Making your doctor more attentive

St Stephen's Basilica, Budapest, Hungary

St Stephen’s Basilica, Budapest, Hungary

My golden rule of medicine is this: Treat every patient with the same care I would want for my best friends and family. I order the same tests, refer to the same consultants and offer the same treatment options.

When I teach medical students about hand washing to prevent the spread of infection between patients, I encourage them to consider it as an important ritual between closing an encounter with one patient and being fully present for another.

When health care providers are rushing from patient to patient, not only are they less likely to clean their hands sufficiently with soap and water or alcohol-based hand sanitizers but they are more likely to be inattentive and make mistakes.

When we are not observant, thoughtful and listening, we miss out on valuable clues, jump to the wrong diagnosis and fail to really help that patient. An experienced clinician develops intuition, and a wise one attends to it.

If our diagnosis doesn’t quite match all the symptoms and physical findings or if we feel that we are missing out on some crucial information, we leave the examination room feeling uneasy. If we ignore that feeling and move on to the next patient, we may be preoccupied and not fully present again. This can have a snowball effect to the detriment of every patient seen that day.

So I teach mindfulness meditation to patients, medical students, residents and colleagues. With each patient’s visit, that patient must be the centre of our attention. We must listen carefully, ask the right questions and perform an appropriate and focussed physical examination. We must consider a broad differential diagnosis. What conditions may explain these symptoms and physical findings? We don’t settle for the most common diagnosis especially if it doesn’t quite fit. We consider less common and more serious possibilities.

We all know that feeling when we have a conversation with someone who isn’t fully present. They may ask, “How are you doing?” but don’t really listen to your answer. They don’t have to be texting to show that they’re not all there.

Healthcare providers can easily fall into a mindless routine, rushing from patient to patient, asking a rapid-fire list of oft rehearsed clichéd medical questions, jumping to the most common diagnosis, not really seeing the person in front of them, and moving on to the next in line.

If you ever get the feeling that the doctor is rushing and may have jumped to the wrong diagnosis, there are ways of triggering a pause and reflection.

I recommend to friends, family members and any of my patients who might be treated at another clinic or hospital – perhaps in another town – three key questions.

1. What else could it be? This forces the doctor to step back and to reconsider the diagnosis. Could it be something other than the obvious that doesn’t quite fit? Do I need more information? Should I ask more questions?

2. What is the worst thing it could be? This triggers the doctor to consider worst case scenarios. One of my patients is alive today because I considered one of the rare but serious possibilities for her worsening sore throat and fever. A day earlier, the nurse attending her during the colonoscopy told her she probably had a cold. That night, the emergency physician prescribed antibiotics for strep throat. I recognized the subcutaneous emphysema – air released from her perforated bowel that had tracked under her skin up to her throat. I sent her to another surgeon who saved her life by removing the injured portion of her bowel and treated the resulting infection with IV antibiotics.

3. What would you recommend if I was your mother (or father)? This of course asks the doctor to consider the golden rule – a gentle reminder that you are someone else’s loved one and deserve that same special attention and consideration.

Dr. Davidicus Wong is a family physician and a Clinical Assistant Professor in the Faculty of Medicine at UBC.

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Posted in Empowering Healthcare, patient-doctor relationship | Tagged | Leave a comment

Real love and real beauty. Truth in a fairy tale.

What We Learn From Fairy Tales Davidicus Wong, M.D., July 7th, 2014

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My beautiful daughter turns 16 this week.

Once upon a time, when we were all much younger, a favourite family ritual was to make up a fresh bedtime story each night. By capturing the experiences, thoughts and feelings of my children’s day, I engaged their imaginations while providing parental lessons both subtle and obvious.

What follows was a favourite inspired by the funny faces my then 8-year-old daughter made. Parents have always warned their children that their faces may freeze that way.

Of course, there is some medical truth in this. In our thirties, we discover that our parents were right after all. Our wrinkles reveal our habitual emotions with lines betraying smiles or frowns.

