Journal of Cancer Education
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Letter to the editor To cite this article: (1991) Letter to the editor, Journal of Cancer Education, 6:2, 105-107 To link to this article: http://dx.doi.org/10.1080/08858199109528099
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 2
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [University of Calgary]
Date: 05 August 2017, At: 17:33
J. Cancer Education. Vol. 6, No. 2, pp. 105-107, 1991 Printed in the U.S.A. Pergamon Press plc
0885-8195/91 $3.00 + .00 © 1991 American Association for Cancer Education
LETTER TO THE EDITOR
Downloaded by [University of Calgary] at 17:33 05 August 2017
Observations of a Physician/Patient To the Editor. — When a physician/teacher becomes a physician/patient, a unique educational experience takes place. Perhaps we should all elect to go through that experience periodically. How better to see the faculty, residents, students, nurses, and support staff—their strengths and foibles—than through a patient's eyes? I was fortunate. My major cancer surgery had an optimal outcome, and the stay in one of the nation's outstanding academic hospitals was letter-perfect. So I have no "axes to grind," and I can be fairly objective. What were the education-related observations? First, I was firmly reminded that nothing is inconsequential from the patient's viewpoint and that I should continually reinforce that dictum with students, residents, and nurses. Major importance is attached by patients to the willingness of each staff member to linger, even for a moment, sitting down if possible, to encourage patient questions and comments, and to provide answers to the patient if possible. Being faced with the need to answer patients' questions in understandable terms is a great learning exercise for the staff. (No jargon, please!) And this goes both ways: when the patient feels up to it, his showing interest in the activities, aggravations, and aspirations of the staff, and getting acquainted with them as individuals, can be mutually gratifying. This was particularly revealing to me as a physician/patient who could empathize with the staff members, their heavy work loads, and their social deprivations. I was admitted (electively) one hour before going to the operating room, in keeping with current pressures to conserve hospitalization costs. With thorough preadmission evaluation, that schedule is probably acceptable (although it depends considerably on good patient judgement, good communications, and an element of good luck). It definitely had an advantage for me. It gave me an extra day, evening, and night with a dear wife. But had I undergone two, three, or even more histories and physical examinations following admission, I wonder if the residents
and students would have grasped my mind set as I contemplated the impending surgery. Even patients without medical training must realize that there may be unavoidable intraoperative complications—idiosyncratic reactions to drugs, uncontrollable hemorrhage, and others. I certainly considered the "worst case scenario," although I tried not to dwell on it. I found myself facing my mortality essentially for the first time to any profound degree. I could not avoid the knowledge that I might not be alive 24 hours hence. As a clinician—and in my teaching—I shall now be more mindful that patients' personal lives always have many loose ends at any point in time, despite the best of intentions. Their anxieties deserve the sensitive awareness of all caregivers. They are not to be taken lightly, or intellectualized, or worse still, totally ignored. I am concerned, however, that the appropriate sensitivity may not be teachable. It may depend on proper selections by medical school admissions committees and relate to the previous 25 years or so of life's experiences. But such somber thoughts of mortality were left behind upon awakening in the recovery room, feeling surprisingly fit, and reveling in what seemed to be a meaningful conversation with a good-natured and perceptive anesthesiologist. In the post-operative period "little" things became magnified, and I was continually reminded that attention to them should be an integral part of my teaching. Attention to pain relief loomed large. (Patient-controlled analgesia has much to offer, actually reducing significantly my doses below those which more standard orders would have dictated.) Appropriately quiet surroundings were greatly appreciated. (The one episode of loud, idle chatter, punctuated with raucous laughter, wafting through the door left open at 5 A.M. ; comes to mind.) Careful attention to hygiene and aseptic technic is important to the patient, and I was reminded that this can easily be overlooked in the rush and intellectual fervor of ward rounds. The prevalence of the use of disposable gloves by nurses, doctors, and technicians was very apparent, probably attributable in large part to the
105
Downloaded by [University of Calgary] at 17:33 05 August 2017
106
Letter to the Editor
