You know you’re in medical school when school doesn’t cancel for a foot of snow mixed with ice. No questions, no possibilities: everyone arrives – on time.

After several weeks with private doctors, I am listening with renewed horror to the interaction of staff/academic doctors with their patients. Or rather, the lack of interaction. How is it possible to lead a train of residents into a patient’s room and start discussing certain factors which might lead a person with the patient’s condition to have a very bad prognosis, without really introducing yourself or anyone else, or explaining why you’re there, or what you’re going to talk about?

Today the cardiology team was consulted for a patient with suspected infectious endocarditis. There are a couple possible sources for his infection, which his several physicians are all still rather confused about. The patient himself, when we met him, appeared to have very little idea why he was in the hospital at all, let alone that he had bacteremia, or needed an extensive cardiac workup. Admittedly, he’s not the brightest guy on the block; but he wasn’t comatose, and he wasn’t unwilling to communicate with us. (Except insofar as an elderly man with no teeth and an Indian with a thick accent are hindered in communicating with each other. I tried to straighten out two or three of their most egregious misunderstandings at crucial points in the history, and had to let the rest go.)

The team walked in and out two or three times, and the second attending to be brought in announced to the patient that he needed a TEE (trans-esophageal echocardiogram; better than trans-thoracic for detailed images of the heart, especially the valves), and so would not be eating for the rest of the day, and did he consent to the procedure? The poor fellow looked so puzzled, quite willing to consent to whatever we wanted, but hardly understanding what he was being asked to consent for, let alone why. So I said, He hasn’t really been told about the bacteremia or anything, or why we need to do this test. Dr. B didn’t really appreciate that interruption, but explained briefly that there were bacteria in his blood, and the nature of the test we needed. And the patient agreed.

How could his primary care team not explain the bacteremia to him? How could nobody tell him about the test results that made us suspicious of vegetations, before sending this crowd of cardiologists in to demand more tests? How can you not tell a patient about a situation which could result in emergency heart surgery? Maybe you don’t have to explain at the beginning that he might need surgery, as long as that possibility is still remote. But with such serious issues in play, frequent explanations are pretty important!

So many doctors give overly simplistic (or non-existent) explanations to patients, and then are frustrated when other patients are unable to give them a meaningful history of what happened at the other specialist’s office, or what procedures were done at another hospital a few years ago. If we expect to get any information back from the patients, we have to give them meaningful and digestible information ourselves. Tsk. No doubt these scruples will only last until I fall behind on morning rounds or clinic a few times, and then I’ll be just as brisk as the others. I hope not. I used to hate the phrase, “seeing the patient as a whole person.” But now I understand that that’s just bureaucratese for, being polite to the patient as a human being, not just a pathological specimen.

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