5 November 2007

House of God Rules - The Ocker Doc

'The House of God' is a book about the first year doctor. The author writes about the American experience. My first year wasn't all that different.

The author, Samuel Shem, meets his mentor at the start of the year. The Fat Man, as his mentor is called, has a series of rules that cover almost every situation. I apply one of the rules is my practice. The rule says "Remember it’s the patient with the problem". This rule has a positive and negative aspect.

On the positive side the rule pushes me to tell the patient what is happening. This takes time. It is also quite difficult because each patient is so different in learning, approach, experience and readiness. I would be kidding myself if I believed that I did better than a poor job. Communication between similar people is so error prone, that adding cultural and professional difference along with the anxiety of a cancer diagnosis can only make it worse. Nevertheless I try!

The negative aspect of the rule is that it removes me from patient's experience. I don't have cancer. I'm not getting treatment. There is no comparison between my hope that treatment will work and their hope that treatment will work. There is most definitely no similarity between our reactions when the cancer returns.

That brings me to John. He was young. He was an asset to his family. He was a righteous man involved in seeing that people were treated right. He impressed me as a man who knew where he fitted in his world. Communication was easy because he wanted to know what was happening. But it was also difficult because he didn't really think in a medical way. He taught me about New Zealand history as much as I taught him about his cancer. That's the positive side.

Then we entered the negative side. The cancer came back. Did I do anything wrong? No. Was I slack? No. Would I do it the same next time? No. I just didn't recognise the rogue cancer early enough. I felt uneasy during the whole treatment but I didn't recognise why. So in the end, John and his family paid the price of this failure. To say that I felt bad rates as an irrelevancy. I understand how his kids feel because I have been in the same situation.

There are no winners. Him, me, his wife, his kids, your country - we have all lost. This disease is a wanton beast. So what do I do differently? I am more suspicious, I'm on my guard looking for the rogue cancer that needs special handling. I also have to work harder not to withdraw from the next patient. The next patient still requires their doctor. I have to start over.

Shame John can't.