Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning to write a post about some of the more subtle difficulties of rotations. But after spending time reflecting on a few patient experiences, I realized I can’t write that entry. Instead, I’m going to write the opposite of that entry, because I think some doctors out there need this reminder.
I think life for a patient in a hospital is incredibly rough. You must be thinking, “Well that’s obvious. They’re sick, suffering, and in a hospital for crying out loud.” But I think people in the medical profession sometimes forget how rough it is, because they are so caught up in the business of treating the disease, not the patient as a whole. And the patient experience can be very dehumanizing. Think of it this way: patients relinquish control over their own bodies so that you can run tests on it, cut it open, and inject drugs into it. Patients make themselves vulnerable to physicians because they trust us, and that trust is not something we should take lightly.
For this entry I want to talk about the little things we as doctors do to patients regularly. I’m not talking surgeries or life threatening procedures. Think more along the lines of daily blood tests or the type of diet we put patients on. For doctors, ordering a morning CBC (blood test) is as easy as clicking a checkbox in the patient’s medical record. Sometimes we forget that this means the patient wakes up to a needle stick. I get my blood drawn once a year and still dread it. And morning rounds. As tired as we are to be rounding at 5 am, I can’t help but think about how tired the patients must be. Imagine being woken up while it’s dark outside to have your surgical wound poked while a team of residents and students are staring at you and asking questions. I sure wouldn’t be a happy camper.
One of the things we do most often in the hospital is to keep patients NPO – in latin it means “nil per os” which translates to nothing by mouth. I know few things with certainty in life, but 25 years of being me has taught me that I transform into a grumpy uncooperative and irrational person when deprived of food. Patients go for days without food, and we expect them to still lovingly embrace our clinical decisions when they’re in that state?
I am playing a bit of devil’s advocate here because you know (or I hope you do) that I am fully aware of the importance of rounding and morning labs and keeping patients NPO. I know these things, among other even more unpleasant procedures and interventions, are absolutely necessary for the patient’s health…most of the time. What I’m proposing is for doctors to try showing a little more empathy. Many of my patients don’t understand why they’re NPO, and they’re understandably angry. Perhaps explaining clearly why and for how long they need to refrain from eating will help frame their thinking. More patience during morning rounds when patients are slow to wake up or cranky from lack of sleep would be appreciated. Give them some time to wake up and answer your questions while alert instead of mumbling answers in a fog of sleep. Just be aware that everything you do and order affects your patients in a very real and sometimes painful way.
Sometimes on rotations, I get exhausted thinking about how little sleep I got the night before or how hungry I am from missing multiple meals during long surgeries. But whatever I face in the hospital is nothing compared to what patients are going through. Again, this must seem so obvious to some readers, and perhaps it is more obvious to readers who aren’t in the medical field. But sometimes in the chaotic daily routine of hospital work, you can forget this humbling thought. And if we can go forward with empathy for little things that you wouldn’t think twice about earlier, then maybe we can make the hospital a slightly better place to be.