Saturday, November 24, 2012

Day 161 - what patients want

Today was notable for two open studio visits, lots of time with Emily, a plumber visit and getting to eat the leftover cheese from Terry's fancy spread.

Ellie's ceramics teacher, Kit Cornell, was having her open studio today so we went over pretty much as it opened and took a tour around. I bought a tiny Christmas present for Dan and am considering a return visit. She makes lovely things and it was fun to go with Ellie and have her point out what she liked and why. Next stop, Emily and I went to Terry's building's open studio. First we admired Terry's studio and then we toured the rest of the building. Terry gave me a large water color by Fran Mallon a couple of Christmases ago and she has made little tiny prints of it and has them in miniature frames. It was very funny to see the picture from my living room wall sitting on a table in her studio. We stopped by to see Lisa Noonis as well and had a nice conversation with her husband. They were tied with Terry for the best food in the building--they had artichoke hearts and nice olives with their cheese and plain crackers. Terry had several kinds of really delicious cheese and both plain and fancy crackers. We also were on a bit of a mission since Emily got her ears pierced to find nice earrings for her, but nothing was quite what she imagined.

My next act after lunch was to take Ellie to her friend's house and then to come home and wait for the plumber. I'm sure you won't be surprised to hear he came in the last half hour of his three hour window if you have ever waited for a plumber. Problem solved, however, and pretty quickly so we're happy. When I see a plumber I always think of our plumber in Berkeley, CA who had a PhD in something, but worked as a plumber because he made more money that way. He told us that all he really learned in plumbing school is that things flow downhill and not to eat the last inch of his sandwich. We didn't have to call him in too often in the five or six years we were homeowners there, but we saw him more than once and that must be his standard schtick because we heard it each time. I didn't mind; I thought it was funny the second time too.

Then Terry brought home what was left of his cheese tray and with smoked fish and Beach Pea bread, it made a great dinner.

Hey, remember my last hospitalization? The one with the fevers, not the really bad fevers, but the second one with fevers? I've been thinking about that discharge recently and the resident said to me, "Well, we're done and you could go home tonight or tomorrow; it's really your choice." Back when I was a hospitalist, I would sometimes realize that some one was ready for discharge a little sooner than I had anticipated. The first few times this happened, I would work hard to get them out earlier than I had planned, but after a few times I stopped and would just have them stay until the morning as initially planned. The reasons I made this policy decision for myself were that I thought I was more error prone if I changed the plan and I thought I looked scattered and disorganized if I changed the plan suddenly right before discharge.

Those are good reasons and I don't know for sure if people are more error prone when there is a sudden change in plans, but it feels like I am. Now that I have seen it from the other side, I can say honestly that the docs don't really look scattered or disorganized (at least not to me, but I may be more understanding than your average bear); things change and it's a complex world we are operating in, plans can be fluid. In my opinion, the main thing to look out for when moving a discharge forward unexpectedly is that the patient doesn't feel abandoned. People who know me well will know that this is one of my "issues"; I am inclined to feel abandoned when other people might not, but the sudden offer to be let out, combined with "it's your choice" made me feel like the resident didn't really care what happened to me. "Stay, go, it's all the same to me. When I come in here tomorrow morning to round, I don't really care who's in this bed."

It's interesting to listen to doctors talking about their philosophy of patient care. Recently, I was listening to an EPEC CD and the speaker said that he felt what patients wanted more than anything from their doctors was to know their doctors loved them. This is only kind of true for me. I want to feel that I am important to my doctor, but only for the doctors I really like; most of them need only offer competence and courtesy and I'll be satisfied. Some one else I heard recently (and cannot remember who it was) said that what patients want more than anything is "to know that their doctors will not abandon them no matter what." I thought: that person is right on--a man after my own heart. Our resident above failed in both of these. (I don't mean to be too critical of him; just using his lack as a spring board for thought. I know residents work very hard and are pulled in twenty directions at once.) The funny thing about all of these statements is that just like there is not one monolithic doctor who wants one thing above all others, there is not one monolithic patient who has a simple, single desire. Or if there were, it might be to be known and understood so that whatever idiosyncratic needs one had could be met.

For tonight, I would like to wish for less intensity on the abandonment issue for myself. For you, I will wish for you to be known and understood. I think it's nice for people who aren't patients too.

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