Thursday, August 2, 2012

Day 47--update

Tomorrow is back to chemo jail (and probably more on that later) but in the meantime I can tell my brain is trying hard to synthesize the experiences it's had so far and last night while I was trying to fall asleep, it brought this up.

I can recall two times for sure and think there were more when a doctor asked me a question that could have a short (one to two words) answer or a long (three or four paragraphs) answer. Being aware that doctors are busy people in general, but that sometimes work is piled up and sometimes it's sparse, I ask in this situation, "That could have a long or short answer. Do you have time for the long answer?" I think if a patient presented me with this, I would say "Of course, I do!" I only asked this question of a few doctors because there were clearly doctors who would like all answers to be given in less than one syllable and these doctors would get the short answer without question and there were other doctors who I was comfortable enough with that I just talked and didn't consider what I was going to say before it popped out of my mouth.

Anyway, for two out of two times that I can for sure remember the details of, the request was for the short answer. This seems a pity--a real lost opportunity. One time was for a doc who only saw me once and with whom I didn't need to have a relationship at all (unless something had gone wrong that night, then a relationship would have been very comforting). The other was with a regular member of my team who had a meeting to get to that day and thus was too busy to hear the long version of the story.

I've said part of my piece before about how one of the most important tools we doctors have for healing our patients is ourselves. With the drive by doctor, s/he did their thing with me, wrote their note and got on with their shift. Nothing life threatening happened to me that night, but it could have because my clinical situation was a little unstable at that point (and the drive by doctor had no way of knowing how likely it was that something bad would happen because this was a new development). If I had developed a life threatening condition later in their shift, I would have had no choice but to be treated by a person who had passed up on an offer to find out a tiny bit about who I was. How could they possibly treat my life threatening condition when they didn't know (and had turned down an opportunity to find out about) my life? Maybe they thought I would be still describing my childhood on the farm twenty minutes later, maybe they thought once they unleashed the demon chat that it would never be put back in the bottle, maybe they really did have a patient somewhere else in the hospital who really needed their attention. None of that have been at all relevant if I were the patient being transferred to the intensive care unit (which fortunately I have never been).

So, maybe I should just not offer people a choice and decide to give everyone the quick answer or to force everyone to understand an extra three paragraphs worth of material about me. (you've just done it--it's not that painful, right?) For me to make this decision feels like a lost opportunity for me (and for them). The docs I make this offer to are the ones I have not decided if I am comfortable. Hearing "yes, please spend a few extra moments telling me about yourself" would have answered the question for me forever. This would have been a doctor I'd forgive almost anything of down the line. Hearing "I'm too busy right now (especially with a good excuse), but would love to hear it later" if followed up even briefly the next day would have the same result. For the doc, to express interest in a patient and have it not take an extra twenty minutes (which it wouldn't in my case) might be a practice altering moment.

Well, I'm going to try to continue providing those practice altering moments to the docs who take care of me. May I recognize those the world offers to me. 

update #1
chemo jail starts at 1 pm tomorrow. I'll go find the suitcase.


  1. I'm not sure I'll have an opportunity to post tomorrow when you are taken captive by the warden at chemo jail. So please know that all your fans with "moi" at the top of the list. Just for the record I hated French. Yes, those of us that think you are the coolest and most humble person/doc out here in civilian land are with you in thought, spirit and prayer as you head out for another stint of jail time. You'll be on parole soon enough, my friend, so chin up for the five days ahead. Rest easy...we've got you covered.

  2. thanks for the nice compliments, hopefully I can fit my head in the car for the trip to Leb. Enjoy the summer extra for me, OK?

  3. important note to self. :) notes taken :) I will listen more :)

  4. I just recently decided not to see a particular doctor again because no questions were asked and any attempt I made to ask questions was talked over and answered before I finished so were not actually answered. You are a great listener and my answers and questions and concerns are rarely short. LOL!

  5. I was told about a really interesting study when I was in med school which I took to heart. Someone taped a bunch of doctor patient interactions and calculated the average time to interruption of a patient was crazy short, like maybe 5 or 10 seconds. Someone else or maybe the same person, then taped patients with doctors not interrupting them to see how long the patient would take to get all the info they wanted to out and it was also surprisingly short, like maybe 45 seconds. Those 40 seconds can make a tremendous difference in how people feel. I have honestly had the experience once of asking a patient a single question and having them talk for one hour without needing any further prompting from me. I think I nodded and "I see"'d at times, but they had a lot of information for me. It was a hospital patient and it was actually all stuff I needed to know so it may have been one of the most "efficient" interviews I've ever done, if non-conventional.

  6. That's amazing! I had an experience when I was 18 that really taught me how to advocate for myself and though I am mostly a very flexible and agreeable person if my health is involved I just don't stick with doctors who won't listen to me. I had mono for 3 months. I asked for a mono test right at the start because I'd heard other kids had it then. I had many doctor visits, antibiotics (thrush followed), tagamet and I was miserable. Every visit to the doc was short and ended in a new RX. My anxiety levels were through the roof! I wish I'd known about meds for that back then! Finally, the doctor I was seeing wasn't available and I saw his partner who said, "Let's do a mono test. I'll just go get my vampires." He's a funny guy. Sure enough, I had mono. All meds were stopped, vitamins prescribed and I was sent home to rest. I always specifically requested this doctor after that and whenever I somehow ended up with the other guy it was always a bad experience. I started writing things down prior to visits if I knew I was seeing him. His partner was much more popular so hard to get in to see. So now, if someone shows signs that they don't want to listen I just stop going to them.