{"id":2274,"date":"2014-05-12T00:25:14","date_gmt":"2014-05-12T04:25:14","guid":{"rendered":"https:\/\/www.med.unc.edu\/dms\/dms\/fax-journal\/2013-2014-edition\/at-the-bedside-2014-william-blythe-essay-competition-winner\/"},"modified":"2018-12-04T15:03:06","modified_gmt":"2018-12-04T20:03:06","slug":"at-the-bedside-2014-william-blythe-essay-competition-winner","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/dms\/fax-journal\/2013-2014-edition\/at-the-bedside-2014-william-blythe-essay-competition-winner\/","title":{"rendered":"“At the Bedside”: 2014 William Blythe Essay Competition Winner"},"content":{"rendered":"
\n

At the Bedside: How Patients Remind Us to Be the Best Doctors<\/p>\n

Joel “Jock” Moore<\/p>\n

2014 William Blythe Essay Competition Winner<\/p>\n

\n

The clinical years of medical school are a very unique time in the training of a future physician. Hopping from one end of the state to the other; commuting to towns with which not even native North Carolinians are familiar; splitting bedrooms with strangers who soon become new friends; constantly readjusting to work with new residents and different institutions; and occasionally feeling that just about every breath you take could be subject to some-sort of evaluation – it can all seem a bit overwhelming. Still, it also affords an incredible opportunity to spend time with patients at the bedside, learning both from their illnesses and from the people themselves. It\u2019s here, alongside patients, that I was reminded of three incredibly valuable lessons that you can\u2019t necessarily read in First Aid, Harrison\u2019s Principals of Internal Medicine, or any other textbook for that matter.<\/p>\n

First of all, I was reminded that taking care of a patient doesn\u2019t necessarily mean doing more tests and procedures. In other words, we should always question \u201cWhat are we doing for <\/i>the patient, not to<\/i> the patient?\u201d In many situations it is very hard not to want to use every therapy possible, spend every last dollar in an effort to squeeze every extra minute of life possible; yet the quandary of quality versus quantity is ever-present. I\u2019ve already seen examples of both extremes in my limited career. One patient, in total denial of widely metastatic cancer, sought multiple \u201csecond opinions\u201d and invasive, expensive therapies at for-profit cancer treatment centers. Other patients were totally at peace with a terminal diagnosis, and made clear their desires to spend every remaining moment richly with friends and family. There is no escaping the fact that patients trust us <\/i>with their lives and rely on us to recommend what we think is in their best interest. Because of this, we often feel compelled to do something<\/i> rather than nothing. <\/i>Yet realizing when not to order additional tests and when not to pursue further treatments ultimately separates the best caregivers from all others. We should remind ourselves that doing something <\/i>doesn\u2019t necessarily equate to ordering more tests, performing additional procedures, or prescribing new medications. Sometimes simple kindness and reassurance, a pleasantry or personal story, or providing comforts like extra blankets or a glass of water rather than asking it of another staff member goes a long way. Spending this extra bit of time and effort, and actually listening <\/i>to patients and their stories is often the best medicine of all.<\/p>\n

Similar to this seemingly simple yet often-forgotten principle, the power of human touch is often underestimated. During my psychiatry rotation, I saw geriatric patients in the end-stages of dementia. Even though most of their personality and social behaviors were a distant memory, a certain calmness and peace would wash over them with a gentle holding of hands. Even when our higher levels of consciousness and cognition are stripped from us, a fellow human being\u2019s touch can be comforting. As future physicians, aren\u2019t we called to do just that \u2013 to alleviate suffering? All too often there seems to be a subconscious drive to maintain a \u201cprofessional distance\u201d from our patients, perhaps stemming from our own discomfort with this suffering. Yet this doesn\u2019t have to mean constantly pushing patients away. Instead, our touch and presence seems to be key to alleviating their isolation and the suffering that inevitably follows. Patients with severe dementia certainly reminded me.<\/p>\n

