Do you value the patient over everything else?

[bythesea]

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I was watching an episode of scrubs (yeah, I know, super-accurate portrayal of medicine 😀), and I found it curious how seriously those characters value their patients. For example, one character was in crisis because his patient wouldn't quit smoking.

I once had a patient with pulmonary issues, and he didn't want to quit smoking. I gave him the little talk, discharged him, and never lost a wink of sleep over it.

Does anyone really agonize about their patients like this?

In med school, my surgery attending said he had to get home to his kids. I replied, "Yeah, gotta have priorities," to which he replied, "The patient is the priority."

Not faulting anyone---just curious.

 

[gutonc]

I was watching an episode of scrubs (yeah, I know, super-accurate portrayal of medicine 😀), and I found it curious how seriously those characters value their patients. For example, one character was in crisis because his patient wouldn't quit smoking.

Probably the most accurate TV portrayal of medicine since St. Elsewhere. Seriously. If you haven't learned this yet, you either need to do more medicine or less TV watching.

Does anyone really agonize about their patients like this?

In med school, my surgery attending said he had to get home to his kids. I replied, "Yeah, gotta have priorities," to which he replied, "The patient is the priority."

Not faulting anyone---just curious.

Pretty much constantly. I just spent a weekend camping in the woods 350 miles from my hospital and I can think of 4 different patients of mine I was worried about during the trip. 2 deceased patients also crossed my mind because I drove through the towns they lived in on the way there and back.

If the patient isn't the priority, you should consider a different business. Not to say that you don't also need a life (because you do) but if you don't make your patients a priority (for the period of time necessary), what good will you be to them?

 

[medicinesux]

This is what makes the medicine field so taxing and draining. If the patient is not your priority, you better get out STAT. Otherwise, you can kill someone...literally. Medicine is not a career where you can just flip a switch when you walk out the door and forget about all your patient encounters. Your patients have a tendency to follow you out the door and creep their way into your consciousness at the dinner table, in your dreams, and on your golden weekends. You can find yourself on some beautiful beach 5000 miles away with 2 days left of your hard earned vacation and feel your stomach twist in knots at the thought of being on 24 hr call the Monday you get back. And when you get back into the full swing of things, you will be asking yourself when you come home at night if you made the right decision in treating Mr. Jones ailment? What happens if he gets worse? Should I have ordered test X? If not and Y happens will I be held liable? If it is not your patients then it is reading up on them that will keep you close and dear to medicine. Failure to constantly be reading and keeping up in your field will be detrimental to your medical duties as well and time not spent reading will emerge as guilt. I equate this to how a schizophrenic must feel with the voices that are always in the background singing their haunting chorus, except in our cases it is to read, read, read. And in my specialty at least, you always have to be thinking ahead of how you are going to tackle the next set of patients you will be seeing the next day. As I mentioned before, medicine is not "just" a 60-70 hr a week job. Add in the above and you can tack on another 20 hrs or so. Take all these hours in a year that medicine occupies your body and mind and divide them into your upcoming socialized govt annual gross income and you will really wonder if going through all this is really worth it anymore. Medicine will truly suck your soul. More than you can ever presently imagine.

 

[dynx]

I was watching an episode of scrubs (yeah, I know, super-accurate portrayal of medicine 😀), and I found it curious how seriously those characters value their patients. For example, one character was in crisis because his patient wouldn't quit smoking.

I once had a patient with pulmonary issues, and he didn't want to quit smoking. I gave him the little talk, discharged him, and never lost a wink of sleep over it.

Does anyone really agonize about their patients like this?

In med school, my surgery attending said he had to get home to his kids. I replied, "Yeah, gotta have priorities," to which he replied, "The patient is the priority."

Not faulting anyone---just curious.

depends.
I Value my patients...but as a rule I never value thier life more than they do. If they're fighting for thier life I ussually worry about them a lot....I'll call the icu or the resident covering during the night to make sure things are going okay. If I see an order I don't like online I'll call the team and find out whats going on. Its rediculous, it pisses my fiance off, but I can't help it.

But, if its a smoker/ETOHism dead beat. I'm checked out. Fortunatly I can pretty much float through most stuff with good outcomes. But I don't second guess myself, I don't waste my free time, I don't stick around to do the procedure..I'm sure the intern can get that line just fine...get a pneumo? not going to keep me awake. Now the intern gets to learn to put in a chest tube...which is great because one day a patient that gives a **** is going to come along and i want the intern to be skilled. In other words, it depends.
I have no delusions that people can be saved.

 

[mig26x]

This is what makes the medicine field so taxing and draining. If the patient is not your priority, you better get out STAT. Otherwise, you can kill someone...literally. Medicine is not a career where you can just flip a switch when you walk out the door and forget about all your patient encounters. Your patients have a tendency to follow you out the door and creep their way into your consciousness at the dinner table, in your dreams, and on your golden weekends. You can find yourself on some beautiful beach 5000 miles away with 2 days left of your hard earned vacation and feel your stomach twist in knots at the thought of being on 24 hr call the Monday you get back. And when you get back into the full swing of things, you will be asking yourself when you come home at night if you made the right decision in treating Mr. Jones ailment? What happens if he gets worse? Should I have ordered test X? If not and Y happens will I be held liable? If it is not your patients then it is reading up on them that will keep you close and dear to medicine. Failure to constantly be reading and keeping up in your field will be detrimental to your medical duties as well and time not spent reading will emerge as guilt. I equate this to how a schizophrenic must feel with the voices that are always in the background singing their haunting chorus, except in our cases it is to read, read, read. And in my specialty at least, you always have to be thinking ahead of how you are going to tackle the next set of patients you will be seeing the next day. As I mentioned before, medicine is not "just" a 60-70 hr a week job. Add in the above and you can tack on another 20 hrs or so. Take all these hours in a year that medicine occupies your body and mind and divide them into your upcoming socialized govt annual gross income and you will really wonder if going through all this is really worth it anymore. Medicine will truly suck your soul. More than you can ever presently imagine.

so freaking true.

