I walked into a patient’s room and noticed the hospital has supplied a fold up stool hung on the wall labeled “For Physicians.”
I shrug. I take it down the stool and open it up and seat it next to the patient’s bed. I greet the patient, and we discuss how he feels and what all is transpiring and planned for the day. He feels cold, nervous, pain in his back, not hungry, overwhelmed, and worried. I reassure and give answers and leave hope. His shoulders relax, and the blanket covering him lays more naturally at ease. That is my queue. I fold the chair back up and hang it on the wall. I walk out. The nurse says, “I’ve never seen anyone use that thing.”
Years later I write an article about the bedside and the physician’s need to reclaim this role more explicitly and obviously. The reality of modern medicine challenges the notion of physicians “taking back the bedside.” Time is a constraint because we are too busy to sit too long or to come back physically. The roles of physicians have expanded so sitting at the bedside is only a small visual part of what needs to be done to doctor these days.
Others lay claim on the bedside because they are seemingly more present and seen. Yet the bedside is something intangible. Yet physicians still have these intimate dealing with illness and death. Yet no one is talking much about the physician’s “bedside” existence with conviction. The stool stays on the wall unused. Perhaps some other kind of care provider claims the stool and places a label on it declaratively. Perhaps the stool just disappears because the bedside intangibles get completely disregarded by the evolution of modern medicine away from relationships and toward outcomes and algorithms.
Perhaps the word choice is wrong. Perhaps I should rally the public to see physicians at the #worryside or the #responsibleside. Perhaps this will not offend or negate all that take time at the physical bedside. Perhaps this will just emphasize better the roles physicians try and are asked to play in patient care still.
Physicians are currently responsible for planning and executing solutions for patient problems. I saw a rheumatologist once as a patient, and after listening to me, she said, “I want to fix you.”
Simply put, she was moved as all physicians are to fix problems. She invited the responsibility to achieve a fix for me. Physicians are in the end responsible. The public says they are because when things of any nature fail the physician will become the last say or the last responsible party. Physicians accept that obligation in so far as that responsibility is paid back with true regard and appreciation. It is very hard to be the bottom line. It is harder when patients are unkind and ungrateful.
Physicians worry a lot. We worry if someone will feel better or cope better or survive trials and disappointments. We worry we did not do enough and the right and timely thing. We worry we missed something or were misunderstood. We worry we didn’t worry enough or at times at all. Worry becomes how we know we care and caring becomes how we keep doing an intangible job with so much responsibility.
Worry and responsibility are fueled by living off the success of a strategic plan and the success of delivering help. We care about patient satisfaction and outcomes. We care if someone hurts or is helped so much so that someone not doing well effects us in ways scarring but someone doing well fuels us on. Ask any physician why they continue, and they will in some way say because one smile of someone doing better or an actual moment of lessened human grief, pain, burden, tension seen in a patient’s affect feels like a victory.
The rally for physicians to reclaim the bedside is not to exclude all that sit or care or worry. It is to refocus and reidentify what the physician is doing in patient care or rather what the physician should continue to do if the system is challenged and evolving. The bedside is intangible. For purpose of debate it can be renamed the #worryside or the #responsibleside.
The point is physicians provide a value to society that cannot and should not be so easily cheapened or disregarded. It is an imperative we have clear understand of what the stool in the room represents. Physicians must distinguish what they provide or perish. Upon their exit, physicians take with them a way to connect with humans that humanity cannot suffer the loss of.
Jean Robey is a nephrologist who blogs at ethosofmedicine.
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