I trust that my daughter will remember this story for its deeper lessons about real beauty that inspires us more than a striking physical appearance and real love, the recognition of that truer beauty within.

To be truly loved is to be accepted and cherished just as we are. As we age, we wrinkle and weaken, shorten and sag yet authentic love sees a beauty that persists. As Yeats wrote in his poem, When You Are Old, “How many loved your moments of glad grace, and loved your beauty with love false or true, but one man loved the pilgrim soul in you, and loved the sorrows of your changing face.”

The Scary-faced Princess

On the day she was born, Princess Michelle had the most beautiful face ever seen. She was certainly the most beautiful baby the doctor had ever delivered. At the moment of her birth, he couldn’t resist pinching her dimpled cheeks. The newborn princess frowned, wrinkled her brows and scrunched up her nose. So shocked with this scary transformation, the doctor nearly dropped her.

One day, the queen while feeding the princess could not resist pinching her precious dimpled cheeks.   The pretty princess frowned, wrinkled her brows and scrunched up her nose. The queen was startled and Princess Michelle spat up her milk into the queen’s eyes.

At the princess’ baptism, everyone in the court, all of the villagers, and each of the forest fairies came to adore her and bring gifts. Each visitor was enchanted by her incredibly sweet face. No one could resist pinching her soft dimpled cheeks.

The royal baby soon grew weary of this. Just at the moment the Pink Fairy approached her crib, raising her wand to grant a spell of eternal beauty, Princess Michelle frowned, wrinkled her brow and scrunched up her nose.

So shocked was the Pink Fairy that she dropped her magic wand into the crib. After an explosion of starry flashes, the Pink Fairy was nowhere to be found.

The king and queen rushed to their daughter’s side but with one look at her once sweet face, the king fainted. The queen, who could not see quite as clearly because of the milk in her eyes, quickly bundled up the princess in a soft blanket and hid her from the eyes of the court.

The face of the once beautiful princess was frozen with her frown, wrinkled brow and scrunched nose. The effect on others was immediate and frightening. One look upon the princess’ face caused a reflex of fear.

Only one person in the kingdom was able to look upon her features and not freeze. The queen whose eyes had been clouded by warm milk could not see the frown, the wrinkles and the scrunch.

Though still loved by her parents the princess grew up in the dark so that even she could not gaze upon her own features in a mirror. No one else would be frozen by her frightening features.

Servants brought Princess Michelle her meals to this darkened room lit only by a single candle in its farthest corner. They would only see the outline of her body, which appeared like a shadow.

Her voice and her heart remained sweet and kind. Each visitor would be entranced by her gentle spirit.   She had many friends but none ever saw her face.

In her dark room, the princess had learned to listen. When her friends came to visit, she would listen and reflect back what they were truly feeling. She had the gift of compassion. The heart of anyone who came to see her would leave a little lighter and happier for no one else could listen and understand so well.

One true friend, Peter learned from the princess how to listen well. He helped Princess Michelle grow up in the dark. He told her of the outside world – what it was like to play with other children and to see the beauty of nature.

The king and queen too enjoyed their daughter’s kind company and counsel. It is difficult to rule a kingdom. There is so much to think about and so many decisions to make.

Princess Michelle was able to make their work easier and their hearts lighter. She had acquired wisdom beyond her years. They knew that one day she would be a fitting queen.

Yet the king and queen worried that she would never marry. Her frightening face would certainly freeze the heart of even the warmest suitor.

According to tradition, the princes from the surrounding kingdoms were allowed to ask for her hand in marriage when the princess was old enough to make her choice. The king and queen could not deny the parade of young men who came to meet the princess when that day arrived.

Although they knew that most of these princes only wanted to acquire the riches of the kingdom, the king and queen felt they must warn them of the princess’ secret. None believed them.

One by one, each prince would enter the princess’ meeting room, where he would try to convince her to accept his hand in marriage.           The princess told each prince that she sought only true love – love that would last regardless of age, illness or appearances.

