I really do not understand the way my patients think.

This one lady, for instance, had surgery. She has pain from the surgery. So for the last two days, she’s been asking every doctor who walks into the room why her right side hurts more than her left side. We’ve all given her, repeatedly, essentially the same explanation: there’s a larger laparoscopic incision on that side, and a little more manipulation was done there.

This morning, the same question again: Why does the right side hurt? I mentioned that there had been a larger trocar there, and she said, what’s a trocar? Well, I guess that’s a fair question; I have no idea of the etymology, myself. So, having not much to do this morning, I stopped and explained the mechanics of laparoscopic surgery in some detail: one site, in this case supra-umbilical, for the camera to go through, and several others, spread around the abdomen, for various instruments. Her surgery had required a stapler, so a larger port had been needed on the left. Thus the larger incision, and more pain from the acrobatics needed to get the stapler oriented correctly.  I thought I did a pretty good job: no words longer than two syllables (except “laparoscopic”), layman’s terms, openings for questions, and so on.

Half an hour later, the attending walks in. Same question: Why does the right side hurt more? I couldn’t believe it. What did I miss? Did I give her too much information? Doubtful, since for her elective surgery, I knew she had received several explanations of the precise anatomy, including diagrams. Was it too early in the morning? But it was 6:45am; that’s not horribly early (is it?). Did I use more technical terms than I recognized?

It seemed to go on all morning. I had an attending covering, so the patients weren’t really his. On such occasions, the attendings expect the residents to have everything neatly bundled up before they arrive. When covering on weekends, the attending cares even less for the details than usual. But my patients seemed determined to quiz him about all the minor details that I’d already addressed on pre-rounds. I guess some of them think that the big tall male attending will give them a different explanation than the small female intern. Maybe. But by their conversation, a lot of them seem to think I’m a partner with the attendings; so rank differences can’t be the only thing.

I am coming to suspect that people in the hospital are never very close to rational. Perhaps it’s the narcotics. Perhaps the element of irrationality in almost every patient I’ve had all year (even the nicest still seem to fixate on some irrelevant point here and there) is due to the drugs, and I’ve just never recognized it before. Either that, or the American non-education system has truly succeeded beyond Dewey’s wildest dreams, producing a populace incapable of proceeding from A and B to C. But outside of the hospital, once properly dressed, and returning for follow-up visits, most of these people seem much easier to talk to. Nevertheless, I’m starting to think that it really doesn’t matter how carefully I explain things, because so much of the time none of it seems to stick. The fact that I did stop to talk does seem to remain though, so perhaps simply the lingering impression of friendliness and helpfulness is worth the efforts at coherence and simplicity which seem to fall so flat.

About these ads