A Wholesome Gallop

While straining to keep an interested look on my face while "listening" to a resident physician go through a consent for a procedure, I noticed that the patient was also not listening. Rather, she kept a suspicious eye on the nurse setting up for an IV, and finally put her hand on the nurse's arm and sassily told her that last time she was in the hospital, no one could get the IV and she was not going to allow someone to stick her five or six times again. Anyway, it really set up for a dismal outcome and it made me realize what an impact a patient can make on his or her own outcome.

As a paramedic I heard that 20 times a day- "I'm a hard stick, don't even try." Honestly, that made me really angry. During some of my "darker" days I took that as a challenge (I had a good track record, pun intended).

Now I realize how that sort of comment can be horrific- if you set the stage for failure, both in your head and the other person's, you'll probably fail. I know most of the "I'm a hard stick" patients are the frequent flyers and the purpose of the statement was anything but the denotation, but nonetheless....

So that was going to be the blog. But later that day in a lecture, a physician mentioned a story along the same lines and it really made an impact.

Long story short, a well-renowned cardiologist was treating a patient with bad heart failure, and made a point to have all the students and residents listen to this man's "wholesome gallop" (a heart sound usually only heard in heart failure).

No one thought this guy would last long, but within a few weeks this guy's heart function was completely back to normal! The cardiologist asked the patient what happened, and the patient told him that he was encouraged when the doctor told him he had a "wholesome gallop," because he reasoned that only a strong heart could still gallop.

The doctor clearly hasn't meant "strong" heart; in fact, he meant the opposite, but the patient's positive interpretation resulted in complete recovery!

According to the physician giving my lecture, the moral is that you should always find the good news. If they have a nonresectable cancer: "Good news! Your cancer doesn't need surgery! We can treat you with chemo and radiation!"

I've always held the opinion that words are a physician's most powerful and influential weapon. Unfortunately, on a daily basis, I hear them misused. To many, a doctor's words are the be-all, end-all, and sometimes assumptions are made on both the doctor's and patient's sides. Seemingly minute details in a conversation can change someone's view or even possibly outcome.

I think the toughest part of learning to be a doctor is how to use your words. The easy way out is to be enigmatic and vague- a commonly used tactic. Many healthcare providers, it seems, are comfortable with medicine but are unsure of how to talk ABOUT medicine with patients (somewhat justifiably so given all the litigious people out there). We need to better teach how to feel comfortable talking to patients by giving the whole picture. We need to tell people what we know, and what we don't know. Sometimes we don't like telling patients when we don't know the answer yet, and they interpret our silence as a deliberate omission (and patients therefore make assumptions about why information was withheld).

Deferring- "why don't we wait until the test results come back to discuss this-" can cause weeks of angst and worry. Granted, there are probably situations where this wouldn't be the best decision, but I think that talking to patients is comforting to them. Being in the dark is a thousand times more frightening than knowing (again, in most cases).

That same cardiologist whose "good news" cured his patient's heart failure wrote an amazing book which I started today: The Lost Art of Healing (Dr. Bernard Lown). A parting thought from Dr. Lown:

"As the patient is empowered, the doctor's curing power is enhanced."