Thursday, October 30, 2014

Six month follow up.




*inner thoughts in italics

Me

"Good morning. Long time no see."

You

"Yeah, I know. And before you can say it, I know what you're thinking. I'm working on it."

Me

"Um, okay."

You

Just because you're the doctor doesn't mean that you know more than me. Just because you have all those letters behind your name and that white coat and that embroidery on your pocket doesn't make you the authority on all that should happen with me and my body.

I get a say, you know. I do. And whether you like it or not, I will.

Me

Sometimes you perplex me. Sometimes I wonder why, if you already felt so set on what you want or what you thought or what you think, that you sought my opinion. Sometimes I wonder if you even wanted to know my thoughts on you at all. Sometimes I think it feels like you're trying to bully me. But I have to make an assessment based upon everything I see and hear.

Even if you don't like it.

You

Your answer to everything is that I need to lose weight. My sugar is too high, so I should lose weight. My blood pressure is up so I should lose weight. My back is hurting so I should lose weight. My sleep isn't good so I should lose weight.

You know what? You could probably stand to lose a few things, too. Starting with that attitude. If I didn't need my prescriptions, I'd never see a doctor again.

Me

So what would be your preference? Would you prefer that just ignore the fourteen pounds you gained since the last time you were here? Would it be more ideal for me to simply refuse to factor your body mass index of thirty something into the medical problems that I know for certain are worsened by that fact? Should I not even try to implore you to rage against those extra pounds since I know for certain that doing that will do more for you than any pill or prescription or referral I can write for you? Should I? Or should I not? And tell me, should I simply shrug my shoulders and say, "Oh well" when I get a call from the inpatient hospital doctors informing me about the cardiovascular event you just had? Should I shake my head and say, "I tried my best" and go on to my next patient? I mean, to preserve our relationship as doctor and patient and also to preserve my sanity--should I?

Tell me. Because I'm running out of answers. And my empathy is on fumes.

You

Here's what I think: Coming to the doctor shouldn't feel like a lashing. When I see you, I feel like you just pulled a switch off of a bush right before you walked into the door. Your eyes look disapproving and your chest heaves in and out like I'm some sort of lost cause. Then you start making all of these recommendations and horrible predictions about what could happen if I don't do what you say. My legs are bloody and scarred from your lashing. Which makes me run away and vow to never come back.

Ever.

Me

Did you know that I don't have all of the answers? Like, I don't. But if I did, you know, have answers to all of this and if I did, you know, have a way to get you to hear what I'm saying without it feeling like I'm insulting you or raining on your parade, I would. The truth, though, is this. There are eight more people I have to see after you.

And you need to lose some weight.

You

Just give me my prescriptions.

Me

Just take your prescriptions.

You

I'm never coming back here again.

Me

I wonder if that patient will ever come back here again.

You

"Have a good day, doctor."

Me

"Six months for follow up?"

You

"Yeah. Okay. Six months."

***

For the record: We are all works in progress and we all fall short. A lot. Sometimes we get it right. Sometimes though? Not so much.

Yeah.

***
Welcome to Thursday.

14 comments:

  1. You listen. You understand. It's hard.

    ReplyDelete
    Replies
    1. It is. Some days are harder than others.

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  2. How about asking your patient to promise to eat 1 apple and drink 1 glass of water each day and you promise not to say anything about her weight. Then the next time she comes in ask if she could manage to eat a whole bunch of celery in a week, maybe 1 stalk per day in addition to her 1 apple each day. And add another glass of water each day. It may help.

    ReplyDelete
    Replies
    1. I like this suggestion. Thanks, Florence.

      Delete
  3. Is it just that it's a Grady clinic, or is this a typical interaction in any medical clinic? Because I would NEVER consider lashing out like that at someone trying to help me. Do patients often come in with chips on their shoulders?

    ReplyDelete
    Replies
    1. Lisa, all but the beginning and ending are meant to be our internal dialogue. None of that "lashing out" is really spoken. Unless you count her saying "before you can say it" part lashing out.

      I think this is typical of many encounters everywhere. Definitely not just at Grady.

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    2. I am really glad to hear that most of that is internal.

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    3. Yeah. I think a lot happens internally on both ends. Hopefully most read it that way.

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  4. This post reminds me of the one you had on your blog earlier in the year which talked about the in ability to out run a big a$$ without changing one's eating habits. I put that quote on my Facebook page, and I could just feel all the hairy eyeballs I had coming my way especially from family members who are almost ALL morbidly obese. URGH!!!

    ReplyDelete
    Replies
    1. Obesity is so tough. It really is, man. Sigh.

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  5. This post made me so sad. I didn't read it as an internal dialogue and it helped that you clarified that. You try your best to help those who come to you and you know first hand how extra weight can impact one's health horribly. You show here how the patient feels embarrassed to see a dr because he/she seems to know but can't help themselves. I wonder if you shared your story about your sister if the patient would know in their heart you truly cared and were not judging them. Or is that crossing professional boundaries? It is so sad that you really do care and the patient can't feel it. That rudeness to you seems like a cover up for deep shame. Sweet Jo

    ReplyDelete
    Replies
    1. Thanks, Sweet Jo. I changed the inner thoughts to italics. Definitely didn't want it to seem like the patient was the villain or rude. My thoughts were equally so. I guess in my head I was just sort of thinking that this happens a lot. I could be wrong, though. But then again, I could be right.

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  6. Keep on doing great things! It probably feels like you are wasting your breath at times but that is when someone eventually surprises you and makes some changes!

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  7. Welp- I think that it's awesome that you're empathetic to their plight, and I bet these undercurrents that you sense are 10000000% accurate. One perspective I can think of is perhaps approaching this by trusting that when they say "I'm working on it"- that they really are (To varying degrees of success, judging by the weight gain, it seems). I think of this situation to be kind of like when you're knitting and you lose a stitch- maybe they've lost a stitch in their weight loss plight, and so then you could take the approach of helping them pick it up? You could hold them to task when they say they're working on it- and perhaps they'll 1. open up to tell you where they are stuck- or 2. if they are lying to you, this might prod them to do something for real? I think with this approach you're allowing them to own their resolution- and it might be best this way since they know their own baggage and can implement change to suit themselves best. - Grace. :)

    ReplyDelete

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