Dr. Jeff Kane: Treatment vs. care
“A specialist is someone who knows more and more about less and less until he or she knows everything about nothing.”
— Sign seen in Mayo Clinic
The sign only exaggerates a bittersweet truth. Cardiologists thoroughly know hearts and neurologists know nerves, but although most specialists claim to also address the “whole patient,” their practice tends to narrow their scope to their organ of interest. That’s fine for technical intervention, but it too often results in overlooking the patient’s well-being.
Jack, who had stage four cancer, noticed a lump in his neck. His oncologist, feeling it, said it was likely a tumor. “It wasn’t there a month ago, so we need to biopsy it,” he added.
Figuring the lump was sure to be cancer, Jack asked, “What if you don’t biopsy it?”
“Well, if it’s a tumor it might get bigger and uncomfortable.”
“You know, Doc, I really don’t want any more procedures. Let it do what it wants.”
“But it could choke you, make it hard to breathe. It might get too big to be operable.” The doc persisted, ignoring Jack’s objections, and finally got angry. He wrote on Jack’s chart “non-compliant patient.”
A few days later, Jack had questions. When he called the medical office, the receptionist said the doctor would call him back within 24 hours. Jack waited by his phone that day and the next. No call. Jack concluded, “I get it. He’s a capable technician, but I wouldn’t call him a caring physician.”
Edith was undergoing a test that required extensive preparation involving skin electrodes and sophisticated computing. When all was ready, the tech summoned the doctor to conduct the test. Edith said the doc literally ran into the room and pressed his face onto the computer screen, neither greeting nor even acknowledging her.
Terry, having been hospitalized with an intestinal obstruction, was sent home with no dietary instructions. He found he couldn’t eat without hurting, so he called his gastroenterologist. The office arranged a phone appointment ten days post-hospitalization. During that interim, Terry continued hurting and lost 10% of his weight. In the phone conversation, the doc advised, “Eat what you can.” Three days later, concerned that he was feeling no better, Terry left a message for the doctor, but got no response. The next day, Saturday, he called the answering service and asked the on-call doc to contact him. The doc didn’t. “I felt scared and abandoned,” said Terry.
Such stories are so common that they suggest that many docs see their work simply as performing procedures: tests, surgeries, prescribing. They treat, which is different than giving care. Care would mean hearing patients, honoring their experiences and preferences, returning calls, and guiding and comforting them.
The flavor of medicine’s entire history, no matter what its stage of technology, is caring. Whether in person or by phone, a physician worth the title will find a way–even within the belly of corporate medicine–to care.
Jeff Kane is a physician and writer in Nevada City.
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