Πέμπτη, 22 Μαΐου 2014

Why are you here to see the doctor today?

...Their stories are more than medical
problems. The problems become part of their existence,
and doctors should realize that they need to treat the person
not just the disease...



Knock, knock. 
Take a breath. Hand on the knob.
Meet and greet. Then comes the line: “So, why are
you here to see the doctor today?” Behind every
door lies a story.


Knock, knock.
So, why are you here to see the doctor today?


The patient explains that he wishes to have bariatric
surgery. I discuss the risks and benefits. I talk about
the paperwork to be filled out. I notice in the chart
that he has a past medical history of depression. I ask
him about it and how the medications are working.
He states that recently he lost his job and has been so
depressed. His children are succeeding at school. He is
worrying how he will pay for their university tuitions.
He told me that he recently attempted suicide.
His story is so sad. Why do some have depression? Good
luck, bad luck? He has so many issues going on. Where do
I start? He was thinking of suicide because of financial difficulties.
Is he still suicidal? Need to tease that out. I need to
let him know of the social supports in the community. I feel
like I want to just tell him that everything is going to be OK.
But I keep my cool and continue.

Knock, knock.
So, why are you here to see the doctor today?
An elderly gentleman has come to the office for a
reassessment of his peripheral neuropathy. I review the
history of the current illness with him; do a thorough
neurological exam. He is a type 2 diabetic. As I continue
with the interview, I ask him about his home life.
He takes care of his wife. He can barely take care of
himself. He tells me that his wife has bipolar disorder.
There are moments when he is verbally abused by her.
He begins to cry because he doesn’t want to blame her.
He loves her.
I have never seen an old man cry. It is so touching. I am
holding back tears. He loves his wife so much that he was
hesitant to bring this up. He has caregiver burnout. This
man can’t care for himself. He hardly has any sensation in
his feet. He looks like he is a very kind person with a warm
heart. I want to tell him that. Why does he have to deal
with this? If only I could cure all his problems with a tap of
a wand. But I can only tackle his problems one at a time.

Knock, knock.
So, why are you here to see the doctor today?
A young married couple have come in today
because last week they had a positive pregnancy test
result. This week it was negative. She had her period.
I take a history regarding infertility. I talk to them
about lab tests we can do to assess fertility. They have
been trying ever since their first son died 5 months
ago. He was only 2 years old. He passed from a rare
disease.
Why them? Look how strong they are even in these circumstances.
Their child passed so recently. Are they still
mourning? Have they come to terms with what has happened?
Are they ready to have another child so quickly? It
is hard to get pregnant after losing a child. I feel so helpless.
I begin to get angry that their child was taken from
them. It is too late. The only thing I can do is comfort them
and encourage their efforts.

Knock, knock.
So, why are you here to see the doctor today?
This patient has come to review her bloodwork
results. Looks like high cholesterol. Risk assessment
reveals she is at high risk because her parents had heart
attacks and strokes at young ages. She is currently taking
no medications. On physical exam she has high
blood pressure, which was also present at her last visit.
I tell her that she has hypertension and hyperlipidemia.
Then I explain to her the long-term risks of these disorders
if she does not take action. I then tell her that she
must start 3 different pills and take them for the rest of
her life. Then I pass her the Kleenex.
This woman came into the office today thinking she
was perfectly healthy. No previous medical history. No
medications. Now in 2 minutes she has 2 diagnoses
and 3 lifelong medications. I had to break it to her. Was
I too harsh? She had to know. As her doctor I have to
help her prevent morbidity and early mortality. Her tears
were tears of realization. I feel like I did a good job. But
I forgot to consider how this would affect her. I gave her
words of motivation.
Behind every door lies a story. People come to their doctors
because they need someone to trust. They need someone
to tell them that everything’s going to be all right and
they will get through it. Their stories are more than medical
problems. The problems become part of their existence,
and doctors should realize that they need to treat the person
not just the disease.
Mrs Doko is a medical student at the University of Western Ontario in Londo

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