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| Sir Luke Fildes: The Doctor |
Do physicians
actually have a duty to help patients? Is that what society expects of us? Many
doctors might say no, that if, for example, a patient is referred to a
gastroenterologist for abdominal pain and nothing is found after
'both-end-oscopy', it is perfectly acceptable to discharge the patient back to
the referring doctor with no answers or recommendations. Others might think
that patients should expect a specialist to actually search for the cause of
the pain and help manage the problem.
It can be argued that helping patients is the primary goal of doctoring.
It is when diagnoses or treatments are less than definitive that the concept of
being of some help to patients becomes most relevant.
So. What does ‘helping the patient’ mean beyond the basics of Hippocrates and
Osler? This is my short list.
FOR PATIENTS:
• More than anything, it begins with the
doctor regarding you as a human being, worthy of respect, whether you are a CEO
or homeless.
• It means the doctor never talking down to
you.
• It means that the doctor acknowledges and
respects the family or friends who accompany you into the examination room.
• It means teaching you, when possible, about
your condition, not merely saying, "I'll notify your family doctor."
FOR
PHYSICIANS:
• More than anything, helping patients means
putting the interests of the patient above our interests of revenue production,
academics, teaching and career.
• It means being willing to admit failure with
one treatment, while continuing to find an alternative.
• It means being more concerned about a
patient's health than about our own legal liability, even when there are risks
from a particular therapy.
• It means never using the phrase ‘there is
nothing I can do for you’ except when it is absolutely true, and then still not
using it.
• It means knowing that even if cure cannot be
achieved, the caring, teaching, hand holding and outlining of expectations are
important parts of management.
• It means knowing when to stop treatment
(chemotherapy, for example).
• It means rethinking difficult cases that
don’t make sense. Start again from the beginning.
• It means combining evidence-based knowledge
with experience to arrive at the most appropriate treatment for every patient.
• It means learning to use new effective
drugs, or at least referring to someone who knows how to use newer drugs.
• It means prescribing off-label drugs if
those are the most appropriate treatment.
• It means getting help from those with more
expertise, not for the purpose of getting rid of the patient, but to help
arrive at a diagnosis and treatment.
• It means taking extra time during the day if
needed, to deal with an urgent problem.
• It means sometimes providing treatment even
when there are relative contraindications.
• It means assisting a patient with an
urgent problem outside the realm of one’s specialty by facilitating a referral
to another specialist or having a discussion with the primary care doctor or
contacting home health nurses or calling an ambulance if necessary.
• It means prescribing narcotics when
needed, even if we suspect drug-seeking behavior. The risk of a one-time
prescription is nil for the physician.
• It means being available personally or
through shared 'on-call' arrangements, and to take responsibility for
complications of treatments originating in our offices.
• It means never allowing one’s own beliefs or
moral convictions to stand in the way of proper medical management.
• Finally, it means never overlooking the fact
that even as specialists, we are doctors first, specialists second.
March 18, 2013
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