Wednesday, December 13, 2017

The caring doctor

Patients often criticize doctors for being unemotional and distant . Because we are taught to maintain a professional barrier , we may seem to be cold and uncaring, but the reality is that doctors have a heart too - we're human after all !
Ironically, sometimes it's this humanness which backfires. Thus, we will often identify with some of our patients - especially when they're of the same age group, or come from a similar background. We sometimes need to break bad news to them , and when they start crying on hearing this, we get emotionally upset as well.  We may then end up saying things to try to console the patient, which he may then misinterpret . This can come back to haunt us , because the patient feels that the doctor was too frank and overstepped his professional boundary.
I recently had a patient who got pregnant after IVF , and I sent her to an ultrasound clinic for a viability scan at 6 weeks, to confirm her pregnancy was progressing well.  Her sonographer was worried that she couldn't see a beating heart, and told her - There is a possibility that this may not be a healthy pregnancy.  The patient broke down and came running to me in tears the same evening , saying - The radiologist told me my baby is dead !
Interestingly, the sonographer is an extremely good doctor who is normally very careful . Because she's a radiologist, she would never provide a clinical interpretation to a patient. Her standard answer is, "I have done the scan and my job is to report what I see on these ultrasound images . It's your doctor who's the clinician , and he will tell you what this means." Interpreting the image in a clinical context is the clinician's job, not the radiologist's, and good radiologist are acutely aware of this fact . So why did she bend the rules this time ?
She could see that the patient was very worried and agitated. The patient had read online that the inability to see a fetal heart at 6 weeks gestational age may mean that the pregnancy may not be healthy. She tried to calm the patient down by giving her some additional information , which the patient then misinterpreted, because she was so upset.
Yes, in one sense, the sonographer over-stepped her professional bounds , but she did that because she's a human being - a  good doctor who is empathetic and who cares for her patient.
I wish patients would appreciate how hard it is to be a good doctor ! It's hard to know where to draw the boundary between being compassionate and being detached. It's much easier being professional and maintaining a distance . We are warned by our professors that we need to be cold and objective if we want to practise properly, but we don't leave our hearts at home when we enter the clinic . When we try to be caring and connect with our patients, sometimes this backfires , as it did in this particular case.
I called up the doctor and told her what had happened. I needed to provide her with feedback , and I reassured her that what she'd done was in good faith, so she shouldn't feel bad about it. Her intentions were good , and her heart was in the right place, but sometimes even well meaning actions backfire. What she had said in order to alleviate the patient's anxieties and reassure her ended up causing the patient even more anxiety, because it's easy for emotional patients to misinterpret what a doctor means. When these messages get distorted, it causes a lot of harm to everyone.
I had to reassure her that it's often hard to draw a final conclusion so early in pregnancy, and that we need to wait and repeat the scan again in one week to check whether the pregnancy is healthy or not.
Patients forget how difficult it can be to be a doctor ! Handling patients who are crying in front of you can be tricky, because you want to be objective, but you also want to do your best to take their pain away - after all, this is why you chose to become a healer in the first place !

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