#IWishMyPatient

I promised Stacey (@coffeemommy) on Twitter that I’d write a blog post on #IWishMyPatient. It’s part of an initiative to foster context, understanding and empathy between doctors and patients (#IWishMyDoc).

#IWishMyPatient

• will give an approximate date rather than an occasion, when asked about when a symptom started. So I asked, “When did you start losing weight?” And she said, “Oh, that was after I went on a trip to the province for my sister’s birthday.” I had to ask a follow-up question, “That was how many months or weeks ago?” It used to bug me (I have no idea when your sister’s birthday was!) but then I realized that’s how people remember things. When my patient can’t remember something now, I’d ask things like – Who was the president then? Was that after Christmas? Was that before typhoon Yolanda?

• will ask questions. The visit is shorter when my patients don’t ask questions but sometimes opportunities are missed. Thyroid hormone tablets are to be taken on an empty stomach so I usually ask my patient to take it 30 minutes before breakfast. I write that on the prescription. It’s also recommended that it be taken only with water, but that I don’t usually write. I had a patient whose thyroid hormone levels were still suboptimal even with the hormone tablets. I asked him if he was taking the tablet on an empty stomach before breakfast. And he said Yes, so I just increased his dose. Several clinic visits later, he asks “Does coffee interfere with the absorption of thyroxine?” Apparently, he takes coffee upon waking up and he takes the thyroxine tablet with it. That cup of coffee is not considered “breakfast” as he take a full meal an hour after. And he thought when I said “empty” stomach, I meant solid food. I apologized for not discussing that with him. But he also said that he should have asked that of me as well.

• will understand when I am late for clinic. I try my best to be punctual but sometimes I really can’t be. Earlier in my career, I’d get to the clinic late and just start the consultation. No word about why I was late. No apologies either. I wanted to apologize but that would take even more time away from the consult. However, as I matured in my practice, I tried that one day. I sat down and said, “Sorry, I’m late.” And my patient said, “That’s ok Doc, no worries.” I do that now and I feel better. Of course, it is better if I am not late.

• won’t always think I’m on vacation when I cancel clinic. I not only hold clinic but have teaching and administrative duties at the university and hospital. I also lecture at various conferences. Meetings, often on short notice, lead to cancellation of my clinic as do classes and speaking engagements. I do go on vacation too! I usually text my secretary when I need to cancel clinic but sometimes I don’t really explain why I will be away or where I’m going. Hence, my secretary is unable to answer when patients ask about my absence. Often my patients would say at the next visit, “You were not here at my last appointment. I hope your vacation went well.” I’d reply that I wasn’t on vacation but that I had this lecture or that meeting. I soon realized that I sounded defensive! I just didn’t want my patients to think that I’d take a day off on their appointment. And even when I had gone on vacation and informed the secretary to tell the patients so, I’d still sound defensive when asked. One day, one of my elderly patients said, “It’s good you took a vacation Doc. You are but human and need to recharge.” Then she joked, “I just prayed I wouldn’t die until you came back but then I could still visit and haunt you if I did!” I’m learning to be more open now about my out-of-clinic activities.

I must confess that this was not a comfortable post to write. But thanks for the opportunity Stacey!