Mar 11, 2011

Doctor D Crossed The Line!

Doctor D has been blogging about the Doctor-Patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.

Well, guess what? Doctor D recently found himself on the patient side of a nasty injury!

Even as Doctor D looked down and realized his leg wasn’t supposed to be that shape he said to himself,
“Self, take mental notes! The readers of Doctor D’s Clinic of Doctor-Patient Relational Awesomeness will want to know about this."

Here is what Doctor D discovered when he became Patient D:



1) Doctor D Is Mostly Right


Any reader of this knows that Dr. D’s insight is typically brilliant and totally useful. I found myself actually looking up posts I had written for the solid and useful advice.


But even D has a lot to learn, so from here on I shall delve into the dark secrets I could only discover when crossing the line to the patient side!



2) Being The Patient Is The Hardest Job In Medicine


We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of!


Lying here isn't as relaxing as overworked docs think it is.


Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.




3) There Is Much More To Pain Than A Number


Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.


The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won't leave can make a person much more miserable than 10 out of 10.


4) Narcotics suck


I’ve seen a lot of nice people get addicted to opiate pain medicines. So Doctor D was the dude in the ER with a bone sticking out of his leg begging not to be given morphine. When they finally convinced me to take the narcotics I was please to discover I didn’t get any high. But what I did discover is that they made me miserable in other ways. I was groggy, nauseated, itchy, constipated, and mushy-brained whenever I had to use them.


Their efficacy varies drastically from person to person. I can say with certainty that a 400 mg Ibuprofen was significantly better for pain for me than a 10 mg Percocet, but since my Ortho wouldn’t let me use ibuprofen I was stuck with narcotics. So I then had to deal with the suspicious look when I told the doc I needed more because I had run out.


I am so happy to be off those things! As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.



5) Being Disabled Can Really Crush An Ego


Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.


I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn't work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.


You can't say you wouldn't complain about it if you've never been thereit's a good thing for docs to keep in mind.



6) There Isn’t A "Sort Of Person" These Things Happen To.


Okay, I have to admit something a bit embarrassing here: We doctors sometimes think of our patients as a completely alien form of human life. It isn’t intentional. We wouldn’t even admit it out loud. It’s a weird psychological quirk that happens like a reflex.


Doctor’s see so much suffering and misery on a daily basis, and we just can’t spend all our time worrying if it will happen to us too. So we develop this mental trick: "These things won’t happen to me, because I’m not that sort of person." What sort of person? Well, the sort of person who ends up the patient with a painful or horrible condition, of course!


Unfortunately, psychological defense mechanisms are useless when the cold, harsh laws of physics apply pressure to human bones. This shit happens to everybody—even doctors. No one is the sort of person that has a debilitating injury, until it happens.



7) Some Doctors Just Can’t Be Helped


Doctor D has spent a lot of time educating you on how to deal with difficult doctors. One of the worse maladies plaguing the medical field is piss-poor communication, and Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.


There's a lot that patients can do to improve their communication with difficult doctors. I had a lot of questions, and I found myself going and reading my own posts for advice on how to get answers out of a doc with weak bedside manner.


In the end I just gave up. This dude just couldn’t communicate like a normal human being with a patient (even a patient who had an MD). I hear he’s an excellent surgeon and the fact that my leg got put back together is proof of this, but his ability to converse was just dismal.


"I'm sorry, but I don't consider speaking with you to be part of my job description."


When faced with a doctor who simply will not or cannot communicate a patient has two options: Leave or trust blindly.


Dr. D had a FUBAR leg, there was only one Orthopedist available at 1:00 am, and the ER doc said this dude was a good surgeon. So I trusted him even though he seemed mentally incapable of explaining the operation he was going to do. The gamble paid off and the leg is improving, but generally I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.


Okay, that’s my story and I’m sticking to it!

Doctor D is back to limping around the exam room with patients, and so Doctor D’s Internet Clinic of Doctor-Patient Relational Awesomeness is back too. Send in those questions and I shall keep dropping knowledge on you!


