Families, Systems, & Health 2014, Vol. 32, No. 1, 16 –17
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000022
COMMENTARY
Clinician as Patient: The Gift of Illness Laura Sudano, MA
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
St. Mary’s Hospital & Regional Medical Center, Grand Junction, Colorado Most individuals have been touched by illness or have experienced illness themselves. This commentary illustrates how, as a clinician, my own life-threatening illness has informed the way I work within integrated care and general health care practice. Keywords: integrated care, medical family therapy, family systems, self of the therapist
It is 7:45 a.m. and I have been poked by lab staff, met with the heart surgeon, infectious disease doctor, cardiologist, family physician, and neurologist. The nurse tells me the plan: blood pressure medication, baby aspirin, iron; the antibiotics I have been taking for four weeks will continue to run, the occupational therapist will teach me how to shower, and the respiratory therapist will review with me how to breathe. Shortly after, my husband (we are newly married) comes in and unloads, “You need to know what is going on with your family.” It is three days after my open heart surgery. The story began one month earlier. Driving back from our honeymoon, I began to shake uncontrollably and then experienced an intense headache and vomiting. I went to my physician with the “worst headache of my life” and, a few days later, came back again with left upper quadrant pain. Imaging determined that I had 12 septic emboli in my brain and infarctions in my spleen, kidneys, liver, feet, and hands. A resident who came to do a physical exam asked, “Has anyone told you that you had a heart murmur?” An echocardiogram revealed a mitral valve vegetation, which had gradually destroyed the valve. I had infective endocarditis and would need antibiotics and open-heart surgery to replace the valve.
I am sharing my experience because clinician as patient is an interesting spot to be in, and just as we have gifts from our most challenging cases, we also have gifts of illness. The following lessons hit home for me in two roles: (a) Laura the family therapist and (b) Laura the human, the newlywed, the patient. I hope that you will also consider them (a) in your role as patient advocate and (b) in your role as potential patient. Tough Conversations Are Secondary Prevention I started going downhill seven days after our wedding. Specialists said that the bacteria had been growing in my body for six months. My husband and I had to discuss such varied medical decisions as the implications of a tissue versus mechanical valve, and his role as caregiver if I developed brain damage. In your own way, engage your patient in an open conversation about their views of caretaking should one get sick. What would this look like for him or her? As a patient, do not wait until you have traded your wedding gown for a hospital gown to focus on the future. Transparency Empowers The race against time was the issue: Go into surgery too early and my brain would bleed; go into surgery too late and my heart would fail. When I met with my heart surgeon to push back the date for my surgery, in hopes that my chance for bleeding out would decrease, he told me that if I were his daughter, he would tell her
Laura Sudano, MA, Medical Family Therapy Fellow, St. Mary’s Family Medicine Residency, Grand Junction, Colorado. Correspondence concerning this article should be addressed to Laura Sudano, MA, 2698 Patterson Road, Grand Junction, CO 81506. E-mail: [email protected] 16
CLINICIAN AS PATIENT
to go into surgery, as planned, the following day, and that, sometimes, you just need to “take a leap of faith.” As a clinician, be transparent and present the statistics while imparting hope. As a patient, request these risks and benefits, and have the transparency empower your care decisions.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
System Trumps the Individual After I was discharged from the hospital, I fell into the conflict of my new husband wanting to take care of me and my mother feeling that she knew best. According to New York State, my husband was my next of kin, but, according to my 26 years of life, my mother was at the guardian. Pulling together a family meeting during hospitalization, whether with or without me, the patient, would have been crucial to recognize the impact of family dynamics in medical decision making. So, treat the patient without the family at the patient’s peril. At your own peril.
17
care team or electronic health record. He dismissed my objections that it was contraindicated due to a risk of hemorrhaging; I received the shot. When, the next day, I again expressed my concern, he threw his hands up at me and walked out of the room—never accepting culpability for his medical error and the risk it caused me. As a patient, project a strong voice and, as a clinical team, amplify your patient’s voice. Fortunately, we do not need an illness to implement these gifts into our own work and lives. I hope that you will join me in taking these gifts to heart. Tough conversations are secondary prevention. Transparency empowers. System trumps the individual. Amplify the patient’s voice.
