Blame

PUBLISHED ON  March 18, 2015

WRITTEN BY  Roni Zeiger

4 COMMENTS  Join the Discussion

SHARE THIS POST

Our training as physicians is about healing, usually conceived as fixing. Many of us struggle with what we cannot fix, which of course in most medical fields is the rule, not the exception.

The language we use speaks volumes, especially when spoken to patients. In oncology for some reason, we frequently hear: “the patient has failed [treatment x].” Doctors don’t usually say it this way to patients, but they hear it and feel it, consciously or otherwise.

In a novel I happen to be reading, the protagonist hears this from her physician after multiple miscarriages:

The doctor had a name for what had happened to her babies, and he threw it at her with unintended cruelty during the final visit. “An incompetent cervix,” he pronounced. “You can keep on conceiving, but I don’t recommend it.” She sat perfectly still, her hands clenched, her jaw stiff. She was defenseless. She couldn’t imagine ever feeling carefree again.

Our collaborative future in healthcare is one where we neither blame the patient nor the physician, but as a team do our best to understand our challenges and how best to approach them.

shift-blame-flickr-cyberslayer

Confession of a dishonest physician

PUBLISHED ON  February 16, 2015

WRITTEN BY  Roni Zeiger

3 COMMENTS  Join the Discussion

SHARE THIS POST

I’ve assessed the patient, we’ve made a plan, and they’re being discharged from clinic. Now I’m at the computer writing my note, deciding how the story will be told. The thing is, I have a conflict of interest. I want to be the hero, the one who asked just the right question and guided the patient to the appropriate treatment.

At a minimum, I don’t want to sound dumb.

I’ve been trained to get good grades, earn praise. On rounds as a trainee, to describe physical findings and construct a thoughtful differential diagnosis to professors and fellow students. Now when it’s just me documenting the truth in the medical record, how can I resist? I confess to claiming I asked a question which in fact I forgot to ask. I confess to omitting from the record a comment that doesn’t fit well enough with the diagnosis I made.

I want my story to be smart. But the real story has a far more interesting tension between the categories we wish to fit people into and the messy details of their experiences and needs and priorities.

flickr-confession-freeparking

Transparency and beautiful data

PUBLISHED ON  January 3, 2015

WRITTEN BY  Roni Zeiger

2 COMMENTS  Join the Discussion

SHARE THIS POST

compost-transparencyAll the talk about transparency in healthcare will eventually make a difference. Much current focus is on price, because we know how to measure it. Quality is harder because we don’t have enough randomized trials to prove what really works and because data in our healthcare system is still a mess. This will improve, especially as we learn to analyze big data to answer questions in a more scalable (if much less perfect) way than randomized trials can.

In the meantime, let’s not forget that data can teach us what questions we should be asking in the first place. At home, we mused about this while enjoying our new composting bin in the kitchen. It has an accidental transparency feature, which lets us observe what we’ve been eating, and ask questions like… Which are the healthiest fruits? What food don’t we put into the compost bin (what data aren’t we measuring)? How can the beauty of this data inspire us?