Finally, I have been reminded of the power of effective communication, not only with our medical colleagues but also with patients themselves. How quickly we forget how much new information we amass and synthesize every day. The \u201cme\u201d of only a few years ago would be lost in many patient presentations and conversations with colleagues today. If this is the case, how must it feel to be the patient with absolutely no medical background, who perhaps hasn’t even a grasp of simple anatomy or basic science? Another example would be the ever-lengthening, complex alphabet soup of modern medicine \u2013 I found myself learning new complex terms with more and more abbreviations until it was as if I was speaking an entirely new language. Somehow \u201cPOD#1 58 yo fem s\/p TLH\/BSO for Stage IIIa cervical SCC\u201d was starting to become easier to understand than \u201ca 58 year old woman who had surgery yesterday to remove her uterus and ovaries due to cancer.\u201d Frighteningly, it was also easier to distance myself from the context of this patient\u2019s life and the enormous impact a lethal disease might have upon it. We owe it to patients and their families to translate this language and explain their individual situations – to navigate the oceans of reputable information, medical jargon, misconceptions and yes even Dr. Google. After all, Albert Einstein was quoted as saying \u201cYou do not really understand something unless you can explain it to your grandmother.\u201d It would likely behoove our own medical education to have such a firm grasp of these difficult medical concepts that we can confidently relay them in everyday English. Only the best physicians are able to enlighten patients and their families in this matter on a daily basis.<\/p>\n

Although I didn\u2019t fully appreciate it at the time, these three lessons were all embodied on my very first rotation, Internal Medicine, with one of the very first patients I helped admit to the hospital. Mr. C was a lifelong farmer from a small NC town, a \u201cgood ol\u2019 boy\u201d if you will, who came into the hospital after he gradually turned more and more yellow and itched ever more severely. When our team first rounded on him he was lying in bed scratching himself, the most jaundiced patient I have, to this day, ever seen. His wife was by his side as she had been for the last 60 years or so, and the look of concern was clear on her aged face. From his country sayings and colorful similes, it was clear that Mr. C was sharp-witted but used to speaking in layman\u2019s terms. A CT scan had found a large 8 cm liver mass, likely an aggressive cholangiocarcinoma pending biopsy results, that was compressing his common bile duct leading to an obstructive jaundice. I was amazed at the job our senior resident did in relaying this disheartening news to the patient, his wife and daughters. He sat down in a chair next to Mr. C at eye level, gently holding his hand from time-to-time, and started going through the findings in terms that Mr. C could fully comprehend. \u201cProbable stage IIIa cholangiocarcinoma\u201d became \u201ca large tumor in your liver that\u2019s probably cancer.\u201d Our resident talked about some of the very difficult treatment decisions to be made over the next few days, allowed time for the patient and family to process the news, and fielded questions with patience and genuine empathy. Towards the end of the conversation, Mr. C\u2019s thoughts turned towards the after-life, and with tear-filled eyes he said, \u201cI hope the Lord has a spot for me in Heaven,\u201d and soon the whole team was fighting back tears. Over the course of the next few days, Mr. C and his family talked with surgical oncologists, medical oncologists, interventional radiologists, gastroenterologists, nurses, my general medicine team, and still others. As his clinical picture continued to evolve, it was clear that even though surgical resection and\/or chemo would be \u201cdoing something rather than nothing,\u201d it would not be curative and would likely take its toll on the late octogenarian. After much discussion with his family, they opted solely for palliative care. Despite the fact that his end was near, Mr. C repeated, \u201cI appreciate how nice every one of y\u2019all has been to me up here. I can\u2019t thank y\u2019all enough, and I really appreciate how honest and up-front y\u2019all are being about things.\u201d It\u2019s my sincere hope and prayer that Mr. C was blessed with a rich end to his life. This man deserves every bit of dignity and respect we have shown him, and no matter how long I practice medicine, one thing is for sure – I\u2019ll never forget Mr. C, or the lessons I\u2019ve learned from this wonderfully challenging journey.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

At the Bedside: How Patients Remind Us to Be the Best Doctors Joel “Jock” Moore 2014 William Blythe Essay Competition Winner The clinical years of medical school are a very unique time in the training of a future physician. Hopping from one end of the state to the other; commuting to towns with which not … Read more<\/a><\/p>\n","protected":false},"author":16100,"featured_media":0,"parent":2227,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2274","page","type-page","status-publish","hentry","odd"],"acf":[],"_links_to":[],"_links_to_target":[],"_links":{"self":[{"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/pages\/2274","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/users\/16100"}],"replies":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/comments?post=2274"}],"version-history":[{"count":0,"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/pages\/2274\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/pages\/2227"}],"wp:attachment":[{"href":"https:\/\/www.med.unc.edu\/dms\/wp-json\/wp\/v2\/media?parent=2274"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}