A surgeon makes it a point to directly communicate with the patient

If nothing else, this post illustrates that surgeons are not that great with the whole bedside manner thing. I would like to think I’m an exception … but I still am a surgeon.

I make a point of communication with my patient. Obviously if he is a child, I use the same measure of effort in communicating with the parents. But few things irritate me more than some or other family member that insists on forcing their way into the fairly personal interaction between patient and the guy that in all likelihood is going to carve him up in the very near future.

I refer to the person who insists on answering my questions directed at the patient as if they know better. I mean if I ask what the pain is like and, before the poor patient can express himself, his well meaning irritating wife or mother begins to describe to me what he is feeling as if she is feeling it too. I often want to tell them to get sick themselves before I give a damn what they feel or think. I’m usually at least slightly more diplomatic.

I was a senior registrar. A private consultant friend of mine asked me if I could look after his patients while he was on leave for two weeks. Apparently he did not trust the other private surgeon working in that hospital. To be frank neither did I (but we’ll keep that story for another post, shall we). We went on a sort of handover round together and I got a feel for what was going on. After rounds he mentioned to me that there was still one more patient coming in from a general practitioner that apparently had a bowel obstruction due to a previous operation as a child. The patient was apparently going to be admitted via x-rays. I could evaluate him and operate if I felt it was indicated. All seemed well. He would be my first ever private patient.

The patient arrived and I was called to evaluate him. I walked into the room and took in the scene before me. The patient, a young man that I estimated must be about 26 years old, was lying in bed and what had to be his father was standing next to him. I greeted them both and introduced myself. I then turned to the patient.

“What seems to be the problem?” I asked, looking at him. The father answered before the patient even had a chance to open his mouth.

“Well doctor, he started with…” I cut him short right there.

“Uhmm, excuse me, but I did not ask you. I asked him.” I said. then turning towards the patient with possibly too much of an ostentatious flick of my head I started again.

“What seems to be the problem?” The moment the patient opened his mouth was the moment I became acutely aware that he was mentally retarded. He very nearly could not string a sentence together and certainly couldn’t express himself in terms above that of about a five year old boy. I felt like a total idiot and could feel my cheeks flush in embarrassment, but what could I do? I just had to soldier on. I mean I could hardly now turn to the father and admit that after careful consideration I did want to hear from him what sort of pain the patient was experiencing, especially seeing that I had just brushed him aside rather unceremoniously.

The entire interview and examination was painful (I think the patient also experienced a bit of pain) but I just kept on slugging through it. I then looked at the x-rays. It was a clear case and I knew I needed to operate. For the consent I fortunately could turn to the father. It was clear the patient didn’t have the mental faculties to sign his own consent, if he even could write at all.

Fortunately the operation and the post operative phase went well and quite soon I discharged the patient into the care of his parents.

Just over a week later I followed the patient up. Luckily everything was in order and I informed him and his father that all was well and they could go in peace. They left the consultation rooms, but then the father turned back to me. I had been expecting something like this from the first moment I had realized the patient was mentally retarded. I was just surprised it had taken so long in coming.

“Doctor, I’d just like to have a word with you in private.” Oh, well, I thought. It’s not as if I don’t deserve some backlash for my unintentional indiscretion at our first meeting. I braced myself for the worst.

“Doctor, at our first meeting, from that first moment when you refused to hear from me what was wrong with my son, but instead insisted on speaking only to him,” I cringed. “Well from that moment I knew we were with the right doctor. Thank you so much for all you have done for him and for the respect you showed him. We as a family will forever remember everything you have done.”

I didn’t see that coming. I decided to just keep quiet about the fact that I hadn’t realized the child was mentally retarded. We all went our separate ways, me with my pride and hide intact and the family chuffed at how I had treated them. I was relieved.

“bongi” is a general surgeon in South Africa who blogs at other things amanzi.

 

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  • http://www.rugbymedical.com Rugby Medical Equipment

    Very interesting situation.
    As a parent, I find that I also speak for my children, even though they are articulate themselves. I guess one just gets used to speaking for them from when they are too young to talk…and that habit is hard to kick (although I’m guessing that by 26 my kids will go to the doctor themselves).
    Not that it’s my position to advise a doctor who no doubt is stressed out and often fatigued, but you could have patiently listened to the father first (he is a person too) and then asked the son to describe everything again. Nothing to lose (except 2 minutes or so), and everything to gain.

  • http://other-things-amanzi.blogspot.com bongi

    rugby, i hear what you are saying. but in the end it isn’t about time or doctor fatigue. it is about getting an accurate subjective history. it is fine to listen to the parent, but not before listening to the patient, otherwise the history is contaminated. also sometimes asking sexual history with the parent there might be a bit awkward.

    but i do hear what you are saying and my intention isn’t to offend the parent.

  • Marly

    I’m glad your situation turned out so well. Most wouldn’t have. Many years ago my ex-husband and I took our 3-year-old child to see an ophthalmologist upon the recommendation of our local optometrist. Dr. Jerk began asking questions. When I tried to answer him, he looked directly at me and stated, “If a father is present, I listen to him. Women know nothing.” Needless to say, there was no return trip to him.

  • Cindy

    Wow did this post bring a memory back to me. I once took my mother to the ER for what I can not remember now. Ironic to me I can’t remember why I took my elderly mother to the ER but I can remember the event. We were greeted by an ER nurse I have known for 30 years. She graduated in my “little sister” class from Nursing School which means she graduated the year after I graduated. We exchanged pleasantries and waited for the doctor. At the time of the visit I was Director of Surgical Services at a competing hospital and I am confident my friend mentioned that to the ER doc. Something like “the daughter of the Pt. in bed 3 is Director of Surgery at ________ hospital. When he arrived to interview my mom he did the same thing as the author of the article. My mom kept looking at me stating “you tell him”. I totally understand you want to hear how the pt. would answer your questions and not the daughter, parent or whomever but………. And there is a huge but. I attempted to answer one question for my mother and I got it both barrels from the MD. He was on a rolling stool in my face with his finger wagging being spoken down to in front of my mother because he wanted HER to answer HIS question!!! My mother was horrified.
    So he went back to grilling my mother as to why she was there. He didn’t get far and I let him go. Eventually he turned his questioning to me because my mother was truly having difficulty giving him what he wanted. My mom had Alzhiemer’s and it was all my sister and I could do to figure out what was going on with mom but we did the best we could for her. She could make you believe at first glance she was perfectly fine which she wasn’t. I was there to get her help and not get into it with this guy but honestly I was ready to take her to St Elsewhere. It was all I could do not to call this guy out but he was taking care of my mother. She was admitted and the rest of the experience went well. The whole experience was about my mother not him and not me but I was very tempted to file a complaint.
    When approaching a patient don’t assume you know everything because you’re “the doctor”.

  • Ramin Royai

    I very much enjoyed reading Dr. Bongi’s story. I have been a physician and surgeon in the San Francisco area for 13 years now. I have always been a patient advocate and believe that open communication is the key to a happy and well informed patient. However, good communication between all health care professionals, in the operating room, the hospital, and the clinics is the best way to eliminate errors. It is time to break down the hierarchy and treat everyone in the healthcare team with the same respect and compassion. Thank you.

    • Marly Slagel

      Well said, Dr. Royal.

  • Penny

    Hilarious! I know of one mother also who is frequently upset by the fact that when she takes her 35 year old handicapped son to the doctor, some speak to her instead of her son. She says she has to constantly remind everyone that her son is actually human and “is” able to express himself — maybe not as well, but able.

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