Impatients
2008; Wiley; Volume: 15; Issue: 12 Linguagem: Inglês
10.1111/j.1553-2712.2008.00136.x
ISSN1553-2712
Autores Tópico(s)Complementary and Alternative Medicine Studies
ResumoI remember my white coat ceremony on the first day of medical school. The Dean of Students quoted Francis Peabody’s “The key in caring for the patient is caring for the patient.”1 Ever since, I’ve carried in my mind a fuzzy, one-size-fits-all picture of the patient for whom I can deeply care while treating his self-destructive alcoholism, jumping lice, anal warts, and rotten teeth. Peabody was wise to appreciate that caring makes it possible to persist in our work. However, I feel the quote is too old-fashioned regarding “the patient.” The Latin verb pati means “to suffer,” and patientem is “the one who is suffering.” To be calm and stoic in doing so has come to mean “to be patient” in English.2 The noun and adjective forms of “patient” now stand for different things, but their connection makes intuitive sense. It clearly influences how physicians expect their customers to behave while waiting for test results and morphine injections. Oddly enough, some people are not well versed in the aforementioned linguistics. I call them “impatients” and they make up 95% of my emergency department (ED) practice. “I’ve been here since morning, you could have done a dozen scans already!” is an indignant expression of an experienced American consumer. He is virtually guaranteed to have his choice of coffee flavor brewed to perfection and served in a custom-sized cup in under 2 minutes at Dunkin’ Donuts and 3 minutes at Starbucks.3 The garage takes 10 minutes to change his oil. He switched his 15-minute abdominal workout4 to “3-minute abs”5 just last week leaving 5 minutes to whiten his teeth6 and 7 minutes to grill a steak.7 In my ED, he waited 30 minutes for triage and another hour to see his doctor, and 6 hours later, he is still here waiting for his CT scan to be read by the radiologist. He was charged $600 just for walking through the door, and the labs and imaging will be billed for several thousand. While we usually provide high-quality care, as measured by outcomes and complications, it is easy to criticize our quality of service given the price tag. While focused on making the right diagnoses, upholding the standard of care, and saving lives and limbs, we frankly care less about the customer’s time and pleasure. Meanwhile, most patients want Starbucks-grade pampering. When they do not get it, they are justifiably annoyed. Medical students are not well taught to care for the angry, entitled, and hyperdemanding folks that I see on every shift. I learned to think of them differently. They simply want to be treated like valued customers whose business is appreciated while our systems are built to approach them as broken cars on an assembly line. The ED is designed to be cost-efficient, which is necessary, since many of our patients are uninsured and many are unable to pay their bill. I am proud to work in a place where any person, of any creed, color, sin, or misfortune, will get help with his or her affliction whenever it flares up, a beacon of humanity for the medical field. The patients who will pay us, whether it’s cash, insurance, or Medicare, are sponsoring our utopian business and frankly are entitled to some gratification. Since we never know, and do not want to know, for sure who will pay, good service for all is the right thing to do. Regardless of what I think should occur, even the best running EDs leave much to be desired in terms of service. I cannot control that the neighbor smells, the floor looks dirty, the tech took 15 minutes to bring the blanket, or the nurse made three painful attempts before getting the IV. The last defense is my attitude. A few rules help me negate the customer service–killing aspects of the overcrowded and understaffed, smelly and noisy, but efficient and lifesaving machine that is the ED. The customer is always heard.“Tell me why you are upset. I believe you feel real pain. I know your time is valuable.” When the customer is wrong or stupid, respect his intent and emotion. Saving face can be and often is more appreciated than saving a life. The doctor is never angry. If those borderline tendencies were easy to help, anyone could do it. I take pride in my ability to help these patients. “Let me refer you to someone who understands your situation and knows how to listen.” Always do something nice.“Let me ease that pain. Enjoy some tea. I’ll explain how it could’ve been worse.” It is never hopeless. Sick patients can recover, the dying can be comforted, and the dead were loved by people who appreciate when I care. Undivided attention. There are 11 letters in multitasker and malpractice. Coincidence? Good luck, not goodbye.“We’ll be happy to see you again for this or anything else in the future.” Do no harm with actions and words.“Despite these risks, I believe your treatment will be safe and effective. I would take it in your place.” Just as placebos help,8 nocebos can really hurt.9, 10 Care, and when you don’t, appear to care. Their questions may be pointless, but they want a doctor, and doctors always care. Admit uncertainty.“The truth is, I am not sure if you are OK.” They’ll respect me more, blame me less, and come back before it’s too late. In the ED, my key in caring for the patient is to appreciate and treat him as the patron of my art. He’ll know I care.
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