5 November 2007

A stitch in time. - The Ocker Doc

This story is about one of my favourite patients. Other doctors can't stand her. She misinterprets, jumps to conclusions, is irrational, over-excitable, accusatory and demands to know things. She also has a sorry background.

She was married to a local medical figure. They had a very acrimonious divorce that was compounded by her depression. She ended up as the 'mad ex-wife'. The worst thing that can happen to such a woman is to also get sick! But she did.

Her initial outlook was excellent; "95% chance of cure" said the cancer specialist, "What are you worried about?" Perhaps being one of the 5%? And sure enough it came to pass that the cancer came back. Her specialist was away and I was on call.

The notes described a very disturbed woman with unreasonable expectations and noisy conflicts. As the next doctor, I felt apprehensive to say the least. I decided to take a low-key approach. I said hello and then let her talk.

Forty minutes later she finished. Then we returned to the beginning of her story. Everything that happened was addressed. I apologised for my colleagues when she appeared to have been fobbed off. I chided her for being unreasonable when her expectations were excessive. I reassured her when she had received standard treatment. When she jumped to conclusions, I forced the conversation back to re-explain. When she misunderstood, I used different analogies. When she became accusatory, I explained the other viewpoint. I just wanted to put the past behind us. Forty minutes later I was finished!

When the old patterns had been cleared away and we had arrived at a common purpose, she turned out to be just like other patients. What common purpose was that? I promised that I would not lie or hold anything back from her ('no crap' was the phrase used), that I would treat her problems seriously and present to her the available options with my opinion and support her with whatever she chose.

Unfortunately the option that she chose made her worse. But still our relationship remains on the same footing. Physically she is worse, and she still jumps to conclusions, but the understanding forged at that first meeting remains. We speak as doctor and patient should, with a common purpose. No crap!

Who is the better doctor? If my medical knowledge is not balanced with humanity then I become useful only while a patient is treated as a curable lump of meat. Patients are more than this. Healing for all patients results from and produces proper relationships. Patch Adams said (and I paraphrase) "Doctors shouldn't just prevent death, they should improve life".

I want to be involved in that!