ADDS situation. But that practice has its pitfalls. I was reminded of this when a laboratory technician came in to do a venipuncture, with a pair of gloves already on. Upon my questioning she explained she had put on a fresh pair after completing the previous patient's veni -puncture. The intervening doorknobs, carts, insides of pockets, telephones, and goodness knows what else seemed inconsequential to her, possibly because technicians may view the main purpose of the gloves as protection for them from contact with body fluids rather than as a source of protection for the patient from hospital-acquired infections. It was clear to me that the latter should have top priority, especially when the patient has nothing particularly contagious. I hope we have not outlived the era of old-fashioned compulsive hand washing. Reliance on our impressive array of antibiotics to compensate for marginal aseptic technic in incision care has its limitations. Luckily, I had no such complication. Veins are literally "little" things, too, and are of extremely great value, with lives actually depending on their patency at times. Our students, residents, nurses, and technicians will benefit from our reminding them (before the fact) that the apparent abundance of peripheral veins at the time of a patient's admission is misleading and transitory. My point shall be that every venipuncture should be approached as if this were the only vein available for the entire hospitalization—because, before long, that is likely to be true. Venipunctures are important procedures which should be allotted adequate time and attention for skills development, with appropriate supervision. Other minutiae which begin to loom large in the patient's new microcosm include tasty, attractive food at its proper temperature, and prompt fulfillment of house staff intentions to write orders. (I missed my first scheduled regular meal when the intern neglected to write the order and then became unavailable.) The pressures of internship and of staff nursing are easily recognized, but a breach of a promise, even of a cup of tea, can assume major proportions in the patient's dependent situation. The power of the pen vis-a-vis the order book is gigantic from the patient's viewpoint.
Finally, two of the first things the patient surrenders at the Admitting Office, along with his valuables, are bis modesty and his privacy. The former can be protected and nurtured with a little extra sensitivity, even in a world where the backsides of hospital gowns insist on flapping open at inappropriate moments. I shall be more aware of the physical modesty which most patients bring to the hospital, somewhat less liberal than the almost cavalier attitude hospital staff members may gravitate toward over the years (which makes total exposure accepted almost without second thought). Even so, patients have amazing capabilities for adjustment to new mores—such as losing their self-consciousness in joining the parade of ambulators in the halls of the Urology Division, as I did, each of us in this "old boys' club" carrying his fluid-filled "lantern" like some latter-day Diogenes looking for an honest man. The privacy situation may present a more serious challenge in our teaching. The patient's confidentiality is all too often repeatedly pilfered by careless conversation in hallways, cafeterias, and elevators—as a sort of extended ward rounds—where the most intimate details are inadvertently shared with passive onlookers. The latter are, at best, disinterested strangers, but all too often they may be acquainted in some manner with the patient being discussed. Of course, a physician/patient presents special problems (and temptations) since virtually everyone within earshot may know who "Dr. X " is, and our natural bent seems to be an inability to avoid commentaries or speculations on "Dr. X's condition." I sense an almost pathologic compulsiveness among the faculty to overlook the rules of confidentiality when a colleague is a patient in one's own institution. Perhaps it involves some kind of morbid identification with the professional-cum-patient. As a teacher of young physicians in training, I shall hereafter try to set even higher standards of confidentiality as examples for my students. There may be easier ways to be reminded of these important facets of medical care and education than becoming a patient. They are all vividly displayed in our own institutions, teaching activities, and patient care responsibilities every day. But I can think of no more effective
Letter to the Editor
Downloaded by [University of Calgary] at 17:33 05 August 2017
way to relearn and to reinforce them than to experience them from the other side of the sheets and from the other end of the needle. The superb surgical and nursing care I received was accompanied by a unique and unforgettable form of continuing medical education. Anonymous AACE Member
107
Editor's Note: The Journal urges readers to submit letters commenting on this or any other subject relevant to cancer education. Requests for anonymity will be respected, although writers must be willing to identify themselves to the Editor-in-Chief for purposes of verification and journalistic accountability.