Sometimes I wake up in the middle of the night thinking about pt X or Y and what I could have done better for him/her.

 

[Doctor Bagel]

Honestly, my thought is that people who place the patient over everything else are people at the greatest risk of burnout. Certainly you should care for your patients and do what you can for them. It's also understandable that you will lose sleep over them now and again, but you've got to have a separation between them and the rest of your life. You have an obligation to yourself, to your significant other/spouse, to your children, etc.. to not always put your patients above them. And face it, you're not saving your patient's life by obsessing about them. Physicians are important, but we're probably not as important as some physicians think we are. Narcissistic altruisim isn't a good recipe for life.

 

[Tone2002]

Honestly, my thought is that people who place the patient over everything else are people at the greatest risk of burnout. Certainly you should care for your patients and do what you can for them. It's also understandable that you will lose sleep over them now and again, but you've got to have a separation between them and the rest of your life. You have an obligation to yourself, to your significant other/spouse, to your children, etc.. to not always put your patients above them. And face it, you're not saving your patient's life by obsessing about them. Physicians are important, but we're probably not as important as some physicians think we are. Narcissistic altruisim isn't a good recipe for life.

Thank you, so eloquently said.

To the question at hand, no I don't.

 

[radslooking]

This isn't the proper or stock answer but I feel worse for the people who have not brought their demise onto themselves. The younger woman with breast ca and the young parent who leaves their children behind. Those definitely engender more of my sympathy than the chronic copd'er or whatever. I think you learn to separate yourself from the job a little after a while, you can't care so much that it clouds your judgment or cripples you emotionally.

 

[John Deere Gree]

Medicine is a part of my life, it is NOT my life, and will never be my life.

When I'm on, sure I care about the patient. When I'm home with the family I rarely think about the patients until I'm driving to work. I won't sit at home pondering every medical decision I make. I'd drive myself and my family crazy.

I don't know where I got this from, but I read it somewhere that one needs to hang their troubles outside before walking in the front door. There have been a few times that I've told myself that I will hang my work-related problems on the tree outside my house and pick them up when I leave for work.

Work is for work, and home is for family. I never want to mix the two.

 

[Top Gun]

I'm sort of in the middle. When I'm at work, the patients are definitely my priority and I push to get everything done for them. Now when I come home, I might take a moment or two to reflect on the successes of the day, and on things that could have gone better, but I try not to let it be all-consuming. You have to have a life outside of medicine. Its what will keep you energized and ready for the next time you're on duty, and it will keep you from burning out.

 

[peerie]

You know, the first thing I thought of when I saw this thread was an older thread from a while ago where the comment was: the most important patient on the service was the senior attending. 🙂 It was an awesome thread and I just loved it.

So, yes I do feel that that is still true however. (*ahem*)

But I also agree that my life is divided into two camps - work and personal. When I am at work, I do my very best and I try as much as I can to put the person first, but to be honest, as a trainee I have to put the senior residents and attendings first. That has been a very hard lesson to learn.

When I walk out the door I think of my family and friends and that is very, very important to me. I care about my patients but no more than they care about themselves. I assume they are doing the best for themselves and I leave it at that. I am in family medicine and I will not care more about someone else's health than they do. If they don't like that they can go see someone else. When my diabetics refuse to monitor their blood sugar or to take any medications whatsoever, then I explain what will happen and I document it in the chart. After that I give them the respect that I accept they are making their own choices in the best way they know how.

I only have just so much energy to care about my patients, and I want to care - but I also respect their choices and I give them the space to make their own choices. I think, it is important to be balanced and to also take good care of myself in this process.

 

[beanbean]

It is unfortunate that your resident threw you under the bus for his/her own error in judgement or lack of knowledge. The positive of the situation is you have seen a perfect example of how never to conduct yourself when you are the senior resident or attending.

 

[Grace34]

I've heard the saying that you should "treat your patients like family" and I always thought that sounded like a good sentiment. Then I had a family member in the hospital and I figured out the difference. I am not going to sit up with my patient for 24 hours and sponge the sweat off of their forehead. I'm not going to agonize over every mL of my patient's urine and wait for hours at his bedside for a specialist to show up and dispense an opinion. I'm not going to watch in paralyzed frustration as the patient develops new symptoms because all medical knowledge seems to have left my brain, simply because I'm scared. That is what happens with family.
The patient is the patient. There is a distance there because it is necessary. I will do my very best for the patient because it is my career. I even think of it as a calling, but my first responsibility in life is still to my family. There are other doctors at the hospital, but only one mom in this house.

 

[lowbudget]

Is it possible to value the patient over everything else if your work is considered a replaceable commodity, disrespected and undervalued?

Maybe it's a which-came-first-chicken-or-the-egg situation: that if I valued the patient over all else, my work would be valued.

I don't know.

 

[oompaloompa]

Of course the patient comes first. The problem is that so many patients certainly don't put themselves and their health first. On TV all it takes is an annoying optimistic resident who makes a few simple interventions and voila! - the patient is profoundly inspired to make major changes in their life. All within a 22 minute episode. It just doesn't work like that.

Doesn't mean we should give up, it just means we can't be expected to help someone who doesn't want our help. Heck, it's hard enough to help the ones that do sometimes.