Posts tagged patient care

16 Stories of the Patient Knowledge Gap

Some of the initial questions I ask a patient are: What brought you into the hospital? What can I do for you today? Tell me your understanding of what is going on?

These questions often sound so arbitrary and so redundant given what are generally provided to us before we even see a patient: We have reasons for referral written in the chart. We have the verbal handover from another physician. We make assumptions of affluence based on a person’s appearance.

However, it is always surprising how often there is a disconnect. For example, I once treated a patient who was a retired internal medicine doctor per the chart. Even as I spoke I realized that he was not following the medical terminology. It turned out afterwards that partly this was due to a language barrier (he was a physician in a different country), he had been retired for many years, and partly because he had some early dementia.

As the stories above illustrate, it never hurts to ask before starting.

HIV, AIDS ward closes at St. Paul Hospital due to decline in disease

The HIV/AIDS ward at St. Paul’s Hospital is closing due to a decline in the once-deadly disease, the B.C. government announced Tuesday.

“This is a proud day for British Columbians as we mark another milestone in our leadership in the fight against HIV/AIDS,” said Premier Christy Clark.

“Thanks to the dedicated efforts of the community, those at the BC Centre for Excellence in HIV/AIDS and health professionals across the province, a ward that once served those dying from AIDS, now supports those living with HIV.”

Bohemian Polypharmacy sung by Aivia, concept by Dr. James McCormack.

James McCormack is a doctor of pharmacy who is well known in Canada for his work in the Therapeutics Initiative, an independent party separate from the government and the pharmaceutical industry aiming to provide evidence-based information on drug therapy.

He is perhaps lesser known for his other side projects, one of which includes making parody music videos surrounding the world of medicine and medications.

In this video, he tackles the topic of polypharmacy.

Being a doctor was once a job with great purpose. Now it's just a business

The ‘free market’ approach to healthcare means seeing more patients in less time. We’ve lost the human connection in health reform.

This is a call to begin a spirited discussion centering on such real healthcare reform. I am not naive to the hard economic realities of healthcare delivery or how civil discussions on reforming healthcare payments need to continue. However, meaningful and lasting solutions will not be found in models that commoditize health and continue to be based on a foundation of reward and punishment alone. They will be found in models that bring back the joy of healthcare to professionals who deliver it – physicians such as me and countless others who seem to have lost the single most powerful driving force – purpose.

A disease is a whole, because one can assign it its elements; it has an aim, because one can calculate its results; it is therefore a whole placed between the limits of invasion and termination.
Audibert-Caille, 1814.
Hospice Care.

A reader asked me what hospice means. To understand hospice, I need to discuss its purpose.

Hospice care is very specific to a terminal patient. It involves palliative or ‘comfort care’ for life-limiting illness rather than curative treatments. It involves professional medical care, advanced pain and symptom management, and emotional, spiritual and practical support based on the patient’s wishes and family’s needs. In Canada, the terms ‘palliative care’ and ‘hospice care’ are often used interchangeably. The word ‘hospice’ is sometimes used to refer to a home-like place where people spend the last days or weeks of life.

I am sick of the pink. This is not pink. Pink is not breast cancer. Look at me. This is what breast cancer is.
A patient’s experience of feeling trivialized.
This has been a patient safety announcement.

This has been a patient safety announcement.

Fixed!
Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.

Fixed!

Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.

The Burning Flush of Confrontation

I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.

The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”

I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.

Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.

However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.

I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.

When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.

The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.

Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.

Were you ever involved in a confrontation? How did you deal with it?