Doctors

Storytelling: The Physician As Writer

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“Every day, I write the book…”  Elvis Costello

 

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I write every day, but somehow have not considered myself a Writer. I am a physician, a surgeon. I take care of patients. I operate, I admit patients to the hospital, I consult. I order tests, labs, images; I do physical examinations, I take medical histories. And I write it down.

I gather all of this information, and more than simply recording the list of symptoms, physical findings, and results, I convey the narrative of what has happened, what is going on, the interpretation, the plan. So, maybe I am a writer. A biographer, of sorts, telling the story of every patient I see, at least as it relates to their health or illness. Synthesizing the data, the history, the laboratory and test results, the imaging–into a narrative that not only explains how and why the patient got here, but also what I think is going on (and what is not going on), what it means, and what we are going to do about it (whether that means fixing it or figuring out what else we need to do). All of this are chapters in the story I am telling, to communicate the information, my thoughts and reasoning, my plan to my colleagues. The original, and still primary, reason for the patient chart (whether electronic or paper), the medical record is Telling A Story.

This special “biography”, the history, is an extremely important piece of this story, of caring for patients. All of the testing in the world–labs and imaging and what have you–are really only in support of, augmenting, what is learned in the history, and can not and do not replace it. My wise professors and teaching attendings held to this, and demonstrated it; it has been my experience throughout my own practice and career. They maintained that about 90% of what was really happening with the patient could be ascertained from a skilled, well-done history.

This takes time to do, time to master. And although this percentage may be a bit inflated, so as to impress the young minds under their tutelage, it does not diminish the importance. Continue reading →

Changing the Clocks – Timely Observations

“Let’s do the Time Warp again!”  – The Time Warp, The Rocky Horror Picture Show

 

IMG_1911I am always a little out of sorts in the days that follow the time change every fall and spring.  I find it easier to get up in the morning when it is light out. In the fall, that is only temporary, and the light continues to slip away and fade as we pass into winter, when the days – or at least the daylight hours – are shorter. So changing the clocks only provides transient respite from the coming dark mornings.

I think people might like the idea of adding an extra hour to their day, as we change the clocks in the fall and despite the annoyance of resetting clocks, as much as they dislike losing that hour in the spring. We all imagine a luxurious extra hour of sleep, though that fantasy is usually thwarted by the reality of our schedules and our internal clocks (especially if you have pets or small children, even if your own internal clock can be ignored). Those internal clocks take frustratingly longer to adjust, so you end up simply waking an hour or so early. When we lose that hour in the spring, we almost invariably sacrifice an hour of sleep, as our busy schedules end up  overriding both lost hour and internal clock. We can be out of sorts with a side of zombie as we tackle those first few days.

The view of the time change is a little bit different for doctors, and anyone who must be on call for their job, though much of what I have just observed still holds. I can speak best to my experience of this as a doctor, though, so it is that perspective I will use. I view the time change, and much of my world in fact, through the prisms of being on call and the on call schedule.   Continue reading →

What’s in a Name

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A rose, by any other name, would smell as sweet.  Wm. Shakespeare, Romeo and Juliette
A rose is a rose is a rose.  Gertrude Stein

IMG_1551“This is Dr. Hughes” or “Hello, I’m Dr. Kathy Hughes” — This is how I answer the phone, or introduce myself as I walk in to a room.

I think it matters what I am called, how I am addressed. It also matters what I call you, as my patient, and how I address you.

Any Tom, Dick, or Kathy  can be Tom, or Dick, or Kathy. But it conveys a special role and relationship to use one’s title or formal name. Not everyone can be Doctor to you, and especially not Your Doctor. It is a special and particular relationship that I have with you. I’m your Doctor, I’m your Surgeon, I’m Dr. Hughes.

And in addressing my patients as Mr., Mrs., Ms., or Dr. (perhaps only with the exception of the very young and the very old, where stage of development or dementia interfere) I also convey and acknowledge the special relationship they have with me.

I admit, I still call my parents Mom and Dad; my aunts and uncles have likewise retained those titles. And even to their chagrin, I use the formal titles to address my parents’ friends, and my old teachers and professors. It’s not just a reflection of how I was raised, but an acknowledgment of the special bonds and relationships in this part of my life, too.

It is important to acknowledge these relationships and bonds. How you address someone, what you call them, does that. It is like a shorthand, a shortcut, spelling it out. It honors them–the relationship, the bond, the person.

I remember a lot of eye-rolling and joking at the expense of the early feminists in the Sixties and Seventies, when they objected to what they felt were sexist titles and names. So work titles like “Mailman” evolved to “Mailperson” to “Letter Carrier”; first year college classes changed from “Freshmen” to “Freshpersons or Freshwomen” to “Firsties” (at least at some Womens’ Colleges). But as silly as some of this seemed and seems, the feminists had it right–there is power and identity in what you call something or someone, or how you refer to them; power in naming. Likewise, the kind of naming, or failure to name, can do the opposite, diminishing power and instead offering disrespect, even contempt.

I confess that I bristle when I am called by my first name by a patient or their family member if I have not invited them to do so. Continue reading →