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Letter to the editor To cite this article: (1991) Letter to the editor, Journal of Cancer Education, 6:2, 105-107 To link to this article: http://dx.doi.org/10.1080/08858199109528099
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 2
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [University of Calgary]
Date: 05 August 2017, At: 17:33
J. Cancer Education. Vol. 6, No. 2, pp. 105-107, 1991 Printed in the U.S.A. Pergamon Press plc
0885-8195/91 $3.00 + .00 © 1991 American Association for Cancer Education
LETTER TO THE EDITOR
Downloaded by [University of Calgary] at 17:33 05 August 2017
Observations of a Physician/Patient To the Editor. — When a physician/teacher becomes a physician/patient, a unique educational experience takes place. Perhaps we should all elect to go through that experience periodically. How better to see the faculty, residents, students, nurses, and support staff—their strengths and foibles—than through a patient's eyes? I was fortunate. My major cancer surgery had an optimal outcome, and the stay in one of the nation's outstanding academic hospitals was letter-perfect. So I have no "axes to grind," and I can be fairly objective. What were the education-related observations? First, I was firmly reminded that nothing is inconsequential from the patient's viewpoint and that I should continually reinforce that dictum with students, residents, and nurses. Major importance is attached by patients to the willingness of each staff member to linger, even for a moment, sitting down if possible, to encourage patient questions and comments, and to provide answers to the patient if possible. Being faced with the need to answer patients' questions in understandable terms is a great learning exercise for the staff. (No jargon, please!) And this goes both ways: when the patient feels up to it, his showing interest in the activities, aggravations, and aspirations of the staff, and getting acquainted with them as individuals, can be mutually gratifying. This was particularly revealing to me as a physician/patient who could empathize with the staff members, their heavy work loads, and their social deprivations. I was admitted (electively) one hour before going to the operating room, in keeping with current pressures to conserve hospitalization costs. With thorough preadmission evaluation, that schedule is probably acceptable (although it depends considerably on good patient judgement, good communications, and an element of good luck). It definitely had an advantage for me. It gave me an extra day, evening, and night with a dear wife. But had I undergone two, three, or even more histories and physical examinations following admission, I wonder if the residents
and students would have grasped my mind set as I contemplated the impending surgery. Even patients without medical training must realize that there may be unavoidable intraoperative complications—idiosyncratic reactions to drugs, uncontrollable hemorrhage, and others. I certainly considered the "worst case scenario," although I tried not to dwell on it. I found myself facing my mortality essentially for the first time to any profound degree. I could not avoid the knowledge that I might not be alive 24 hours hence. As a clinician—and in my teaching—I shall now be more mindful that patients' personal lives always have many loose ends at any point in time, despite the best of intentions. Their anxieties deserve the sensitive awareness of all caregivers. They are not to be taken lightly, or intellectualized, or worse still, totally ignored. I am concerned, however, that the appropriate sensitivity may not be teachable. It may depend on proper selections by medical school admissions committees and relate to the previous 25 years or so of life's experiences. But such somber thoughts of mortality were left behind upon awakening in the recovery room, feeling surprisingly fit, and reveling in what seemed to be a meaningful conversation with a good-natured and perceptive anesthesiologist. In the post-operative period "little" things became magnified, and I was continually reminded that attention to them should be an integral part of my teaching. Attention to pain relief loomed large. (Patient-controlled analgesia has much to offer, actually reducing significantly my doses below those which more standard orders would have dictated.) Appropriately quiet surroundings were greatly appreciated. (The one episode of loud, idle chatter, punctuated with raucous laughter, wafting through the door left open at 5 A.M. ; comes to mind.) Careful attention to hygiene and aseptic technic is important to the patient, and I was reminded that this can easily be overlooked in the rush and intellectual fervor of ward rounds. The prevalence of the use of disposable gloves by nurses, doctors, and technicians was very apparent, probably attributable in large part to the
105
Downloaded by [University of Calgary] at 17:33 05 August 2017
106
Letter to the Editor
