Yes HANS DUVEFELT
Today a patient told me that a cancer doctor had told her husband that he had only one year to live. She was angry, because she felt that this statement stole hope from her husband and she knew well enough that the doctors did not always know the prognosis of a patient with such a statement.
“I’d like to know if you’ve only had one year to live,” he asked me.
I thought for a moment and then replied that I probably want to know. I explained that I would like to make decisions and decisions because I live alone and am responsible for my animals. Like I said, I’m well aware that if I were left dead now, things would be pretty chaotic for a while.
Two and a half years ago, I wrote a post titled Be the Doctor Every Patient Needer. In this I presumably invented the phrase I posted later just above the sidebar of this blog:
Osler said “Stay tuned to your patient, he’ll tell you the diagnosis.” Duvefelt says “Stay tuned to your patient, he’ll tell you what kind of doctor he needs you to be.”
I always believe that we need to be incredibly sensitive to all the verbal and non-verbal cues that our patients give us about what they need. In my 2018 post, I used the analogy of being like a chameleon. It’s not the same as being dishonest. It’s about knowing that your education and your degree give you an authority, an opportunity, and an obligation to use your position of trust in your patient’s life to say things they will feel to continue or perhaps to take the first step in a new direction. We all wear the cloak of a superhero in a sense, and we can use this symbol for good. But this carries the responsibility of using our powers prudently.
We should try to get to know our patients well enough to know what they need. These things are rarely apparent from the medical record. They are subtle, subjective, and often to some degree flow through the course of time and the course of life and illness.
The other day, a colleague who was scheduled to see a patient of mine who I was unable to accommodate in my program asked me if there was anything she needed to know before seeing this patient. What I did, in less than two minutes, was explain this person’s track of resources, understanding and following.
These qualities or abilities in a patient should determine our behavior and care planning. Sometimes I have a very busy schedule because I think I know when I need to monitor every step in the treatment of some patients or get lost in terms of what to do and maybe even get lost for the entire follow-up.
When I think of medicine as an art, I see art in people’s reading and art in the application of basic treatment principles in an individualized way. This takes time to learn and refine, and sometimes requires extra time in meeting patients. My goal and desire in practice is to automate and delegate the many mandated aspects of health care so that I can focus on what only a treating physician can do: Combine all objective and subjective data, develop a plan of treatment that makes sense for the patient and helps them see the direction and steps needed to implement that plan.
Another phrase that I invented, perhaps as presumptuous as the first one I quoted, and that I tried in my head a while ago (I can’t read the reaction I had) was “I am an artist, not an accountant». I think that’s what my patients need and are looking for.
Hans Duvefelt is a Swedish-born rural family physician in Maine. This post initially appeared on his blog, A Country Doctor Writes, here.