Patients Seem to be the Last of Our Cares

[8744]

Oh, and that "unconditional positive regard" is a scream. Do you mean that we have to approve of everything the patient does or we have to pretend that we do?

I bet if you polled Teuflel's and my patients against yours they'd probably like us better.

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[neilc]

looks like you need a refresher, so here are some definitions for you:
unconditional positive regard=respect, an ability to look beyond what you dislike about the person, accept it (which does NOT imply that you agree with it) and that is it.
empathy=being aware of the feelings of a person, trying to see things through their eyes.

now, i just don't see either of those as a group hug thing...personally, i am not into that kind of stuff myself. i am not some huggy, touchy-feely do-gooder that wants everybody to just get along. i don't see myself as an enabler, and giving strong words of direction are often the proper approach. but, you can do this and allow the patient some of your respect and their dignity.

it is simple. in order to properly care for you patients you must do so in a non-judgemental way. you must respect them as individuals, which does not mean you must agree with their choices. you must try to see things through their eyes. and you must be transparent (see congruence in the previous post).

i worked with an ER doc like i imagine you may be for several years. he was quite competent, at least diagnostically and technically (at least from a medical standpoint, i never heard any standard of care complaints...i certainly was not in a position to judge this, i did bedpans!) he showed up, worked his shifts, dictated his charts, yada yada yada. however, he was not cool, talked smack about all the patients, had a decent poker face, and generally thought that patients were slimeballs. he was confrontational and not at all empathetic. he also thought he was the most respected doc, both by patients and ER staff. the funny thing is, most people gave him the "poker face" right back, and he bought it. he got fired, which blew him away.he could not believe it when he kept getting complaints from the patients, and when he was told the staff couldn't stand him as well. but, it never changed his behavior, and they finally canned him.

moral of the story is...if you look down on your patients for the situations they are in, assign blame and don't try to be a positive influence and a partner in the change, you will be seen through. and if you think that the poker face works so well, you will prob also fall for it.

as for which patients like who better, we will never know. that is actually a pretty weak argument. my goal is generally to take the best care of the patient possible, and to help the patient become more healthy in all aspects. and, if you just aim to make you patients happy, give them the poker face, and not truly do what you need to foster a doctor patient relationship that will result in a compliant patient, then you will fail as a physician.

i am sure that nothing anyone says on the forum will change you. but, maybe on one of the lesser dirtball patients that you have, give it the old college try...what have you got to lose? if you want , i will try it your way too, and we can compare notes!

 

[8744]

Originally posted by neilc
looks like you need a refresher, so here are some definitions for you:
unconditional positive regard=respect, an ability to look beyond what you dislike about the person, accept it (which does NOT imply that you agree with it) and that is it.
empathy=being aware of the feelings of a person, trying to see things through their eyes.

now, i just don't see either of those as a group hug thing...personally, i am not into that kind of stuff myself. i am not some huggy, touchy-feely do-gooder that wants everybody to just get along. i don't see myself as an enabler, and giving strong words of direction are often the proper approach. but, you can do this and allow the patient some of your respect and their dignity.

it is simple. in order to properly care for you patients you must do so in a non-judgemental way. you must respect them as individuals, which does not mean you must agree with their choices. you must try to see things through their eyes. and you must be transparent (see congruence in the previous post).

i worked with an ER doc like i imagine you may be for several years. he was quite competent, at least diagnostically and technically (at least from a medical standpoint, i never heard any standard of care complaints...i certainly was not in a position to judge this, i did bedpans!) he showed up, worked his shifts, dictated his charts, yada yada yada. however, he was not cool, talked smack about all the patients, had a decent poker face, and generally thought that patients were slimeballs. he was confrontational and not at all empathetic. he also thought he was the most respected doc, both by patients and ER staff. the funny thing is, most people gave him the "poker face" right back, and he bought it. he got fired, which blew him away.he could not believe it when he kept getting complaints from the patients, and when he was told the staff couldn't stand him as well. but, it never changed his behavior, and they finally canned him.

moral of the story is...if you look down on your patients for the situations they are in, assign blame and don't try to be a positive influence and a partner in the change, you will be seen through. and if you think that the poker face works so well, you will prob also fall for it.

as for which patients like who better, we will never know. that is actually a pretty weak argument. my goal is generally to take the best care of the patient possible, and to help the patient become more healthy in all aspects. and, if you just aim to make you patients happy, give them the poker face, and not truly do what you need to foster a doctor patient relationship that will result in a compliant patient, then you will fail as a physician.

i am sure that nothing anyone says on the forum will change you. but, maybe on one of the lesser dirtball patients that you have, give it the old college try...what have you got to lose? if you want , i will try it your way too, and we can compare notes!

So in other words, you're going to pretend to respect the views and opinions of patients who you do not like which is different, exactly how, from me and Teufelheunden pretending to respect the views and opinions of patients who we don't like?

The only difference is that you have been conditioned by your upbringing (some might say brainwashed) to believe that it is wrong to be judgemental and thus you feel guilty when you look at a 500 pound patient and say to yourself, "Jeez, look at the size of her! I bet her ass-cheeks have different congressmen!"