Amplify the Patient’s Voice A surgeon covering for a weekend ordered a blood thinner without consulting my primary
Received November 10, 2013 Revision received December 19, 2013 Accepted December 23, 2013 䡲
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000022
COMMENTARY
Clinician as Patient: The Gift of Illness Laura Sudano, MA
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
St. Mary’s Hospital & Regional Medical Center, Grand Junction, Colorado Most individuals have been touched by illness or have experienced illness themselves. This commentary illustrates how, as a clinician, my own life-threatening illness has informed the way I work within integrated care and general health care practice. Keywords: integrated care, medical family therapy, family systems, self of the therapist
It is 7:45 a.m. and I have been poked by lab staff, met with the heart surgeon, infectious disease doctor, cardiologist, family physician, and neurologist. The nurse tells me the plan: blood pressure medication, baby aspirin, iron; the antibiotics I have been taking for four weeks will continue to run, the occupational therapist will teach me how to shower, and the respiratory therapist will review with me how to breathe. Shortly after, my husband (we are newly married) comes in and unloads, “You need to know what is going on with your family.” It is three days after my open heart surgery. The story began one month earlier. Driving back from our honeymoon, I began to shake uncontrollably and then experienced an intense headache and vomiting. I went to my physician with the “worst headache of my life” and, a few days later, came back again with left upper quadrant pain. Imaging determined that I had 12 septic emboli in my brain and infarctions in my spleen, kidneys, liver, feet, and hands. A resident who came to do a physical exam asked, “Has anyone told you that you had a heart murmur?” An echocardiogram revealed a mitral valve vegetation, which had gradually destroyed the valve. I had infective endocarditis and would need antibiotics and open-heart surgery to replace the valve.
I am sharing my experience because clinician as patient is an interesting spot to be in, and just as we have gifts from our most challenging cases, we also have gifts of illness. The following lessons hit home for me in two roles: (a) Laura the family therapist and (b) Laura the human, the newlywed, the patient. I hope that you will also consider them (a) in your role as patient advocate and (b) in your role as potential patient. Tough Conversations Are Secondary Prevention I started going downhill seven days after our wedding. Specialists said that the bacteria had been growing in my body for six months. My husband and I had to discuss such varied medical decisions as the implications of a tissue versus mechanical valve, and his role as caregiver if I developed brain damage. In your own way, engage your patient in an open conversation about their views of caretaking should one get sick. What would this look like for him or her? As a patient, do not wait until you have traded your wedding gown for a hospital gown to focus on the future. Transparency Empowers The race against time was the issue: Go into surgery too early and my brain would bleed; go into surgery too late and my heart would fail. When I met with my heart surgeon to push back the date for my surgery, in hopes that my chance for bleeding out would decrease, he told me that if I were his daughter, he would tell her
Laura Sudano, MA, Medical Family Therapy Fellow, St. Mary’s Family Medicine Residency, Grand Junction, Colorado. Correspondence concerning this article should be addressed to Laura Sudano, MA, 2698 Patterson Road, Grand Junction, CO 81506. E-mail: [email protected] 16
CLINICIAN AS PATIENT
to go into surgery, as planned, the following day, and that, sometimes, you just need to “take a leap of faith.” As a clinician, be transparent and present the statistics while imparting hope. As a patient, request these risks and benefits, and have the transparency empower your care decisions.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
System Trumps the Individual After I was discharged from the hospital, I fell into the conflict of my new husband wanting to take care of me and my mother feeling that she knew best. According to New York State, my husband was my next of kin, but, according to my 26 years of life, my mother was at the guardian. Pulling together a family meeting during hospitalization, whether with or without me, the patient, would have been crucial to recognize the impact of family dynamics in medical decision making. So, treat the patient without the family at the patient’s peril. At your own peril.
17
care team or electronic health record. He dismissed my objections that it was contraindicated due to a risk of hemorrhaging; I received the shot. When, the next day, I again expressed my concern, he threw his hands up at me and walked out of the room—never accepting culpability for his medical error and the risk it caused me. As a patient, project a strong voice and, as a clinical team, amplify your patient’s voice. Fortunately, we do not need an illness to implement these gifts into our own work and lives. I hope that you will join me in taking these gifts to heart. Tough conversations are secondary prevention. Transparency empowers. System trumps the individual. Amplify the patient’s voice.
Amplify the Patient’s Voice A surgeon covering for a weekend ordered a blood thinner without consulting my primary
Received November 10, 2013 Revision received December 19, 2013 Accepted December 23, 2013 䡲
