Tuesday, September 30, 2008

Team players

One of my good friends is in the hospital right now recovering from extensive abdominal surgery. She's doing beautifully, but, as expected after a 10 hour operation, the road back to health is slow and painful. Each morning, her 'surgical team' breezes through, asks her how she is feeling, then flitters out without really hearing the answer. Imagine their surprise when they announced that it was time to stop the IV pain meds, and she announced "I'M NOT READY!"

The surgical team scuttled out the door and discontinued the IV drip for pain.

One day later the 'psychiatry team' shows up. Team members are one unhappy-looking med student and one psychiatry resident. They ask permission to be there, permission to talk in front of me the visitor, but choose not a we're-all-just-human-here sort of opener such as "Geez, what a journey you've been on, how are you holding up?" Rather med student leads off with "Are you feeling a little anxious?" Hell yes, major surgery, slow discouraging recovery, still got chemo treatments left to go, what on earth do you expect... says my friend.

"Well," says Dr. Psych Resident, taking charge, "your team asked our team to come in and find out why you're anxious." I kid you not, and he said it with a straight face. He continues, "They wondered what the problem was."

The problem? That one team needs another team to find out why a post-operative patient in pain reacts strongly to a surgeon who won't listen to what she says.


kenju said...

It's all too typical, in my esperience. I hope YOU told them what's what!

30 years from Darling said...

Oh ... my .... goodness!! I've met this team. Please tell me you did set the record straight?

And ... psych eval in front of someone? HELLO HIPPA??!??!?!? Just love what that med student learned from that supervising ..ahem, doc.

KGMom said...

Years ago, when I worked for the PA Medical Society, I heard a wonderful speaker who was instructing doctors on how to avoid being sued.
His advice--the patient is the book (which he repeated many times). He said--listen to the patient. Whatever the patient tells you--he also instructed how to listen to the message behind the words.
Very insightful; very simple.

JeanMac said...

In my opinion,one has to have experienced something to truly be aware - not suggesting major surgery on them(although, maybe)- I remember an RN asking me if my contractions were strong - excuse me! After feeling my abdomen, she replied, "no." Luckily, I was less assertive way back then.Did ask if she had children - you can guess the answer.

Wendy said...

Just read JeanMac's comment - oh that makes me laugh! Actually, I had the same experience!!

Re: this post - I can't believe it. Are they for real???

tobiwan said...

GAAHHH!- As one psychiatric evaluator here-- I'm aghast, horrified & a bit embarrassed for my poor colleagues who had to follow the direction of their supervising psychiatrist and visit the patient in question. At the hospital I work at my team will get similar requests for things like "post-surgical depression". What our best practice is, in situations like this, is not to argue with the attending physician about the patient's mental health but to meet with the patient and remind her that depression, anxiety & anger are normal after such traumatic medical procedures coupled with a life threatening illness. We'll encourage her to keep asking for what she needs, make a chart note to the effect that the patient is NOT in need of psychiatric follow up, and then ask the patient if there is anything else we can help with. We will try to get the med floor social worker involved to help the patient communicate her needs to the medical staff without the charge nurse calling psych. again.
I am constantly amazed , and not in a good way, that medical schools do not teach doctors how to treat the "whole" patient and not just the part that presents as sick. Too many times doctors make decisions based on protocol, the expected outcome for a given procedure, and their own time table. They tend to forget that there is a human being attached to a diagnosis and an illness.
As is happens, this is someting I take great issue with and am constantly striving to advocate for patients as people not statistics. Thanks for listening.

Haralee said...

I agree with Darling, HIPPA!
I suggest your friend fire her surgeon, and maybe her Dr too.

femail doc said...

KJ, Darling: Definitely oh my goodness moments. I did not feel it my place to speak out, except to reiterate on behalf of friend (who was nearly asleep from drugs and who also had just had a dreadful reaction to a pain med) that the team's final offer of drugs to deal with her anxiety would not be such a good idea at this time.

KGM: Wish we had more wonderful speakers like the one you heard speaking to our medical students.

JM: I suppose all professional caregivers could use a personal look at healthcare from the pt's point of view. That has certainly opened my eyes.

Wendy: Isn't that amazing that anyone would presume to know how we feel?

Tobi: What a perfect response you and your team have to this sort of situation. Here's an excerpt from an article in the NEJM about teaching doctors who are unable to generate a genuine response how to fake a humanoid sort of exchange:

Patients ideally deserve to have a compassionate
doctor, but might they be satisfied with one who is
simply well-behaved? ...A doctor who has trouble feeling
compassion for or even recognizing a patient's suffering
can nevertheless behave in certain specified ways that
will result in the patient's feeling well treated.
---Michael Kahn, MD