You might have been raised and educated by the hand-wringing baby-boomers but I wasn't. Fortunantly my parents were immigrants from Greece and were never infected with the cultural rot of the sixties.

Since I am "old-school" I tend to accept responsibility for my own shortcomings and naturally expect others to accept responsibility for thiers. This "Society's to blame" attitude which has become the dominant morality is a relatively recent addition to our culture.

I know this is hard for you to believe, but there was a time when people were expected to work, support their own children, and unwed mothers and illiterate high school graduates were uncommon.

When I was a teenager back in the late 1970's, a girl at my school got herself pregnant. This was the biggest scandal of the decade. Now most high schools in my city make special accomodations for their population of pregnant 10th graders.

Very broadly speaking, we have become a non-judgemental society and have traded whatever problems this tolerance was supposed to correct for truely horrific social pathologies.

I hope you don't think that I dislike my patients. Broadly speaking, I like them all, even the fat disgusting ones because they are all God's creatures and have interesting stories to tell. But it's a stretch to say I respect all of the choices many of them have made.

And I'm also a good listener and have finally arrived at that point where I dislike talking about myself and would rather listen to other people tell me their stories. You will all get there one day.

But one may as well enjoy the freakshow when it lumbers down the hall like some prehistoric leviathan.

 

[neilc]

Originally posted by Panda Bear
So in other words, you're going to pretend to respect the views and opinions of patients who you do not like which is different, exactly how, from me and Teufelheunden pretending to respect the views and opinions of patients who we don't like?

The only difference is that you have been conditioned by your upbringing (some might say brainwashed) to believe that it is wrong to be judgemental and thus you feel guilty when you look at a 500 pound patient and say to yourself, "Jeez, look at the size of her! I bet her ass-cheeks have different congressmen!"

first of all, i am not planning on pretending. and respecting views and opinions has nothing to do with it. i can and will respect them as a person. i will try to understand them and the circumstances that led them to where they are now, so i can better treat them. you really think that your straight talk, hey you are fat, so eat less is gonna work? it doesn't.

it is wrong to be judgemental. period. who are you to judge? are you that perfect? somehow, i doubt it...

looking at a patient, and noticing the hugeness of ass, making a joke or two do not a bad doctor make. in some situations it happens, and i certainly will not lose any sleep over it. however, if i ever become like you, where i am constantly belittling those that are less fortunate then me, when i am judging people harshly based on a single contact and without knowing anything about them, and when i think that i am above the poor fat guy simply because my life has better prepared my to take care of myself, then i will feel guilty. i certainly hope you do soon. i do feel sorry for you though. what a waste of an education. you already know everything.

 

[8744]

I think that you just don't understand American humor. Sorry.

Also, almost every doctor I know has funny stories to tell about their more ridiculous/disgusting/idiotic patients. A saintly, perfectly politically correct doctor is the exception rather then the rule here in the United States. I think my American collegues will confirm this.

I don't know if you are an American but sarcasm has been refined to high art here in the states.

"Respect them as a person" is a meaningless phrase. (I mean, how else would you respect them?) Naturally, as a good Christian man (but imperfect) I love or try to love everybody with varying degrees of success. But can you seperate the person from their ignorance, their faults, and the mistakes they may have made? What you are saying is that you respect the hunk of meat which is the body regardless of their actions. Or to put it another way, their character has nothing to do with your level of respect.

Great. But I respect the Pope. I tolerate and feel sorry for a crack *****.

I think you are confusing tolerance with respect

 

[annushka]

Isn't it a breach of confidentiality to discuss your patients with others for reasons other than getting a second opinion?
Meaning...couldn't you be SUED for that?
Last time I checked, the answers to these two questions were yes and yes...

 

[neilc]

repect: be considerate toward somebody or something: to show consideration or thoughtfulness in relation to somebody or something

that is the definition of respect i use.

you tolerate them? lucky for them that you are so willing to tolerate their presence! wheeew....

you clearly don't get it....the person can be an idiot, make horrible choices, etc... they are responsible for their actions. however, they are coming to you for help. your job is not to be entertained.your job is not to say, hey, you got yourself in this mess, you are a screw up who can't stop eating, so take this advice or leave it. your job is to look at them and say "hey, mr obese man...what is it about your life that i don't understand that contributes to your problems. what does a day look like through your eyes." maybe with this insight you can offer some advice, and maybe they will listen to you, and be able to tell that you took the time and effot to empathize and try to help.

your veiws, as well as mine are imperfect. your interpretation of the world and its people is also imperfect. don't hurt your patients by imposing your bias and beliefs on them, when it takes just a little effort, empathy and open-mindedness to really understand them. and with understanding, perhaps you can offer some help.

and don't think i live in some imaginary happy-land where i think this will work on every fatty that comes into my office. it won't. however, it is my responsibility, and yours, to offer our patients our best. if you can't do that, get into another profession, please.

