Tuesday, April 13, 2010

Jennifer Frank, MD: A reflection on me

I recently had to readmit a patient to the hospital for pneumonia. A lovely and delightful woman, she happens to have severe COPD exacerbated by continued smoking. She knows she shouldn’t smoke. I know she shouldn’t smoke. I know that she knows that she shouldn’t smoke. We have been over this countless times.

Speaking to the pulmonologist about her care, I was informed that she needs to quit smoking. I became embarrassed that my patient was still smoking, as if I was somehow responsible for this behavior. I have been scolded by consultants on other occasions when my patient was rude to the nurse in the hospital or didn’t keep a follow up appointment. Sometimes the consultant catches herself before continuing the tirade, and sometimes my therapeutic relationship is perceived to be so close with my patient that the patient’s behavior becomes one with my own.

Really it boils down to a blow to my professional pride.
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I cringe to call a specialist on those patients who continue to abuse their own bodies, eschewing medical care until they are practically in extremis. As a primary-care physician, I pride myself on the close relationships I establish over months and years with my patients. However, sometimes my role as the family doctor seems to carry the responsibility for my patients’ actions along with it.

I liken this to what happens when one of my kids goes to school with a stain on his shirt or her hair uncombed. This doesn’t happen most mornings, but occasionally, the juice spills on the shirt at breakfast and I don’t notice the stain until dinnertime. Or, in the mad rush to get out of the house I assume my husband will brush the girls’ hair and he assumes I will and then the bus is there and the opportunity is gone. When this does happen, I wonder if the kindergarten teacher or classroom parent thinks I am careless. I am already suspect as a working mother, so maybe this adds fuel to the fire of speculation about my commitment to my family.

There is an understandable element of pride in how our children behave, appear, and are regarded. We all want to have the most beautiful, talented, polite, and exceptionally bright kids. When our children make the inevitable mistakes or fail to practice the basic elements of personal hygiene, it is challenging as a parent to not inwardly wince at what this says about us.

It is similar being a primary-care doctor. I take pride (or not) in my patients’ performance – if their A1Cs are below 7, this not only reflects what “good” patients they are, but also what a “good” doctor I am. But just like we can’t pick our kids, we can’t pick our patients. So, I must deny the pull of professional (or parental) pride and accept my patients just as I accept my own children – as imperfect people who look to me for help and often for approval as well.

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