Tuesday, February 19, 2008

Trust vs Mistrust

A few months into my post-graduate internship, I bought a book entitled "How Doctors Think," which attempts to explain to the common people, how their doctor processes their feelings, complaints and diseases. Hard-pressed for topics as we bloggers are, hehe, I found the interest in the book quite amusing as fellow PGI's and residents alike have expressed their desire to borrow the book.

Anyway, what got me hooked on the book was the introduction on the book jacket that read that the common physician usually interrupts his or her patient during the initial interview a few minutes into launching his complaint.

It is true.

Too many times have I done it.

Too many times have I heard my fellow PGI's, my residents do it.

Too many times have I heard my consultants do it.

By doing this we want the patients to tell us something that will confirm that diagnosis we have in the back of our minds instead of listening to our patients' complaints.

Recently, we had a patient come into the emergency room in severe respiratory distress -- O2 saturation 30-40%, turning into this really scary shade of blue, no appreciable breath sounds. I called my resident and we got a history -- a known asthmatic, with multiple hospitalizations for asthma and a rich history of allergies. Apparently, from the mother's very words, a butterfly landed on his right shoulder as he was going to sleep. He started itching all over, gradually having a difficult time breathing and was rushed to the hospital.

Sure it sounds logical now -- anaphylactic shock. But at that time, in the ER confronted with that butterfly story (which was more likely a moth, with that really annoying powder), I refused to listen. I can't speak for my resident (but I think he didn't buy it either), but I kept thinking there is no way a butterfly could do this much damage. (Deadly brown and yellow butterflies, perish the thought of them terrorizing our flowers).

As we loaded him with steroids, shot him with epinephrine, bagged him until that shade of blue on his cheeks turned a light shade of pink, we noted a reddish elevated patch of skin around his right shoulder and eventually small pinpoint rashes came out. It was then we both admitted, my resident and I, "tinuod jud diay 'tong butterfly." So what the mother said was true.

It's a mistake we make often, not listening enough, to patients or not. Our generation of MD's have often been criticized as having lost touch with the art of medicine -- that we rely on new-fangled machines, laboratories to make our diagnoses rather than old-fashioned clinical sense.

I beg to differ.

We have the best of both worlds.

If we do not lose sight of how a good clinical history and physical examination goes with our laboratories and imaging, we will be better doctors than those that have come before us.

Let's renew our faith in our patients.

After reading that book, I may still interrupt patients and forgive me if I still do not trust them fully (given the barrage of late-night consults with really stupid complaints like incessant crying and a few-minutes-ago cough), I resolve to listen more and at most, give them the benefit of the doubt.