What do you think?


Any of you medical folks have similar experiences and want to add some points?


Any of you with more experience as patients wish Dr. D had picked up more from his time on your side? If so, what did I miss?


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



25 comments:

Anonymous said...

Dr. D, how did this happen to you? A limp for life? I'm so sorry. Do you think this incident will change any ways you treat patients?

Mandy in CA

Anonymous said...

Yeah, if that's your x-ray, I want to know how it happened too. That looks almost like a gunshot shatter without the bullet. I'm sure it wasn't, so I'm wondering how the hell it happened.

Sara

Josh said...

Sir, I hope that you are well. I just had to educate my mother on not getting a PE/DVT or Pneumonia; she had a complex ankle/ femur fracture. It should require no surgical intervention; although a mandatory 6-8 weeks in a chair.
I am a lowly :) tech on a med/surge floor; at a busy academic hospital. There are times that it kills me to lecture a patient on moving and preventing issues. I can see the pain in their eyes when I help them move for the first time POD or POD1; But those people get home!

Doctor D said...

The X-ray above is actually from the painscale post so I don't know the details of that image. My X-ray didn't too different.

I got it with my thrill-seeking lifestyle. Not all adventures end up fun!

Pissed Off Patient said...

Wow. Sorry to hear how difficult the recovery has been. My Dad shattered his ankle parachuting and had to be pinned back together. I don't think his recovery was quite so long.

I'm with the others, I want to know what happened!

Also, I laughed on the pain killer thing. I prefer ibuprofen as well and the docs push narcotics on me. I just recently wrote about the last time I had narcotics. (http://pissedoffpatient.blogspot.com/2011/02/dr-vicodin-story.html) Hallucinating that I was dead and melted was not fun.

M

Anonymous said...

ok, I'm gonna guess; bicycle accident, motorcycle accident, or you fell off a barstool. Am I close?

Mandy

Anonymous said...

Dear Dr. D,

I really do love this post -- well, most of it. See, I was really surprised and disappointed to read the phrase, "mentally-retarded clam."

Not cool, Dr. D, not cool.

Maybe those narcotics really messed with your brain and it just slipped in. I get how that can happen because I've said it without noticing. And if you think it's bad to slip up on a blog, try jokingly saying it to your brother in the company of your aunt as she's holding her granddaughter who has Down syndrome (I was a stupid teenager, and I was mortified when my mother pointed it out). So I really do get it. But I also stopped saying that word from that day forward.

You seem like a pretty considerate and kind dude, so I'm going to give you the benefit of the doubt. But I think it would be pretty great if you took the pledge to stop saying/writing the R word at http://www.r-word.org/

-Cara

P.S. I really do hope the leg is better soon.

DrSnit said...

This is a powerful reflection. And I'm glad you shared. Thank you.

Dreaming again said...

#6 ... it may not be that the professional is thinking that it can't happen to them because they are not 'that sort of person' but rather ... a mentality of "I already gave at the office so my karma will protect me"

My parents taught special eduction since long before it was federal law.Dad taught at California School for the Deaf from 1958 to 1972 and then in a public school in a special education class until 2005. My mom taught from 1968 to 1995.

When my son was born, with special needs they both had trouble accepting it. They'd spent their lives giving to this ..how could it effect them so very personally?
It wasn't that they thought they were not that type of person .. but rather "I already gave at the office"

Doctor D said...

Yes Cara,

I was aware "retarded clam" was potentially offensive when I wrote it. It is a quote from one of the pink panther movies. I find it funny and am not interested in signing pledges not to use offensive language (although I appreciate the spirit in which it was given).

I'm not in favor of censoring offensive language in others or myself. Making words taboo only gives them power, while embracing the ridiculousness of offensive language is empowering for everyone. (Example: homosexual community embracing the word "queer") Illegalizing the word retarded won't help attitudes toward mentally challenged people and may cause harm.

