Growth patient-doctor relationship Relationships Wisdom

What I Learn From My Patients

In my last post, I said that good doctors learn from their patients. That may be one reason why we say we practice medicine. And I guess patients do have to be patient – waiting for a young doctor to practice on them until they get good at it.

We’re just lucky that no one asks why we get paid to just practice.

Now don’t take that to mean that older docs are better or safer than rookie physicians. The most dangerous physician – whether young or old – is one who is overconfident. We can make mistakes if we step beyond our scope of practice, if we don’t recognize and respect our personal limitations, if we stop listening, and if we jump to conclusions.

Both inexperienced and jaded physicians may assume that a patient’s symptoms are due to the most common diagnosis. They may jump to a quick diagnosis even if the signs and symptoms don’t quite match.

Physicians are more likely to do this when rushing from patient to patient in a busy ER or clinic.

An astute physician will listen to his intuition and maintain a broad differential diagnosis. When symptoms don’t quite fit, he will ask more questions.

When I teach hand washing technique to 1st year medical students (Yes. We now teach this in med school.), I stress the importance of taking the time to disinfect effectively. I advise them to wash their hands mindfully and ritually, closing with the patient they have just seen – and making sure there are no loose ends, unanswered or unasked questions or pieces that do not fit – before preparing to focus fully and mindfully with the next patient.

If you find that your physician may have rushed to make your diagnosis, you can open her mind by asking, “What’s the worst thing it could be?” and “What else could it be?”

These questions force physicians to pause and look at all the information again, reformulating a broader differential diagnosis of all the possibilities, including the less probable but more serious.

I continue to learn from my patients as they learn from their experiences and relationships. And what I learn from them enriches my care of other patients.

Real life teaches grownups in ways much different from school or practice. In life, lessons come after the tests. We learn by failing. We succeed by first falling.

In real life, we may not have to repeat a grade, but we have to repeat our lessons until we have learned them.

As we grow older, gain knowledge from experience and grow wiser, the more we recognize how little we know. As teens and young adults, we may think we know a lot more than our parents but as we face the challenges of independence and parenthood, we may better recognize their wisdom.

May you never believe that you are too old to learn something new. Even if you become forgetful, you will have to relearn what you used to know.

Growth patient-doctor relationship

Never Stop Learning. Doctors Don’t.

As students have settled into their classes and are just starting to hit the books, the rest of us can sit back and relax. Right?

As any physician can attest, the learning never stops.

The hardest first day of school was my first day at medical school. We started anatomy lectures that very first day which ended in the gross anatomy lab itself. There we met the cadavers we would be dissecting as we immersed our minds in the infinite details of the human body.

We felt behind from day one, and the question that haunted every medical student was, “Will I ever know enough?”

We learned a great deal in medical school. There was no limit to the detail and depth we could study. Any detail could be clinically relevant and not only be the difference between passing and failing but life and death.

We were told that we were learning enough medical words to constitute a whole new language. No wonder normal people have difficulty understanding what their doctors are saying.

But in spite of the hours of study in libraries, in labs and on hospital wards, all that we learned in medical school was not enough to make us great doctors.

Good doctors learn from their patients. That may be one reason why we say we practice medicine. And I guess patients do have to be patient – waiting for a young doctor to practice on them until they get good at it.

Next: Who are the most dangerous doctors?

patient-doctor relationship Positive Potential Relationships

The Patient-Doctor Relationship: The Sources of Conflict

The positive patient-doctor relationship is essential to your health, but it is often far from perfect.

The reasons for conflict and discomfort are complex. Doctors are human too with their own priorities and emotional reactions. Sometimes our styles and personalities clash. As with all our relationships, we each bring emotional baggage to the bedside.

Medical school teaches us to be dispassionate and dissociated so that we can be objective and clear-headed in an emergency. If we do this too well, we can come across as cold and clinical.

We learn a particular system of inquiry – a way of funneling down our questions from broad to narrow. When we become too focused on disease and overly task-oriented, we may seem abrupt and rushed. Doctors are known to interrupt their patients’ answers in order to ask another question!

Patients sometimes feel like they are treated like a number or a disease. They want to be seen and treated as complete individuals.

Next: You may be surprised how doctors really feel about patients.

Healthy Living

Back to Basics: How to Wash Your Hands, Pt 2 of 2

This week, my theme is small things that make a big difference. This month, I taught my Medical students the key procedure in infection control: handwashing.

I spent some time – 15 seconds to be exact – demonstrating proper handwashing technique to my students. Although this sounds like the kindergarten curriculum, it’s important to start with the basics . . . especially when patients’ lives are at stake.

Like with any other medical procedure, I taught them to plan their approach – just as you would approach a public washroom – with your exit in mind. Make sure you have everything at hand. You’ll need soap of course.

There should be a paper towel available (without you having to crank a contaminated lever with your freshly washed hands) that you will use to dry your hands, turn off the taps and in the case of a public washroom, open the door.

There are parts of our hands that are commonly missed when washing. These include the fingertips and the back of each hands. If you take the time to lather up the soap and wash the four sides of each finger, the palms and the back of each hand, you’ll find that it really does take about 15 seconds.

I teach my students to treat handwashing as a ritual between each patient: do it carefully and mindfully as a transition between the sacred one-on-one time with each patient. When we are with a patient, it is essential to be mindful – to be totally focused on that individual’s problems and experiences. If we are distracted with interruptions, the pressure of time or our own thoughts about the previous patient, we will not fully attend to the patient before us and we are more likely to make a mistake.

If we are not fully present, we will notice the difference and so will our patients.

Today: note how well you normally wash your hands, then take the time to wash them like a conscientious doctor or medical student. By doing this before and after you eat or touch your eyes, nose or mouth, you will greatly reduce your chances of picking up and spreading infections, like the common cold, strep throat and influenza.

Little things like handwashing can make a big difference in your own health and the health of others.