YOU’RE the patient

PUBLISHED ON  April 7, 2015

WRITTEN BY  Roni Zeiger

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Yesterday while working in urgent care clinic, I had a great opportunity to talk the talk. I was with a man whose abdominal complaints we still haven’t figured out. While discussing the possibilities, he said, “You’re the doctor” — implying we should do whatever I think is best. I took a moment to share with him that I don’t know what’s best and that his insights are critical to help guide us. “YOU’RE the patient,” I said, smiling. We are a team.

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A few patients later, I walked into another room, this time a young man was on his smart phone. “I’ve been researching this a lot,” he said, “and I think this is what’s going on with my shoulder.” I’m really good at talking the talk. However, when I heard this, my immediate reaction was: I’ll be the judge of that. I noticed that unspoken reaction of mine, and said something very different. We had a lovely interaction and I think he was right about his shoulder. But I’ve been reflecting on that initial reaction I had, and how engrained our expert-centric culture is. There’s a long path from talking the talk to walking the walk.

Blame

PUBLISHED ON  March 18, 2015

WRITTEN BY  Roni Zeiger

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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.

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Confession of a dishonest physician

PUBLISHED ON  February 16, 2015

WRITTEN BY  Roni Zeiger

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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.

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