One of our patients came off sedation and was extubated.
A few hours later, the doctor came by to assess the patient’s mental status. He asked,
“How old are you, Mr. Smith?”
The patient replied, “I was born in 1924.”
It wasn’t really the answer the doc was looking for, so he asked again,
“But how old are you?”
And the patient looked up at the doctor and said,
“You do the math.”
**This post originally appeared at Gina Rybolt’s CodeBlog.**
My friend and fellow blogger David Kroll just wrote an interesting post about the use of “doctor” as a title for a wide range of expertise, including medical. The discussion reminded me of the usual misunderstandings associated with my title…
Typical Val conversation with lay strangers:
Dr. Val: “Hello, I’m Dr. Jones…”
Person: “Oh, hi Dr. Jones. What kind of doctor are you?”
Dr. Val: “A medical doctor.”
Person: “Oh, so you’re like, a pediatrician?”
Dr. Val: “No, my specialty is rehabilitation medicine.”
Person: “Oh, my uncle has a drug problem. He’s been in and out of rehab for years. I’m so glad that there are people like you willing to help addicts.”
Dr. Val: “Uh… Well, actually my specialty is focused on physical rehabilitation – like patients with spinal cord injuries, amputations, strokes, car accidents, etc…”
Person: “Oh, so you’re a physical therapist?”
Dr. Val: “No, I’m a physician. But I work closely with physical therapists.”
Person: “So you’re a REAL doctor?”
Dr. Val: “Yes, I went to Columbia Medical School…”
Person: “Well, you don’t LOOK like a doctor.” [See example here]
Dr. Val: “Uh… thanks?”
***
Dr. Val: “Mom, why don’t people believe I’m a medical doctor?”
Dr. Val’s Mother: “Well, you picked an oddball specialty, dear.”
Dr. Val: “What’s oddball about helping the disabled population?”
Dr. Val’s Mother: “Well, you know ‘rehabilitation’ usually conjures up ideas of drug rehab.”
Dr. Val: “Yeah, my specialty has the weakest PR in all of medicine. Nobody knows what we do.”
Dr. Val’s Mother: “At least people don’t think you’re a hypnotist.”
Dr. Val: “What?”
Dr. Val’s Mother: “Did I ever tell you about the time I was on an elevator with someone at a Spanish literature convention?”
Dr. Val: “Uh…”
Dr. Val’s Mother: “My tag said ‘Dr. Sonia Jones, member of the American Association of Hispanists.’ A woman in the elevator with me was staring at my name tag and finally blurted: ‘Are you here with the convention?’ And I said, ‘yes.’ And then she responded: ‘Could you hypnotize me too?!’”
Thanks to KevinMD for pointing out a recent NYT article about “etiquette-based medicine.” The author, a psychiatrist, suggests that physicians should use a check list to ensure courteous behavior and that this sort of thing should be taught in medical school. His suggestions were also published in the New England Journal of Medicine:
• Ask permission to enter the room; wait for an answer.
• Introduce yourself; show your ID badge.
• Shake hands.
• Sit down. Smile if appropriate.
• Explain your role on the health care team.
• Ask how the patient feels about being in the hospital.
If this sort of thing isn’t intuitively obvious to a physician then I’d say the blame should rest with his parents not his medical school. I mean, do we really need to teach doctors to knock on doors and smile on cue? Aren’t those sorts of things taught in pre-school?
It grieves me that some of my peers do not display what some might call “normal behavior” when interacting with patients. But I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.
Now, I don’t excuse disrespectful behavior – we docs must rise above our natural urge to be irritable at times, and remember that our patients are vulnerable and need our help. But for heaven’s sake… let’s drop the smug check lists and finger pointing. We’re all in this together, and it ain’t pretty.
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