After each prince, promised such love, she would open the curtains of the window revealing her frown, wrinkled brow and scrunched up nose.One by one, each prince froze in fear and had to be carried out by her servants. The princess was heartbroken. It seemed she would never find true love. No prince would see past her scary face.

At that moment of need, her best friend, Peter came to comfort her. He knew her better than anyone in the whole world and he knew that she had beauty within. Peter then revealed his secret.   He was also a prince and he had always loved her.

Before she could stop him, he opened the curtains of the window, gazed into her eyes but instead of fainting or freezing, he smiled and kissed her. Princess Michelle felt her face transform – her frown melted into a smile, her brow relaxed and her nose unscrunched. The room was filled with a wondrous light, and the kingdom was again enchanted by the princess’ beauty.

 

Posted in Love, Parenting, real beauty, real love, Relationships, The Qualities of a Child | Leave a comment

Live Life Deliberately

Our lives are bittersweet – messy and beautiful.
Like a baby with diapers, tears and giggles.
Like a toddler with tantrums, laughter and sweetness.
Like a six-year-old, stubborn but wanting to please.
Like a teen, with budding maturity and brimming with emotions, messy and beautiful.
Like parenthood with sleepless nights, endless work and great expectations.
Like our relationships with quirks that endear and infuriate and our bonds of intimacy.
Like maturity with bittersweet memories, physical decline and wisdom.
So easy is it to be caught up in the messiness of life – the demands of the day, the detours from our dreams, illnesses and accidents. Sometimes it seems that our lives are not our own. We are flotsam randomly floating on the waves, gerbils running endlessly in our cages, or gamers reacting to obstacles thrown before us.
The alternative is to live life deliberately.
Some of us are fighting life. We start off with goals, but life intervenes. We fail, relationships end and we don’t get the job of our dreams. It can seem that fate conspires against us and things never go our way. Life is a battle.
Some of us just go through the motions. We do what we’re expected to do as students, employees, parents or friends but we are not fully engaged. Our days slip on by as we forget about the fleeting nature of life and its circumstances. Everything and everyone about us is in constant motion and change. What is here today may be gone tomorrow.
Our relationships are never perfect except in rosy retrospect. We are all guilty of not being at our best and not fully appreciating one another. Life together is messy, bittersweet but potentially beautiful. We can only realize the best in our relationships through our actions today.
Some of us live passively. Surrendering as if none of it is within our control, we take the job that comes and do it without question. We settle into passionless relationships and do nothing to make them better. We float along to the end of our lives then wonder where it all went.
Some of us live reactively. Life hits us so we hit right back. We take a lousy job to pay the bills. We explode in anger to each successive frustration. We can’t win but we keep on fighting.
At no time are our lives totally under our control – not as a dependent child, a starving student, a young adult, or a busy parent. Yet we can resolve to live our lives more deliberately.
It begins with making choices. Choose happiness. In the hours of your day not consumed by work or duty, choose what you really want to do and with whom you wish to do it. With your limited funds and resources, recognize your personal needs and honour your passions. Do what you love to do. Do what you need to do.
Live life on purpose. When life seems to have no meaning, you must find it or make it. Where do you find meaning? Put your time and energies where your heart is.
Resolve to live life more deliberately. If you have a choice, have you chosen the work that best engages your passions and talents? How can you make this day more meaningful? What can you do today to bring more happiness to you and others?

Dr. Davidicus Wong is a family physician.

Posted in Growth, Happiness, Positive Change, Positive Potential, Purpose, Relationships, Wisdom, Your Goals | Leave a comment

What the world needs now . . . is unconditional love.

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In Homer’s Iliad, Odysseus commands his crew to tie him to his ship’s mast so that he can hear the beautiful but tempting song of the Sirens. With their ears covered, the crew has been ordered to ignore Odysseus’ demands when he is under the influence of the Sirens.

In psychiatry, a patient with bipolar disorder may request an Odysseus contract whereby he agrees to be admitted if he is manic and unable to make appropriate decisions for himself. In other words, he tells his family and doctor, “Don’t do as I say when I am not of sound mind”.

