My mind used to float from one thing to another during clinical school. I spent a great deal of energy observing the sights and sounds of hospitals, the attire and attitude of doctors and nurses, their interactions with one another and with their patients. Sometimes I wondered what it was like on the other side of the bed. If the students that shadowed our teams watched us so closely, and thought so much about how we talked and what we said, I think I’d be rather squirmish.
For a week I had annual leave for “no reason”. For the first time I didn’t go anywhere, I didn’t plan a trip beforehand, it wasn’t post nights, I didn’t have any celebrations or special events to attend, and I wasn’t even particularly tired of working. But as it happened, I have been in the hospital every day anyway as a visitor. Often you read those articles of cold and heartless doctors suddenly finding themselves in the patient’s or relative’s shoes – this is something similar. Although I’m not going to assess whether I’m cold and heartless here, ha. There’s many things that could be written about with the whole thing but here’s a few thoughts.
1. There is a lot of waiting – waiting in the emergency department, waiting for theatre, waiting for a bed on the ward after theatre, waiting to be seen at the clinic. We were expecting to wait but if you thought hospital timing was predictable, or if you parked in a 2-hour free parking thinking you’d be in and out, then I guess it can be pretty frustrating.
2. Conveying information – there were some good communicators, but during one of the clinic appointments you had the classic thing of several registrars and consultants doing the physical examination, then talking about it in medical jargon, then everyone leaves. It’s as if we needed to read the file to see what they really thought was the problem, treatment plan, and prognosis. I think it’s only when the doctors realised that I worked there, because I asked doctor-y questions (unintentionally), that they explained in a bit more detail.
3. Medication mix ups – I tried to be minimally involved for most of the part because I figured that it might be uncomfortable to have someone look over your shoulder constantly. So I sat back and read, and didn’t say much, but I glanced at the chart and saw an antibiotic that was meant to be given hours ago. “Um… I don’t think this IV antibiotic has been given yet, and it was due several hours ago?” One nurse told me that the reason for not giving the medicine was that it reacted with an oral antibiotic that was also charged. But they didn’t ask the doctors about it. I said I didn’t think there was a contraindication but she should check with the treating team, and so she asked me (as the patient’s relative) “okay, should we give it then?” Later one of our friends who was visiting socially was asked the same question because she worked as a doctor at the hospital too. Actually it wasn’t about drug interactions at all but the rather large intravenous dose was charted as intraocular or something else so couldn’t be administered. On another occasion, we pointed that the same medications were being administered because a new one was written but the old one wasn’t crossed out.
4. Ethical constraints – I found this to be the hardest part, especially with other crazy (okay, worried) relatives saying “can’t you do something?”. I make medication errors too, but ironically if it’s on anyone else’s chart it’s usually quite straightforward to pick up a pen and change the route, dosing, or whatever needs to be fixed. Yes, sometimes other doctors don’t explain their thinking too clearly but you can (often) read their notes. Or you can phone or page the relevant people to get an answer. It’s tricky as a patient or relative – so do you request to read the notes? Even if you don’t, often the progress notes or bedside charts are in front of you anyway, so do you look at it or not?
5. You’re always wrong – since studies show that up to 90% of the medical diagnosis is based on history alone, I’m not even going to talk about the equipment or investigations you lack, or the unlikelihood of you doing a thorough physical exam in a non clinical setting. Even the history taking part is not the same. Some patients do this too, but I think family are more likely to exaggerate or downplay symptoms and force their interpretation on you, rather than treat you as a healthcare professional. Your advice to see a doctor is often dismissed, because you are a doctor. If there are delays as a result of this, you weren’t pushy enough. If something goes wrong, family are the only normal people around who will not only your tell you exactly what they think of your work and clinical skills, but also how this relates to your inadequacies in attitude, character, life decisions, and basically everything.
Maybe I’ll add to this list as the days go on. It’s an unfortunate foretaste of the inevitable days to come when parents age and these brushes with the other side, or the other world, becomes more frequent.
“…But as soon as he falls ill, as soon as the normal earthly order of his organism is disturbed, the possibility of another world begins to become more apparent, and the more ill he is, the more closely does he come into touch with the other world.” – Dostoevsky, quoted in Oxford Handbook of Clinical Specialties