Our patients are more than the sum of their parts

As a nursing student, I always enjoyed being able to see first-hand new procedures, treatments, wounds and wound care on patients. Many of the patients were older and all were in the nursing homes we did our clinical rotations in. It wouldn’t be unusual for several of us to be gathered around a patient while the wound care nurse or doctor cleaned, debrided and dressed a pressure ulcer, and for us students, the opportunity to watch and help was always met with excitement.

But most of the time, the patient is given little thought, as though he or she is no more than a body part to show other doctors, nurses and students. Though many of the patients are admittedly demented, I sometimes wonder if we can’t do a better job of retaining their humanity in the process. Thinking about my own experience, I tried to always keep in mind that there was a living, breathing person attached to whatever body part we were examining.

Years ago, I was in a particularly volatile relationship. I was cut off from friends and family and convinced they wouldn’t help me. I had no access to my phone (and if any male friends called, I would have bruises later to show for it), nor did I have access to my car or money. He regularly beat me, forced me to do things with others, and slept around and bragged about it. When he hit me in public, people would look away, rather than try to intervene or help. When I finally did get the courage to leave (which amounted to me taking back streets and a taxi in the middle of the night with nothing more than my purse and what I was wearing), I went to the police and was the (female) officer told me she didn’t believe me.

All that aside, I had to go to the ED because he gave me herpes (the primary outbreak tends to be pretty terrible, and I didn’t have a doctor and wasn’t in a position to find one and wait for an appointment). Condoms were not exactly an option because I had very little say in anything, and often had no say in whether or not we had sex in the first place.

So there I was, 18-years-old and humiliated, ashamed, and thinking this is the end of my life, and that no one will ever love me or want me ever again, while the doctor is doing a pelvic exam and giving me the diagnosis I already knew.

But here’s where my point comes in: while the doctor is examining me, I show him my finger, which I thought was infected from a cut. He looks at it, then brings another younger doctor (or student) in, and shows it to her, explaining that it was actually herpetic whitlow. I’m lying on the exam table, still undressed with my legs in stirrups from the pelvic exam, crying and ashamed of the diagnosis and everything that led up to it, and this doctor decided that it was a perfect time to use me as a teaching example.

I understand the importance of doctors and medical students being able to see first-hand new or rare procedures, exams or illnesses, but don’t dehumanize your (awake, alert and oriented and obviously uncomfortable) patient in order to do so. In my case, I probably wouldn’t have minded the doctor bringing others in if he had simply asked my permission first. Had he explained what was wrong and why he wanted to show others, and allowed me to sit up and put my clothes back on first, I most likely would have gladly let him bring in whomever he wanted.

In our excitement to teach and learn, we must be careful not to forget that our patients are human.

“Alissa” is a nursing student.

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  • EmilyAnon

    Alissa, your story made me cringe. I’m sure you will never forget a patient’s humanity after that insensitive encounter with your doctor as you pursue your nursing career. I think you will be a great nurse.

    • Alissa

      Thank you for reading it. It wasn’t the easiest story to tell, but I think it serves as an important reminder to think about the patient as a whole when learning, teaching and treating.

  • Devon Vickery

    Wow! As a nurse this story makes me ashamed of the health care profession and how we often dehumanize our patients. We classify and refer to our patients as their disease or injury and remove their name from how we think about them. I am so sorry this doctor shamed you in this manner instead of seeing your trauma and having empathy and understanding for how you were feeling. Good luck in your studies and I’m sure you will be a very caring nurse who will be able to stand up for the dignity and humanity of your patients.

    • Jan Curry Fortier

      I make great effort to keep the humanity in what I do. My patients all have names, and I use them when I speak to others involved in their care. I NEVER refer to any patient by their bed number or diagnosis without first using their name. I’ll say something like, “Joe Blow, our patient with blahblahblah in bed 5…” because I know that without those identifiers the other person isn’t going to know who I’m talking about and that drives me crazy! Another thing that just sets me off is when the attending refers to the patient by the wrong gender. I’ve gotten some dirty looks for pointing out in rounds in front of a dozen people that “he is a SHE and her name is Suzy” but I really can’t let it pass without comment. If I have a student or new staff orientee with me and want to provide them with learning experiences, I ask permission first and wait for a ‘good’ time. I always hope that by modelling this kind of behaviour that more people will just pick it up, but so far I’m not seeing it happen much.

      Alissa, you showed great courage in sharing your experience. I feel ashamed of my colleagues on your behalf. You have so much that you’ll bring to your practice and I congratulate you for your willingness to give of yourself to others.

      • Alissa

        Thank you for being the kind of practitioner we all want to see, and for your kind words.

        I don’t think I’ve ever seen someone call a patient by the wrong gender, but I do remember one patient who was transgender and half the staff either refused or couldn’t be bothered to use the right pronoun when referring to her. She wanted to be called “she” or “her”, because she identified as a woman, not a man. She was one of my favorite patients, too.

  • Lee

    Alissa your story broke my heart. Though I am a man, I can totally relate. Towards the end of my chemo and radiation for Stage 3 throat cancer, I was hospitalized for a “life-threatening” infection from my feeding tube. While hospitalized I experienced “care, or the lack of it, that was so consistently dehumanizing, insensitive, and lacking in simple kindness (for $10,000 a day!) that I became so humiliated and ashamed that I hoped to die. Failing that, I came to believe that I had so little value as a human being, as opposed to the “cancer/infection in Rm 2713″, that I seriously considered suicide. Now, please know that I have infinite respect and gratitude for doctors, nurses and other health care professionals who have literally brought me back from near death experiences on three separate occasions. BUT, sometimes those same extraordinary professionals seems to get overtaken by the anger, frustration and stresses that accompany such a hugely challenging profession. And, when they unwittingly take it out on us, the patients who have entrusted them with our very lives, the results can make a bad situation worse and cause disastrous outcomes. I know that’s not why they got into the business of medicine, and it is a business, let’s be real, but again, in order to give their patients the best possible chance for a positive outcome, I hope that they remember that their “job” is to both cure and heal. Not one or the other. Our very lives are at stake if they do otherwise. You get that. Once you become a nurse, you may be distracted and sometimes forget that. Please don’t. Neither of us want that.

    • Alissa

      Wow, I’m so sorry to hear about your experience. I’m glad that you made it through. Thank you for sharing your story.

      I think you’re right, that sometimes even the best doctors get overtaken by stress and emotion. When I was in clinicals, my grandmother passed away during the last week. I’d been taking care of her for nearly a year, and though she had Alzheimer’s and had gone downhill in the last few months, the suggestion to put her on hospice blindsided me, as just a month or two before she’d been walking with her walker, eating, etc. Anyhow, she passed a week after our doctor recommended hospice. It was a hard week, going to clinicals and coming home to watch her fade away. i hope I did a good job of separating my emotions everyday while I was at clinicals, and if I didn’t, I might have appeared to be distracted or uncaring. But my point is, even though we expect our doctors and nurses to always be 100%, you never know what’s going on in their personal lives, or what happened in the (other patient’s) room they were in prior to yours. I’m not excusing bad treatment, but sometimes there’s more going on than we see.

  • Alissa

    Haha oh man, those stories are the best. Though the initial experience with the bad doctor isn’t fun, there’s nothing better than watching another doctor try to stifle his laughter or annoyance at that bad doctor’s actions or words. And sometimes the bad doctors make you appreciate the good ones that much more. Thanks for sharing!

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