 

[Mirror Form]

Originally posted by neilc
i agree that many folks can generate a nasty comment or two, and while not exactly cool, this can be excused. maybe you are tired, maybe someone is just being an ass, whatever. what i find inexcusable is the fact that you are trying to justify contempt for another human being, that you are trying to say it is ok to pass judgement on somebody who you really know very little about.

You're correct that it isn't our job or right to pass judgements on our patients. However, I wonder if in prague you have had the same experience as many medical personel have working in the ghettos of american cities. I've only been to prague once, but I think you're basing your view on a totally different patient population (for example, not everyone in prague is fat).

I'm from one of the US's drug and STD capitals. I don't care how idealistic somebody is, when the only three hours of sleep you would have got that night are lost b/c you got paged to go down to the ER for an irrigation and drainage on an IV drug user who's been to the ER twice before that month for the same thing, you're not happy. Especially since the patient can afford a 100 dollar per day heroin habit, but won't be paying a cent for the health care you're giving them (my tax dollars will). And instead of saying thanks for the free health care, they just whine, moan, and complain the entire time (it's not my fault it's takes 15 minutes to get an IV into one of their veins!).

Is it right for me to pass any judgements on this patient? Maybe in Utopia it wouldn't be. But in the world I live in, this patient is a loser who's a major leech on society and health care. Since I'll have to go through over 30-some hours of 3rd year med student scut without any sleep thanks to her, it's hard not to feel a little contempt! After the tenth time this happens, it hard not to feel a lot of contempt, which explains the attitudes of many residents and attendings.

Maybe if this sort of stuff only happended once in awhile I would still be more empathetic and try not to pass any judgements, but this crap happened every time I was on call during my surgery rotation. At first you can try and think, gee, what happened to this person that made them end up like this. But, after you see many of these types of patients, you realize that not all are victims of society. In fact, the vast majority are pretty happy (probably ten time happier then I was during my surgery rotation) and don't have any intention of changing their ways anytime soon. And why should they when we'll bail them out of every immediate consequence?

And then there's the 50 something y/o woman yesterday who came in b/c her tongue was hurting after blow-jobs (probably how she affords her heroin addiction). Not that I was at all shocked by her story though, it's the norm around here. She had just been through rehab, but got involved with heroin again as soon as she could afterward. Deep down I know it's not my place to pass judgement, but after awhile it gets very hard not to.

Anyway, my point is that you eventually get sick of this crap and can't feel sorry for people destroying their own lives anymore. Especially when they're not just destroying their own lives, but simultaneously being a huge burden on society, spreading diseases, contributing to abx resistance, etc. Maybe some saints can, but it's a matter of time before most people get fed up.

 

[rrreagan]

I think he was exagerrating, at least to some extent.

Nevertheless, students <b>are</b> treated pretty miserably.

That's undeniable.

By definition, students get no autonomy and have no authority and there is often little for us to do.

Yet, during third year, they'll keep us around interminably.

Why?

 

[neilc]

well, maybe it is different here. i can tell you that we have a lot less direct responsibility for patient care. we get a lot of theory, we see a few patients, then we go home and read. so, maybe that is it....

anyhow, i just hope i can keep an open mind to it. i am sorry that there are so many losers out there that take advantage of the system, and that do not want to help themselves. but, i am still convinced that no matter how tired of it i get, that it is my JOB to look at each patient like they are my first. getting jaded my be inevitable, but i hope to resist as long as possible...

good luck to all!

 

[8744]

Neil, I'm not coming down on you and I apologize if I offended you.

I don't doubt that your attitude will make you an excellent physician.

 

[neilc]

no offense taken, panda bear....in fact, i rather enjoy a heated discussion.

reminds me of my hockey days in college. we would play our hearts out, get in fights, and be chippy little pricks. but, after the game, all is well, grab a beer or 10 with the other team.

it is important to me to be able to get in a discussion (aka argument ) and to not take it personally. it can get ugly, stuff gets said, etc. but whatever. i am convinced that most folks out there are pretty decent, even if they are wrong!

have a good weekend, everyone. i gotta get rid of this hangover now....

 

[Teufelhunden]

Originally posted by annushka
Isn't it a breach of confidentiality to discuss your patients with others for reasons other than getting a second opinion?
Meaning...couldn't you be SUED for that?
Last time I checked, the answers to these two questions were yes and yes...

No. As long as you don't use identifying information, you're safe to talk about your patients.

Certainly, talking about your "fat smelly patient" is non-identifying as that description fits a zillion or so people.

 

[willow212]

What an entertaining thread.

I'm sure my views would have been among the OP's and compatriots during my first few years of med school.

However, it's quite fascinating how many views of Panda Bear and Teufelhunden resonate with my experiences during my MS-3/MS-4 years.

Of course one should always strive to be professional with patients.

But I think it's only natural that some of our patients make us quite frustrated, and venting to colleagues is certainly one way to relieve the anxiety these patients bring out in us.

In addition, I'm all for improving the environment for medical personnel so we don't feel so frustrated - better hours, better pay, more support personnel... (Yeah, yeah, what a pipe dream...)

 

[Teufelhunden]

bump