Medical school teaches us many important things. The anatomy of the brain. The physiology of the cardiovascular system. Which antibiotics to give the patient with sinusitis.
We were also taught things that weren’t so easy to put into diagrams and mind maps. How to break bad news to a patient. How to encourage a patient to stop smoking. How to involve patients in clinical decisions, so that they can assist in choosing the best possible management of their condition. The heart-warming, fuzzy stuff that none of us really wanted to learn.
And then comes the day when you have to tell a mother her newborn child has died. When you have to convince your morbidly obese, poorly controlled diabetic patient to exercise and take his medication. When you need to make a clinical decision for a patient who is too ill to tell you whether or not they agree with your management. And you realise the innate position of power that you, the doctor, possess.
Think about when you go to your financial adviser. They present you with hundreds of complicated graphs and brochures, and tell you that if don’t start saving for retirement right now you’ll be eating cat food for breakfast at age 65. And because you know nothing about investing and retirement annuities, you trust what this person is telling you and decide to set aside some money every month. This person has knowledge that you don’t, and hopefully tries to guide you to make the best decision possible with the money you have.Again, these people are in an inherent position of power. If you know nothing about money and have a corrupt financial adviser, things will not end so well for your bank account.
Now think about when you need to go the emergency room. Chances are, you’re seeking medical attention because you’re feeling really poorly. You have a terrible headache which hasn’t gone away with the myprodol and cataflam you’ve already taken. You were in a car accident and you think you’ve broken your wrist. You have chest pain. You have diarrhoea. You fell off a ladder. So now you’re sitting at your local hospital, and you’re scared. You’re in pain. You feel like death warmed up. And you wait for the doctor to come tell you what’s wrong and how he can make it better.
A patient in pain or who is feeling ill is going to be feeling vulnerable. And the person treating him, the doctor, is powerful simply by nature of the fact that he has the ways and means to take the patient back to good health. Yes, in this day and age we have access to the internet and can look our symptoms up online. The patient might have a good idea of what’s going on with their health. But ultimately, the patient has to rely on the doctor to order the appropriate investigations and prescribe the correct medication. It’s all well and good involving the patient in the clinical decision, offering the patient various options and allowing them to choose what suits them best. Sometimes there are not multiple options though. An oftentimes the patient will ask what you, the doctor, thinks is the best decision any way.
As doctors, we see patients in every state and form of health. These situations can provoke fear, anxiety or embarrassment for patients. The trauma patient who gets wheeled in and whose clothes we have to remove to check for injuries. The elderly gentleman in his pyjamas who keeps vomiting on himself. The pretty young wife who was assaulted by her husband. These patients are perhaps the extreme of what we’d call vulnerable. But nevertheless, a sick patient is a vulnerable person. We have to be cognisant of the power we possess as a doctor, and to not abuse that power.
Medicine is moving away from the old thinking that ‘the doctor knows best’. The doctor still knows so much though, and it is our responsibility to use what we know to always act in the best interests of our patients. Remember how vulnerable your patients are, and how much faith they’re placing in you. The oath that we pledge at the beginning of our medical career, to first do no harm, must always be the guiding light for how we manage our patients, and regardless of the power we seem to possess, we must always use that for the good of our patients.
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