Wednesday, June 12, 2013

Being an attending physician

This article in the NYT today (free with registration) reminds me of something one of my first patients in Exeter said to me, "If you are going to be my attending physician, the thing you will need to do for me is attend. Don't just do something, stand there." When I started in Exeter, I took over the practice of a beloved physician who had been there for eleven years and left to live closer to her aging parents. A few of her, now my, patients didn't even come in to meet me, just went off and found new doctors right away. A handful (I specifically remember two, but there were probably more) met me once and decided it would not be a good match and went off to other doctors. Many made it clear the first time they met me that they were checking me out and if I didn't meet their expectations, they would go find themselves a new doctor. Most of this group decided pretty quickly that I would do OK. My style and the old doctor's style were fairly similar which helped a lot. The patient above, who was well over ninety when I first met him, was one of the last group. I am not even sure as he left after our first meeting that he had decided he would keep me, but ultimately he did, dying two years later in my care suddenly at his home.
In our time together, he taught me a lot, including much of what I know about advanced care planning. He had thought extensively about what he wanted at the end of his life and was the first person to tell me that he did not want under any circumstances to spend a single day in a nursing home. If he entered the hospital for any reason and I thought he was going to need to be discharged to a nursing home even for a few days of rehab, he did not want any medical support at all; he preferred not to survive if nursing home would be the result. He was very adamant about this. He was worried about having an illness that would weaken him so that he could not be independent, but not take his life. His wife had spent years in a nursing home and he was very afraid of a similar fate. He had had this same conversation with his cardiologist, too. And just in case I had any doubts, he would remind me of this conversation from time to time. Did I mention he was a retired physician?
As I stated above, he died suddenly at home after laughing at a joke. I think of him often, especially his reminder of the true meaning of "attending physician." Just attend.
I attended a football game a long time ago where the sharp eyed will see Emily in the formation.
I am grateful for all the lessons from my patients over the years. I am hopeful that I can continue to pay attention and learn from them.

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