I wonder if Homer was warning us of the pitfalls of lust and love. Perhaps young people should not be allowed to marry when they are madly in love. Before they sign their lives away at the end of the wedding ceremony, they should at least produce a doctor’s note certifying that they are capable of making rational decisions.

Joseph Goldstein has called infatuation and desire the near enemy of love, and by love, I mean unconditional love – agape, metta, lovingkindness or brotherly love. The former is obsessive and possessive. It seeks to take, to hold and control. Unconditional love is giving, forgiving and letting go.

Pleasure and the satisfaction of our material wants are worldly counterfeits of true happiness. Unlike enduring happiness, they soon give way to emptiness and disappointment. So too do infatuation and desire – counterfeits of real love – give way to disappointment, disillusionment and ill will.

It’s okay to enjoy a delicious meal, a cup of coffee and a relaxing massage but don’t expect pleasure alone to give you a complete and meaningful life. It’s okay to fall in love as we all do, but that alone is not enough to sustain meaningful relationships over a lifetime.

Romantic love is a lens that creates a distorted image of another, magnifying positive qualities and blurring the rough edges that will later prickle us. Unconditional love allows you to see and accept the whole, appreciate beauty and genuinely want the best for the other.

My children have taught me how to love unconditionally. Becoming a father and holding in my arms a helpless and beautiful child who is completely dependent on parental care has helped me grow in love. As each of my children grow, stumble, fall and succeed, the most important thing that I can teach them is that I see the best in them and love them completely just as they are.

Sometimes as parents, our children may feel that our love is dependent on their innate qualities or their behaviour, and being human, egos can get in the way and we may love imperfectly. But in the end, the wellbeing of our children takes precedence over our own.

Real happiness and the meaning in our lives come from our relationships. The purpose of our lives is to accept love and learn to love more fully. We are given a lifetime.

My parents surrounded their three children with love. They saw the best in us and this inspired us to be our best, and their circle of concern extended far beyond our family.

Love is limitless. Unlike its near enemy that can only be given to few and for a limited time, our love can extend and benefit many even beyond our lifetimes.

When I think of our potential for love, I use the metaphor of the water cycle. Water is a key constituent of our bodies and we share it with the whole world. Water is excreted and evaporates from our bodies. Water condenses into clouds. It falls as rain and snow. It flows in rivers to lakes and oceans. We drink it and it sustains physical life.

Throughout our lives, we receive love in many forms from countless people. We depend on the kindness of strangers, our teachers, coaches, parents, mentors, friends, and the people of the past who have worked to create the places we live and the systems that sustain our lives.

Love is not ours to keep for our selves or share with just a few. It has been freely given to us to give out and give forward.

In your life, what gifts great or small have you received that you cannot fully give back? How are you paying this forward?

 

Posted in Compassion, Friendship, Happiness, Love, Relationships, Uncategorized | Tagged , , , , , , , | 1 Comment

Why I Chose Medicine

Rhythm of Life Davidicus Wong 3
Family doctors treat the whole community:
everyone is our patient

DR. DAVIDICUS WONG / TRI-CITIES NOW 
MAY 28, 2014

In this week’s column, Dr. Davidicus Wong speaks to how as a child he was inspired to enter medicine.  

I chose family medicine because I love stories – not fairy tales, fantasy and fiction but the narratives of everyday people living their lives. Nothing is more engaging or authentic; no bestselling novel, blockbuster movie or reality TV show can match.

Physicians are privileged to listen to the personal stories of our patients – the history of their experiences and the joys and challenges of their relationships, and we are entrusted to become a part of these stories as we, understanding each person’s personal values, guide them in making the most appropriate choices for themselves.

At a recent strategic planning session for the Burnaby Division of Family Practice, I invited all board members to share their stories. Why did they choose medicine as a career? Why did they choose family medicine as a specialty? Why did they choose to practice in this community, and why did they join the Division of Family Practice?

Medicine chose me when, in Grade 6, I was hospitalized for inflammatory arthritis and was moved by the nurses and doctors who cared for me as a person and not just the disease. I wanted to help others to cope with challenging and uncertain circumstances and see and treat them as whole people.

