Sunday, September 16, 2007

my patient's patience

"we should get those results to you today"

as soon as I heard those words from another resident, I knew it was too late. we were explaining some test and the approximate time frame when the results of said test would be known. I turned to my med student.

"today! you realize that we have just doomed ourselves to finding out those results and letting them (family) know. actually, I think she just doomed you, because that kid is your patient."

and they say I'm too nice to my med student... In all reality, it really sucks that we setup these unrealistic expectations once a patient is admitted to the hospital. I thought for a second during my own medical school that such practices were limited only there, but it was really an afterthought. After all, what patient or parent would NOT want to be given the answers and solutions to everything once they set foot and set up camp in a hospital bed and room? after all, you are now in the big great academic hospital (which shall remain anonymous).

this sort of reminds of the movie Sicko, where one explaination I read somewhere suggested that our insane health costs are partially to blame on the expectation that the American people demand and our own culture of fast food medicine. we want answers to everything, and we want them fast. if we are discharged from a hospital stay, we damn well better give them a magic elixir to solve them, or else ligitation reigns supreme.

unfortunately, medicine is very much the opposite. in many cases, we are trying to undo the years of bad health and this is only where we know what is going on. many other times, we have no idea what the hell is going on with our patients. We rule out all the immediate badness like cancer, infections, vascular abnormalities, cardiac oddities, and other quick kills, and discharge you home to follow up with your general practitioner and specialists. if it's something possibly rheumatologic, then it will show itself in a few months, or maybe not. lab tests are sent out and if they miss a courier time, then it's another day wait. our lab vampires suck out several tubes of blood and leave the patient's arms and legs all bruised, yet no one gets a chance to fully explain that some of those tests may have to be redrawn tomorrow.

I'm still learning, but I do know what my expectations should be now. Fortunately for that patient, the MRI results came back later that evening. I think I'll start setting up false expectations now though. it's like the directv guy telling you he'll be there at 3pm and showing up at 2.