I come from a mixed family and have had to listen to black relatives tell offensive white jokes and white relatives tell offensive black jokes. If I got offended by offensive language I'd always be mad. Looking at a person's heart rather than word choice is the best way to avoid true bigots.

I hope you see that my heart is in the right place towards my mentally challenged patients even though I'm not changing the post.

-D

Anonymous said...

Thank you so much for sharing your experiences as a patient. I am also sorry that you have been through this painful trauma and that it might leave you with a lasting limp. I am also very curious as to what exactly caused it. Come on, Doctor D, spill! There's got to be a good story there.

I can totally relate to your frustration with your ortho. When my elderly father fell and suffered an intertroch fx his was the same way. Poor communicator and exuded a vibe like he was very uncomfortable having to actually talk to people. All we could do was trust him.

Anonymous said...

What a unique perspective. You nailed it though, when you said that being a patient is a lot harder than you ever thought. It is always frustrating, when healing from surgery, and the surgeon says, "You will be better in this many weeks." When in reality, it took you double that time. And then they look at you perplexed as to why it took longer than "Normal" to heal.

It does take a HELL of a lot of trust to agree to be put under general anesthetic and be out for hours while they go to town on you... I have been there.

Hope you continue to heal. Sometimes the emotional/psychological pain that one has to endure after a physical trauma, is worse than the trauma itself.

Absentbabinski said...

Really interesting post and a nice reminder that patients are people. I sometimes wonder if all medics should have to be patients every couple of years, just to remind them how it feels to be on the other side of the desk.

Best of luck on the recovery :)

Anonymous said...

LOL. I liked the part about some doctors who can't be helped. Just having a thoracotomy, I really liked my surgeon. But on the way to getting my problem fixed I had one surgeon who I swear had aspergers. Holy crap flat affect.

Anyways, great post. So sorry you had to cross over. But recovering from a major surgery myself, and being hospitalized twice. One: being in the hospital totally stresses me out. Two: Pain sucks and I've had it for weeks. Three: Why didn't I take the pain docs suggestion of getting a spinal block while I was in the hospital Four: Narcotics suck because of all the reasons you listed..and I also hated asking for more.

Oh, and I also got a pleural effusion and those really hurt so I resented that my surgeon's NP kept telling me I should be fine. Yeah.

About the getting used to it part and coming up with a slightly different perspective on life...you'll get there Dr. D. For me it's always a process.

Melissa

Anonymous said...

Welcome to our world, Dr. D. Although I hope that perhaps the pain will go away eventually and not give you trouble throughout life. Especially with the weather!

You also nailed it when you said this:
"Low-intensity pain that won't leave can make a person miserable much more miserable than 10 out of 10."

RA'ers and others who have chronic pain - that for all the medicines they take still have pain, although hopefully not as high on the scale as without any treatment - are glad to hear a doc say that and understand it, even if they don't truly wish it on you (ok, maybe they wish it on their rheumys and GP's many times - but just so they could get better treatment!)

Thanks for stating that it's the CHRONICITY of the pain and knowing that it won't go away either for a long time, or ever, that gets such folks so down.
Chels

tracy said...

Dear Dr. D,
i'm so sorry you had such a terrible injury. i hope you are healing well and eventually the limp will also "disappear".

Thank you so much for telling your story. Your Ortho-man sounds like a total dud. (Trying to keep my language under control.) Wish you could see someone else, you deserve sooo much better.

Please take good care of yourself,
With all best wishes,
tracy

Anonymous said...

Dr D, I loved this post. I love your site. I'll even probably keep following you even though you've become one of us gimps. ;-)

-Christy... an RA Chick with a strong will and a bizarre sense of humor. (PS - I'm the one who shared the boyfriend has ebola pain scale link with you.)

sara r. said...

Your insight on feeling depressed and hopeless after 3 weeks in bed struck a chord with me- I have a friend who is on strict bedrest with 1.5 months left to go in her pregnancy, despite the fact that studies show almost no benefit to bedrest, and lots of negative consequences, like weight loss, depression, and muscle atrophy. She feels like she has to do what the doctors tell her, but could one of them really survive 2 months laying in bed without going crazy, and then take care of a newborn?