I chose to work in my community because this was my hometown. I went to school here, played in most of the parks and spent countless hours in our libraries. To work here was to give back to the community that has given me so much more.

I chose to lead the Burnaby Division of Family Practice because this non-profit organization’s purpose resonated with my personal calling. When I talk to patients and my children about finding their calling – what they were meant to do with their lives – I identify their calling as the intersection of their talents, passions and values with the needs of the world. What do you love to do and how can you use your talents in the most meaningful way to meet the needs before you?

Our mission is to engage, support and mobilize family physicians in co-creating a network that will support the well-being of all members of our community. At the heart of our mission – at the core of all that we do – is the well-being of every patient.

Family physicians care about their patients and they share the unique perspective of seeing the whole person.

They also understand that through the resources of their community – and through new partnerships our organization has developed with others interested in improving the health of our community – we can help provide the care each patient needs.

Our organization and the GP for Me initiative ask all family physicians to expand their circle of care. Family doctors are used to making the patients they personally treat their primary concern. We are asking them to think beyond their own practices, and ask, “Who are our patients?” The answer is, “Everyone is our patient” just as everyone is our neighbour, our brother or sister.

As a group we are engaged in the care of everyone in our community, especially those who do not yet have a family physician and are not receiving the care they need.

Our organization is involved in multiple initiatives that will ultimately enhance access to primary care, the health of our community and the patient-doctor relationship. Every family physician can shape the story of our community.

Throughout B.C., family physicians are organized into Divisions of Family Practice, working together to improve primary care in their communities.

On Monday, June 2, I’ll be speaking at the Metrotown branch of the Burnaby Public Library on “The Patient-Doctor Relationship: making the most of each visit with your family doctor.” For more information, please phone the Metrotown branch at 604-436-5400 or register online at http://www.bpl.bc.ca/events.

Dr. Davidicus Wong is Physician Lead of the Burnaby Division of Family Practice. His Healthwise column appears regularly in the Now newspapers.

 

Posted in Burnaby Division of Family Practice, patient-doctor relationship, Your Calling | Tagged , , , , | Leave a comment

What you need to know about confidentiality and your doctor

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Confidentiality is crucial to the patient-doctor relationship.

Without the assurance that whatever you tell your physician will be kept confidential, there would be no trust, and you would hold back important information that your physician may need to give you the best care and most appropriate advice.

In turn, your physician trusts that you provide all the information needed to understand your situation and make a correct diagnosis.

Physicians are taught to accept without judgment all that their patients share, including excessive drinking, smoking, the use of recreational drugs and other risky behaviour. Of course, we are rooting for them to make the best choices for their health and prepared to offer support for them to make positive changes.

Be aware however, that our profession requires us to appropriately document all important information even if you would prefer it to be “off the record.” Your medical record must be complete.

Doctors cannot reliably remember everything you tell them, and information about your history and habits impact on your risk for potentially dangerous drug interactions and serious conditions such as sleep apnea, hypertensive crises, strokes, cardiac arrhythmias and heart attacks.

In your usual medical care, who else may see some parts of your medical record?

The nurses or medical office assistants who assist your physician may access your records but are also well versed in confidentiality. They will look at those portions of your record necessary for them to perform their work. If a family member inquires on the nature of your recent visit, they will not disclose any information without your permission. In fact, they understand that they cannot even confirm with parents the recent appointments made by mature teens.

When teens are capable of making their own health decisions, doctors should have a frank discussion with the family clarifying respect for the mature child’s confidentiality and autonomy. If this is not clear, parents may continue to make inquiries about their teen’s health without permission and teens may attend a walk-in clinic instead of their family physician’s office.

Other physicians who share in your care may have access to a portion of your records. This includes the physicians who belong in your doctor’s call group, doctors who are covering when your doctor is away from the office and specialists to whom your doctor refers you.

When you are injured in a car accident or applying for insurance, you may sign a consent for the release of your medical records. You should read carefully and ensure that you understand what information has been requested.

