Sunday, September 05, 2004
In Focus
I don't know if anyone else keeps up with medical news regularly (other than what they show on the nightly news), but I am a fan of medscape dot com. I have been a member for roughly 7 years and have long used the resources available there. In particular, however, I am a fan of a certain EM resident that writes articles for the site. The reasons should be pretty obvious why I'm such a fan.
He is a great writer, and always seems to find subjects that are very touching for me. For example, his latest article is about how often the medical system fails those people that just "fall through the cracks," so to speak. It also speaks to how the medical administration is frequently responsible for the rift between physicians and their patients, and how, in EM, it is difficult to help mend that rift.
Physician-patient relationship. That is a term often thrown about lightly in school, but never really defined (so to speak). The easy definition would be superficial and would be the fulfilling of the patient's needs on a particular visit. This is often the sense of the term used in the ED (being an urgent care setting).
However, in the more encompassing definition (i.e. the one I am learning about now on my Family Medicine rotation), it means much, much more. It is knowing not only the patient, but the patient's parents and children - and sometimes their grandchildren. It is calling them by their first name when you first see them, not checking their last name as you walk in the room so you'll remember. It is being involved in their lives - seeing them in church, in the mall, at the grocery store - and always portraying the role of the physician-teacher - for that is what we all should strive to be.
This month has opened a whole new dimension of the physician-patient relationship for me. Being an integral part of patients lives and actually making a difference to them.. now I can see why Matt M so much desires to enter this field. It is actually much more appealing than I ever dreamed.
I'll be sure to keep you updated with more as the 2 months go on. For now, let me end with a story to emphasize my point:
A 41 y.o. WF came into the office last week for a medication refill appointment. How boring, you might say, right? Med refills? Come on!?! But every visit is a chance for patient education and to see how everything is going. Knowing this patient has a history of HTN, smoking, Hep C induced liver failure and bullous pemphigoid from reviewing her history, I armed myself to go talk with her.
The first thing that I noticed when I entered the room was the pervasive smell of cigarette smoke. My eyes started watering as I entered the room, it was so strong. But I persevered, introduced myself and clarified that she was, in fact, here only for medication refills. I talked with her for a while about how she had been: what has her BP been like, has she had any outbreaks of her pemphigoid, etc. I broached the subject of smoking with her briefly - she said she had considered quitting, but didn't think she could do it unless her husband also agreed. So I spoke with both of them briefly about smoking cessation and encouraged them to quit. I then proceeded to a brief physical exam. What I found would change the course of the visit.
On every patient I see, I always do a cardiovascular, pulmonary, abdominal and brief extremity exam - no matter the reason for the visit. Just seems prudent to me. As I was performing the pulmonary exam, I noted pretty widespread expiratory prolongation - an early physical finding in COPD. I asked the patient exactly how long she had been smoking and how much: about 40 pack-years is what it came out to be. I also asked her whether she frequently became short of breath or wheezy - she said "yes, how did you know?" So I discussed the physical findings I discovered on her exam. As I explained what I found and what the possible implications were, a look of fear and understanding came over her. She said "my father and brother died with emphysema from smoking.." and became very quiet. I explained that these are early findings and if she quits smoking now, the damage will stop - but cannot be reversed. She turned to her husband and said "I need to stop now."
Just that small physical finding - something one might miss if they weren't paying attention - may make such a huge difference in the patient's life (if she, in fact, chooses to stop smoking). As she left with her prescriptions, I felt a small amount of joy - thinking that I may have actually helped someone that day.
The smallest things can sometimes make the largest amount of difference: a 5 minute physical exam may change the course of a woman's life.
Maybe. ¶ 3:15 PM
He is a great writer, and always seems to find subjects that are very touching for me. For example, his latest article is about how often the medical system fails those people that just "fall through the cracks," so to speak. It also speaks to how the medical administration is frequently responsible for the rift between physicians and their patients, and how, in EM, it is difficult to help mend that rift.
Physician-patient relationship. That is a term often thrown about lightly in school, but never really defined (so to speak). The easy definition would be superficial and would be the fulfilling of the patient's needs on a particular visit. This is often the sense of the term used in the ED (being an urgent care setting).
However, in the more encompassing definition (i.e. the one I am learning about now on my Family Medicine rotation), it means much, much more. It is knowing not only the patient, but the patient's parents and children - and sometimes their grandchildren. It is calling them by their first name when you first see them, not checking their last name as you walk in the room so you'll remember. It is being involved in their lives - seeing them in church, in the mall, at the grocery store - and always portraying the role of the physician-teacher - for that is what we all should strive to be.
This month has opened a whole new dimension of the physician-patient relationship for me. Being an integral part of patients lives and actually making a difference to them.. now I can see why Matt M so much desires to enter this field. It is actually much more appealing than I ever dreamed.
I'll be sure to keep you updated with more as the 2 months go on. For now, let me end with a story to emphasize my point:
A 41 y.o. WF came into the office last week for a medication refill appointment. How boring, you might say, right? Med refills? Come on!?! But every visit is a chance for patient education and to see how everything is going. Knowing this patient has a history of HTN, smoking, Hep C induced liver failure and bullous pemphigoid from reviewing her history, I armed myself to go talk with her.
The first thing that I noticed when I entered the room was the pervasive smell of cigarette smoke. My eyes started watering as I entered the room, it was so strong. But I persevered, introduced myself and clarified that she was, in fact, here only for medication refills. I talked with her for a while about how she had been: what has her BP been like, has she had any outbreaks of her pemphigoid, etc. I broached the subject of smoking with her briefly - she said she had considered quitting, but didn't think she could do it unless her husband also agreed. So I spoke with both of them briefly about smoking cessation and encouraged them to quit. I then proceeded to a brief physical exam. What I found would change the course of the visit.
On every patient I see, I always do a cardiovascular, pulmonary, abdominal and brief extremity exam - no matter the reason for the visit. Just seems prudent to me. As I was performing the pulmonary exam, I noted pretty widespread expiratory prolongation - an early physical finding in COPD. I asked the patient exactly how long she had been smoking and how much: about 40 pack-years is what it came out to be. I also asked her whether she frequently became short of breath or wheezy - she said "yes, how did you know?" So I discussed the physical findings I discovered on her exam. As I explained what I found and what the possible implications were, a look of fear and understanding came over her. She said "my father and brother died with emphysema from smoking.." and became very quiet. I explained that these are early findings and if she quits smoking now, the damage will stop - but cannot be reversed. She turned to her husband and said "I need to stop now."
Just that small physical finding - something one might miss if they weren't paying attention - may make such a huge difference in the patient's life (if she, in fact, chooses to stop smoking). As she left with her prescriptions, I felt a small amount of joy - thinking that I may have actually helped someone that day.
The smallest things can sometimes make the largest amount of difference: a 5 minute physical exam may change the course of a woman's life.
Maybe. ¶ 3:15 PM