Honey said...

I'm so glad you've seen the other side! Compassion is always a good trait to add behind that MD title. As a RN I've seen the good, bad, and the ugly with doctors. I've been on the receiving end of some rather ugly communication, usually over things that I had no control over, including other doctors' orders. Seeing the human in others, whether it is patients, nurses, or peers, can only make one a better person. Good for you for having the courage to share your story!

Aviva said...

My first shoulder surgeon back in '97 was like your ortho. I'm sure he was a competent surgeon, and he had a good reputation in the town I lived in. But oh, it didn't work out well. So not only was I not instantly bounced back after having my a/c joint removed AND a tear in my labrum fixed as he'd told me was "normal" but because the nerve block hadn't taken, my pain levels were through the roof.

The worst part was the man clearly was somewhere on the autism spectrum. He couldn't make eye contact, he could barely converse, and he'd literally dash out the door if I didn't get a question out fast enough. I ended up bringing my now-husband, then-boyfriend to the appointments and he'd casually stand with his back to the door so the surgeon couldn't do his normal dash and had to actually answer a couple questions.

Ever since then, I've sworn I'd choose the second- or third-best doctor before ever going to one like him again.

Doctor D, I hope you're on the mend. I appreciate your insights, in this post and always! Feel better soon!

A Lady said...

Reading your post put a HUGE smile on my face, because, as a *palliative nurse* I am ALWAYS fighting to get patients comfortable, and opiates are not always the answer. There are so.many.other.ways of getting pain under control, and you are *totally* right, pain is so incredibly much more than a number. Did you know there were such people, in medicine, whose entire job is to figure out Your pain, and come up with the best pain regime for You???
You, kind doctor, are the reason I have a job. But I would bet good money no one has referred you to a palliative team. Ah well, baby steps, my friend. Baby steps.

Anonymous said...

Hey, thanks. I'm a med school applicant for this coming cycle. Although I was competitive, I was forced to delay application by a year because of a long illness (which lasted well over 12 months and still has residual effects). I did not handle this with grace...I struggled a lot with being resentful and envious of my friends who got the white coat ceremony first. It's a funny thing - I was so blinded by the process of getting in that I never stopped to really consider the important reasons for going in the first place. A twist of fate, maybe....but maybe the best thing that could have happened to me professionally.

Dr. H said...

Crossing the lines, is a learning experience!

Even more so, when you have a rare illness, and it took you 6 years , until you have found a physician you can really work with.

katydogcrazy said...

An MD friend needed surgery to remove pins from a leg - a skiing fracture; only half joking he wrote in indelible marker, "Not THIS leg you idiots" on the unaffected leg. They tied a helium balloon to his dick in friendly retaliation - I kid you not! Some orthpods have personality.

All nurses know that docs make TERRIBLE patients, and hopefully understand that it is for the reasons you have listed; crossing to the other side is a horrible shock. Weirdly enough.

A good rule of thumb for narcotic dosing is that if you have enough pain to "use up" the dose you won't get any high at all and will not be at risk for addiction. Ideally pain will be treated in multiple ways - even just using a narcotic to deal with, say, 80% of the treatable pain and an anti-inflammatory or tylenol, or TENS, or whatever for the rest of it will keep addiction at bay. Plus not all narcotics work equally well in all patients and often if a patient says they need more trying a different drug at an equivalent dose will work better for them. Ditto with handling pain without getting the fuzzy headedness.

I am so sorry that you learned this lesson the hard way: "The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won't leave can make a person much more miserable than 10 out of 10.", but it will make you a much better doc.

Anonymous said...

I loved your description of the surgeons communication skills...I am actually fantasizing about telling my neurologist
that his skills in this area are comparable to a 'mentally retarded clam'
However, I won't actually say this, I don't want to be labelled a 'bad patient'
Great blog! Thanks for the insight...and a good chuckle

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