When I get into an Uber these days or have a decent conversation with someone I haven't met before at Scouting events invariably the conversation turns to medicine. As soon as I say I'm a doctor ("an endo-what-now? That's the one for the kidneys isn't it?") one of the below follows:
A formative episode for me took place a few years ago when I was a medical registrar at a country Victorian hospital. With no specialty physicians teams, everything non-surgical came under us, including drug overdoses. A young female patient who was addicted to benzodiazepines (Valium being the most well-known trade name) was at high risk of withdrawal seizures and so instead of going to the psychiatric ward was admitted under our team. Unfortunately as is all too common in these situations she was what the nurses would call 'a difficult patient'. Demanding and less than polite the poor nurses, whose bread and butter was old, poorly mobile patients with memory issues, didn't know what to do with her and this inevitably led to conflict. I, and my resident in turn, continued to treat her as we would any of our patients, leading to her asking at the end of one round, "Why are you being so nice to me?" In retrospect this no doubt said more about she and the way she had been treated in the past than our care, but we thought little of it. On exiting the room, however, we were mildly berated by the nurse in charge, "If you give these people an inch they'll take a mile you know. You have to be firm and you can't be their friend". That afternoon there was more conflict, our patient leaving the ward multiple times to smoke, a nurse having to go with her each time, and demanding more than her charted maximum Valium dose, the nurses valiantly refusing. It was into this tense environment that we brought our consultant for the afternoon round. A tall silver-haired professor, he had made his name in the city but moved to the country in his later years where the golf courses were plenty and the on-call hours few. Having been briefed by us he sauntered into the patient's room, his lower belly paunch at odds with his almost military gait, greeted the patient, and sat down in the visitor's chair. After a the pleasantries were exchanged our patient faced Prof and asked pointedly, "Do you like me?" We all held our breath. Wiping the silver curtain of hair from his forehead our consultant chuckled, lay back in the chair putting his hands behind his head and replied, "What I would like is for you to get better". Immediately the tension melted palpably and a 15 minute entirely non-medical conversation later the issues were seemingly resolved. Of course a peace cheaply won never lasts and within a few days our patient got into a fight with a nurse and left the hospital; at least the riskiest part of the withdrawal was over and her seizure risk was minimal. To me this episode epitomised the art of medicine. It was the distillation of a keen sense of the situation, a rapid assessment of the real issues at play, followed by addressing the patient's real concerns in an entirely non-threatening way. My answer to the question that prompted this navel-gazing will change in time but I'm sure this lesson will stay with me the length of my career.
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