Doctor, remember thy patient!
Written by Purvi Patel
When I started my first real clinical attachment at one of the most prestigious hospitals in the country, none of the doctors had any time for us. Four weeks on, nothing has changed but what’s worse is that I’ve noticed they don’t even have time for the patients. Ward rounds on this surgical firm start at grim 7.30am, at which time, for reasons unbeknownst to me, the patients are already awake – not that it matters. Consultants and registrars, who have performed surgery on a patient the night before, blindly follow the juniors around with the timeless phrases, ‘who’s next?’ and ‘what’s wrong with them?’ as if they hadn’t just had their hands inside these people’s bodies.
Once it has been established who we are seeing and what is ‘wrong’ with them, the consultant will stand right next to the patient, and completely ignore them. He and the registrars will have a conversation about the patient, while the patient himself looks on in bemusement. The juniors will be shouted at for not knowing every detail about the patient’s Hb, WCC, U&Es, LFTs, CRP and anything else in which the consultant might have a passing interest. He may at this point turn to us, the medical students cowering in the corner, trying as hard as possible to appear as if we know what’s going on. Once we have been grilled (read tortured) to an appropriate level, it is time to move on. On to the next patient, ‘Who’s next? What’s wrong with her?’
This patient’s turn is up. He has had no opportunity to ask questions. Not only this but nobody even acknowledged him, despite being surrounded by up to nine medical professionals of varying levels.
“There might as well be no patients, just a set of notes outlining if this person has a fever, their drain output and their obs.”
Surgery is possibly the most invasive thing you can allow someone to do to you. To let someone perform surgery on you is to give them permission to slice you open, have a fiddle around inside your body, take out whatever bits they please and then put you back together again (or not), all while you are knocked out. So you wouldn’t let just anyone do it, would you? You would only let someone whose skills you had complete confidence in come anywhere near you with a scalpel.
So then when the surgery is over, you would expect these people, who have been messing about inside your body, to explain what they’ve done and why. You would not expect them to come to your bedside, perhaps throw a smile over their shoulder in your direction, and explain to what is essentially a group of complete strangers what they have done inside your body. To me, this would be completely unacceptable. I would be outraged! There might as well be no patients, just a set of notes outlining if this person has a fever, their drain output and their obs. There was one instance where the patient was in the bathroom when the doctors were at her bedside. The doctors followed the same routine - discuss amongst themselves, chastise the juniors, interrogate the students. They didn’t see the patient and it didn’t make the slightest bit of difference to them. For them, a patient may as well just be a set of notes.
A patient is not a tool for us to practice our skills on;; he is not an instrument we use to get better at taking histories, or carrying out examinations, or performing surgery. He is a person, a happily-married, father of three, who likes going to the gym, something he won’t be able to do for a while because you’ve just sliced open his abdomen. She is a person, divorced and living alone; having to go to work with a stoma bag because you told her it was for the best. They are people, real people with real lives outside the hospital. There is no point in going to review a patient without seeing them as a person first.
At Imperial, we are made to sit through countless lectures on how to talk to people. My thoughts at the time were along the lines of what on earth is the point? How can people be doctors without knowing how to talk to people? This is the most idiotic thing I’ve ever seen. Little did I know, the entire hospital environment consists of not talking to the most important people in them.
“There is no point in going to review a patient without seeing them as a person first.”
The current generation of consultants and registrars have not had this drilled into them from day one. Perhaps they had some sort of teaching on how to communicate effectively and have simply forgotten what it means, maybe they don’t have the time for it, or maybe they just don’t care. Hopefully, the next generation will actually talk to the patients instead of taking over them; hopefully our generation of doctors will not be so callous. I hope I never forget that I am not treating a disease, but a person; I hope I never treat anyone the way I have seen people being treated.
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