ADDS situation. But that practice has its pitfalls. I was reminded of this when a laboratory technician came in to do a venipuncture, with a pair of gloves already on. Upon my questioning she explained she had put on a fresh pair after completing the previous patient's veni -puncture. The intervening doorknobs, carts, insides of pockets, telephones, and goodness knows what else seemed inconsequential to her, possibly because technicians may view the main purpose of the gloves as protection for them from contact with body fluids rather than as a source of protection for the patient from hospital-acquired infections. It was clear to me that the latter should have top priority, especially when the patient has nothing particularly contagious. I hope we have not outlived the era of old-fashioned compulsive hand washing. Reliance on our impressive array of antibiotics to compensate for marginal aseptic technic in incision care has its limitations. Luckily, I had no such complication. Veins are literally "little" things, too, and are of extremely great value, with lives actually depending on their patency at times. Our students, residents, nurses, and technicians will benefit from our reminding them (before the fact) that the apparent abundance of peripheral veins at the time of a patient's admission is misleading and transitory. My point shall be that every venipuncture should be approached as if this were the only vein available for the entire hospitalization—because, before long, that is likely to be true. Venipunctures are important procedures which should be allotted adequate time and attention for skills development, with appropriate supervision. Other minutiae which begin to loom large in the patient's new microcosm include tasty, attractive food at its proper temperature, and prompt fulfillment of house staff intentions to write orders. (I missed my first scheduled regular meal when the intern neglected to write the order and then became unavailable.) The pressures of internship and of staff nursing are easily recognized, but a breach of a promise, even of a cup of tea, can assume major proportions in the patient's dependent situation. The power of the pen vis-a-vis the order book is gigantic from the patient's viewpoint.
Finally, two of the first things the patient surrenders at the Admitting Office, along with his valuables, are bis modesty and his privacy. The former can be protected and nurtured with a little extra sensitivity, even in a world where the backsides of hospital gowns insist on flapping open at inappropriate moments. I shall be more aware of the physical modesty which most patients bring to the hospital, somewhat less liberal than the almost cavalier attitude hospital staff members may gravitate toward over the years (which makes total exposure accepted almost without second thought). Even so, patients have amazing capabilities for adjustment to new mores—such as losing their self-consciousness in joining the parade of ambulators in the halls of the Urology Division, as I did, each of us in this "old boys' club" carrying his fluid-filled "lantern" like some latter-day Diogenes looking for an honest man. The privacy situation may present a more serious challenge in our teaching. The patient's confidentiality is all too often repeatedly pilfered by careless conversation in hallways, cafeterias, and elevators—as a sort of extended ward rounds—where the most intimate details are inadvertently shared with passive onlookers. The latter are, at best, disinterested strangers, but all too often they may be acquainted in some manner with the patient being discussed. Of course, a physician/patient presents special problems (and temptations) since virtually everyone within earshot may know who "Dr. X " is, and our natural bent seems to be an inability to avoid commentaries or speculations on "Dr. X's condition." I sense an almost pathologic compulsiveness among the faculty to overlook the rules of confidentiality when a colleague is a patient in one's own institution. Perhaps it involves some kind of morbid identification with the professional-cum-patient. As a teacher of young physicians in training, I shall hereafter try to set even higher standards of confidentiality as examples for my students. There may be easier ways to be reminded of these important facets of medical care and education than becoming a patient. They are all vividly displayed in our own institutions, teaching activities, and patient care responsibilities every day. But I can think of no more effective
Letter to the Editor
Downloaded by [University of Calgary] at 17:33 05 August 2017
way to relearn and to reinforce them than to experience them from the other side of the sheets and from the other end of the needle. The superb surgical and nursing care I received was accompanied by a unique and unforgettable form of continuing medical education. Anonymous AACE Member
107
Editor's Note: The Journal urges readers to submit letters commenting on this or any other subject relevant to cancer education. Requests for anonymity will be respected, although writers must be willing to identify themselves to the Editor-in-Chief for purposes of verification and journalistic accountability.
