Patience for Patients

April 8, 2020

Last Tuesday I became impatient while waiting for a resident physician to finish seeing her last patient. It was snowing and growing dark outside and I was anxious to get home. The second-year resident had been in an exam room with her patient, a late work-in appointment, for nearly an hour. As a supervisor, I am reluctant to leave until the last patient visit is completed even though I am usually not needed. I was preparing for an early exit when her nurse called and said the resident had a “quick question”. I entered the exam room and encountered a young woman seated on the exam table. The resident stood in front of her patient looking directly into her eyes. A young man slumped alongside in a side chair wearing a tattered faux sheepskin coat. I asked if we should step out of the room to talk, but the young physician said no.

The patient appeared comfortable and handsome, but her red and swollen face alerted me of the likelihood of a serious illness. The resident doctor began reciting a litany of problems that the young lady had suffered. She had inflammatory bowel disease. She had had a considerable segment of her small bowel surgically resected. She had recently been in a major medical center where an investigational drug had failed to control her bloody diarrhea and constant gnawing abdominal pain. She had survived episodes of pneumonia, pleural effusions and pericardial effusions that required repeated prolonged stays in intensive care. Now her abdominal symptoms were somewhat moderated on high dose corticosteroids, but she was experiencing severe headaches, facial pain and an asymmetrical sinus pressure. As the resident ticked off her litany of recent problems, the woman nodded in agreement, added a few details and only occasionally glanced in my direction. The “quick question” was, “do you think we must admit her to the hospital and do a spinal tap?”

Doctor readers might be interested in how I answered this question, but I am going to diverge from that part of the story at this point. What I wish to illustrate is this so true story of the work of a resident physician. The woman had already called the doctor in the city whose office told her to call her local specialist whose nurse told her to call her family doctor. It was a grey day and getting late and no one would be anxious to see a patient of this complexity under these social circumstances (that extend well beyond the length of this piece) at that particular time. But the resident did. In fact, the woman had the resident’s cell phone number and had been given instructions to “call anytime if you need anything that your specialists cannot provide.” The woman and her husband were scared so she exercised her privileged direct call option. The resident said come right over and I will see you. This couple had been through several serious illnesses and complications. Their plight was well beyond what most of us can fathom. Their story made mincemeat of the notion that simplistic Venn diagramed phone triage protocols could excuse the doctor. She needed a real human being to hear her story, touch her pain, look into her eyes, comfort her husband, discuss frank possibilities and courageously decide upon a rational plan of action that may turn out wrong. The plan to wait was as well as could be constructed under those circumstances and at that moment for this young woman and her family.

The woman got what she deserved and what she needed thanks to the compassion of one tired and overworked resident physician. The resident will not be reasonably recognized by the community for that effort. She will not be paid like the city super-specialist. She might be sued if their improvised plan does not work out. She will be vigorously criticized by many second guessers wearing different hats who were not there in that moment with that family. The woman and her family were spared a spinal tap and another hospitalization that they could ill afford and desperately hoped to avoid. The cost of care can be manageable if there is patience for patients and the medical culture does not transform another resident physician into another cog in the wheel of medical extremism that eats money and disregards humanity.

Sign up for my Newsletter