Not there

Assuming I take the same route, it consistently takes me something like double the time to get home as it does to get to work. The other day, as I strolled along, I thought about how often I’m not there in clinic. I am physically there, of course, the numerous sessions of pre-admissions clinic and surgical outpatients that is involved with this job. And I always liked clinics as a medical student, and still do. But with the poorly managed outpatients at this hospital, with patients asked to come in much earlier than they need to, and being understandably frustrated as they wait for many hours, there is an understanding amongst the doctors that an “in and out” consult is a good one.

Over the rotation, I am indeed able to understand the issue at hand, complete a targeted assessment, make a plan, and communicate these things more efficiently to the consultants, to the patient and in my dictations. I’ve learnt something useful, and that’s good. I didn’t realise though, how focussed I have become, in churning through as many as possible in a single session (safely). In doing so, I suppose I am pleasant enough, but sometimes I tune out beyond the key information I need to finish the consult. Almost every patient comes to see us with the possibility of cancer, or follow-up of a cancer, and it is so routine that I forget how personal the journeys are too. The anxiety, the disruption to their lives, the recovery from surgery, living with the side effects of chemotherapy, radiotherapy, hormone therapy. Perhaps, beyond being medically safe and efficient, quality matters in the sense that people matter. In the midst of other priorities, even the most caring, empathetic doctors, can be distant.

I was surprised then, when this morning an opinionated patient thought she should let me know that the last doctor who saw made her feel invisible, like he was seeing through her, like she wasn’t there. Not that he was rude, but she didn’t feel listened to, was upset, and her husband chimed in and said how he had to deal with the consequences of her moodiness. Surprised, because I had been thinking about the same thing, about doing consults as if the person in front of me wasn’t there, or I wasn’t there. Surprised, because the doctor she saw is in my opinion competent, personable, and a good communicator. I don’t know exactly what went on but I think it’s partly her emotions, and partly the business of us churning through people.

What boundless love, what fathomless grace
You have shown us, O God of compassion.
Each day we live an offering of praise
As we show to the world Your compassion.

Compassion Hymn

At church, we sing these lyrics sincerely, but at least for me I imagine dramatic gestures and fail to see how compassion matters just as much, in matters at work in and in daily life. Anyway, how can we show compassion in big ways if don’t begin in smaller, less obvious ways?


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