses, phlebotomists, paramedics, and other healthcare staff do. We get to ride in at the end with the triumphant diagnosis. All the people who do the hard stuff rarely get thanked.

You thank Doctor D he'll probably think you're a cool patient. You thank the phelebotomist who stuck you and he'll recommend you for beautification. You cuss out the phlebotomist and D's cool vibe about you vaporizes.

What if the phelbotomist really deserved to be cussed out?
I know the healthcare system has a few jerks in every job, but if you let them bring you to their level the only person you shame is yourself.

So spread the love! Treat the healthcare team nice and your doc will love you. By the way, it's Nurses Week (which is totally a more legitimate holiday than Doctor's Day) so go hug a nurse or something!

There you have it! You know all there is to know about thanking doctors.

But honestly, as long as you're polite you don't really have to thank your doctor. We work in a service profession. It's not like we are war heros or humanitarians. You don't always have to thank someone for doing their job, but it is nice when you do.

Thanks for reading!

Next week Doctor D shall take on more interesting questions... Email me some!

May 6, 2010

Be Cheap!

Cheap Gifts Are Better!

Doctor D has been amazed at all the kind things readers have done for their doctors, but D's a bit disturbed by the funds some of you are putting into your gratitude!

Believe it or not, the less money you spend on thanking your doc the better! A doctor is not your niece at Christmas who will only be impressed if the gift put you in debt. In fact, any gift you obviously spent money on is likely to make your MD uncomfortable.

Reason #1: Lawyers
As I've mentioned before, we doctors live in constant dread of bloodsucking lawyers. A clever lawyer can turn even a friendly gift into a felony, so doctors have all been taught to shun gifts of any value.

A gift worth anything can be legally considered a payment for services. If Doctor D took care of you for free and you give him a gift he loses all of his "Good Samaritan" legal protection and can be sued vigorously. If I accept a gift from someone who already paid through insurance I'm in even more trouble. One of those slippery lawyer-types could point to Doctor D's gift and scream, "Fraud! Kickbacks! Felonies!"

Doctor D likes his job and doesn't want to lose it on a legal technicality, so please keep the gifts worth nothing: a written-in card or some cookies you baked is as valuable as you should go.

Rule of thumb: If your doc could conceivably resell your gift for more than $1 on eBay, don't give it!

Reason #2: Doctors Are Overpaid
Let's face it: physicians aren't hurting for purchasing power.

While the business of keeping a medical practice afloat may be frustrating and getting worse, the actual annual salaries of those of us in medicine are usually much higher than our patients'. Doctor D is in one of the worse paying medical specialties and he still makes almost twice as much as his friends. D isn't getting rich doing this, but he's never going to worry about keeping food on the table.

I also know how much medical care costs: way too much! A serious workup or a chronic illness can bankrupt you. I'm glad you're thankful, but when you bring me an expensive gift after you just paid thousands to be poked, prodded, and embarrassed in the medical meat grinder it just kills me. I don't need things of value. I wish you'd spent the money on yourself, and just written me a heartfelt thank you note.

If you like giving really valuable gifts then give them to teachers or police officers. Those guys sacrifice just as much as doctors to make the world a better place, and the pay they get is just sad.

Listen to Your Inner Cheapskate When You Thank Doctors!
Doctor D tries to politely decline expensive gifts, but it still ends up awkward.

So go cheap: really cheapdon't even worry about paying Hallmark for those fancy cards. The patient gifts that Doctor D treasures most are simple homemade cards, produced with simple paper and pen.

Have you every given or received an expensive gift in a doctor-patient relationship? How did it go? Ever have a gift declined?

What is the coolest "worthless" gift you ever got?

Doctor D always loves to hear your stories in the comments!