Thursday, May 24, 2007

Medicine upside down

Sometimes in medicine, the hierarchy breaks down. Our etiquette, which rivals the military’s in its degree of structural rigidity, fails to inform our behavior in particular situations. It happened to me the other night in fact: I had a physician as a patient. That may sound trivial, but here’s how I ended up introducing myself to him: “Hi Dr. Lambert, I’m Wyatt, and I’ll be the medical resident handling your admission this evening.” Of course, he loved it, instinctively raising his chin and straightening out his posture in the gurney. By my addressing him as doctor and myself by first name, I had just indicated that I was planning on giving him the full respect that I would afford one of my own attendings. Not only would he receive the utmost politeness and consideration, but his opinion would be given a very heavy weight. From my few words of greeting, he knew that the full VIP treatment was his.

Myself, I felt more ambivalent about the tone I had set for our interactions. By addressing him as a superior, I had just conceded my power as the doctor over to him. This would be one warped doctor-patient relationship: he would be calling the shots and I would simply be carrying them out. In fact, in all actuality he would be his own doctor. The implications of this were still unclear to me, but I figured that basically I would run all of my orders by him while avoiding any uncomfortable questions or elements of the examination that I might otherwise have performed.

Directing your own medical care may sound nice, but I can testify that in reality, it’s not. For one, it’s impossible to see yourself objectively. To verify this, simply take a stroll around the hospital ward counting the number of bare buttocks that you see. Those nice hospital gowns that cover everything up so neatly in the front, it so happens, leave gaping holes in the back if even a single renegade string goes untied. Moreover, doctors are notorious hypochondriacs. When you know the constellation of symptoms for hundreds of rare diseases and see people sick with them on a daily basis, you forget that rare diseases are actually rare. If left to yourself, you’d likely cause your own drawn out death from bleeding due to excessive lab testing. Alaskans, already familiar with the concept of death by mosquito bite, know what I'm talking about.

Fortunately, this doctor was much cooler than expected, and he pretty much let me run the show. Having an attending physician asking and caring about my opinion felt really great and restored the standing that I had abdicated earlier. It turned out that he actually wanted to have a doctor, rather than be one, so we both ended up satisfied. In fact, the experience was so positive that next time not only will I keep the same introduction, I won’t even skip out on the rectal exam.