Doctors are not known for being empathic. I have always found this surprising since ask any medical student why she wants to be a doctor, and one invariably hears the "I want to help people" reply. Somewhere along the path to being a physician, however, we seem to lose that desire to understand and share the feelings of patients, and instead we start referring to patients as "the heart attack in Room 306" rather than, "Mrs. Smith, mother of three children." Some of it is likely a coping mechanism, but this detachment also impacts our delivery of care.
As I've approached my mid-40s, I started to see a change in how I practice medicine. Getting older has helped me relate more to patients -- even understand medicine more thoroughly from a patient's perspective -- and thereby become a better doctor.
Here's what I have learned:
1. Pain needs to be managed aggressively. Low back pain is one of the most common reasons people go to the doctor. And when a primary care physician sees "LBP" (low back pain) on the schedule, he/she often cringes. That's because low back pain is quite difficult to diagnose the specific cause and therefore to treat successfully. And it can sometimes be a diagnosis necessary for workman's comp or desire for opioids -- two areas many doctors want to avoid. So it's a condition that some doctors loathe to see, and therefore don't manage well. However, having experienced some acute episodes of low back pain, I can attest how debilitating it is. I didn't quite appreciate the ramifications of not being able to bend over to tie one's shoes or to pick something off the floor. Now I am much more focused on getting pain relief for patients, whether it is medicines, physical therapy, time off of work, or sometimes surgery. I understand their pain, and actively work to manage it. I don't question patient's motives for pain relief nor do I view pain as a natural part of getting older -- because it isn't!
2. The site of blood from any orifice needs to be looked into -- ASAP (no pun intended!). Physicians are used to seeing patients in clinic with the complaint of blood. And often, physicians get "annoyed" because they know that it is going to take a lot of time to work up. It takes much longer than the 12 minutes we are usually allotted for a visit. But now I understand that once you're past 45, if you see blood coming out from anywhere -- your nose, your mouth, or your rectum, you immediately think you are now on death's door. One episode of bloody stools sent me running to my doctor. I was sure it was colon cancer even though I knew hemorrhoids are the most common reason -- which it turned out to be. But I am much more sensitive about patients' anxiety about seeing blood in places where it doesn't belong. Most of the time, bleeding is not serious but the anxiety associated with the sight of blood can be overwhelming for many people, and the fears need to be addressed directly. And we do it by figuring out the cause -- quickly. I take patient's bleeding complaints very seriously and aggressively work it up as quickly as I can.
3. It is hard to incorporate exercise into family life. I have always been a big supporter of healthy living -- eating fruits, nuts, vegetables, fish and being active. And I probably was not always understanding or sympathetic when I was single as to why patients could not find 30-60 minutes a day to exercise, or make a healthy meal. Now that I'm older, married, and a parent -- I can't figure out how to find one day a week to go to the gym! And dinner with a toddler is a ticking time bomb until food is all over the floor, or there's a fit of crying. Making Chilean sea bass with Chinese vegetables simply isn't going to happen anymore without a lot of advanced planning! Now I talk to patients about how they can multitask -- spend time being active by playing with their children, walk around at work instead of sitting in the chair all day, prepare healthy meals on Sunday for the entire week. I try to show patients the value of small steps, and how small steps combined over time can make a significant difference in reducing and preventing disease.
4. Remembering to take medicines sounds a lot more simple than it really is. How difficult is it to remember to take two pills a day for the rest of your life? Well, I've learned it's much more difficult than I thought. Although I don't take any daily medicine for any chronic diseases, I have had to take courses of antibiotics over the years. Treatment courses are typically for 14 days, and like most people I quit somewhere around the half-way point, when we feel better. And I 'm a doctor, so I should know better! Nowadays, I constantly ask patients about missing any dosages of medicines. I don't do it in a judgmental way, but rather I acknowledge that it's hard. And I don't make it seem like a failure if they forget to take all their medicines every day. Patients often like to please their doctors, and don't want to admit when they forget to take medicines. That can cause problems because if a patient's blood pressure is high, and we think a patient is taking all their medicines, when in reality, they are not, we might end up switching them to a higher dose than they need. And that can cause problems.
Our grandparents were right that we become wiser when we get older. But I didn't expect I'd also become a better physician. And there is still progress to be made. I'm really glad I am making this transformation.