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.