If you are injured at work and have a Worksafe claim. Medical information pertaining to this may be released to Worksafe. The same applies to ICBC claims.

There are two cases where confidentiality may be breached without your consent. If you were suicidal or homicidal – at real risk of harming yourself or others, your physician may inform others (e.g. police, family, psychiatrists) in order to protect the life of yourself or another. The other exception is a court order – where a physician is required by law to produce your medical records.

With these facts in mind, you can trust that your physician will respect your confidentiality, and you may share crucial information about your health with confidence.

On Monday, June 2nd, I’ll be speaking at the Metrotown branch of the Burnaby Public Library on “The Patient-Doctor Relationship: making the most of each visit with your family doctor.” For more information, please phone the Metrotown branch at (604) 436-5400 or register online at http://www.bpl.bc.ca/events.

Dr. Davidicus Wong is a family physician at PrimeCare Medical. His Healthwise column appears regularly in Now newspapers and the Vancouver Courier. 

 

Posted in Burnaby Division of Family Practice, Empowering Healthcare, patient-doctor relationship, Uncategorized | Tagged , , | Leave a comment

Walking boosts creativity

I recently wrote of the many benefits of regular physical activity. These include improvements in cardiovascular fitness, sleep quality, mood and anxiety levels and reductions in the risks for heart disease, stroke, diabetes and osteoporosis.

So you won’t be surprised when your doctor writes you a prescription for exercise.

You might be if your teacher or boss tells you to take a hike – all for the sake of creativity.

A recent study at Stanford University has shown that we are more creative while walking than when we are sitting. In their study published last week in the Journal of Experimental Psychology: Learning, Memory and Cognition, coauthors Marily Oppezzo and Daniel Schwartz looked at the immediate effect of walking on performance in standardized tests of divergent thinking. They tested 176 college students and other adults in four experiments after they had walked indoors on a treadmill, sat indoors, walked outdoors or sat in a wheelchair while they were pushed along the same path.

Divergent thinking involves generating creative ideas by exploring possible solutions. It is essential for brainstorming – the free flow of ideas we need before we can begin to write an essay or story, solve a problem or collaborate as a group.

In the Stanford study, subjects were asked to come up with alternate uses of a specific object and to generate complex analogies to specific phrases.

Walking – either indoors or outdoors – resulted in significantly more creative responses than sitting.

Creative thinking isn’t just for artists, writers and students. It can benefit every aspect of our lives. Our most troublesome problems seem to come up over and over again. Divergent thinking can help us generate new approaches to those problems. It can help us reimagine and reinvent our lives. It can open the window to new possibilities.

In B.C., doctors are connecting with their patients in creative new ways.

Last Saturday, I had a 90-minute group medical visit with 15 of my long-time patients, all living with chronic pain. This alternative way of serving my patients allowed me the time to share new approaches to the challenges of their conditions.

I introduced the concept of neuroplasticity – how the function of different areas of the brain and the connections between neurons can change and adapt to new learning. I was able to teach them mindfulness meditation, the principles of cognitive therapy (how we can change both our emotional states and our perception of pain by changing our thoughts) and the practice of self-hypnosis.

On Saturday, May 3rd, I’ll be connecting with my patients in another creative way. The Doctors of B.C. (formerly the B.C. Medical Association) will demonstrate their care and commitment to our patients and community with a free and fun 2 km walk at Kitsilano Beach Park in Vancouver at 9:30 am.

All members of the public are invited, but come early to get your free pedometer. You never know what great ideas we’ll come up with just walking and talking. For more information about this event, check online at www.bcma.org/walk-with-your-doc.

Drs. Davidicus Wong, Karime Mitha and Shelley Ross at the BCMA's Walk With Your Doc May 4th, 2013

Drs. Davidicus Wong, Karime Mitha and Shelley Ross at the BCMA’s Walk With Your Doc May 4th, 2013

 

Posted in Empowering Healthcare, Healthy Living, patient-doctor relationship, Physical Activity, Positive Potential | Tagged , , , , , , | 4 Comments