Saturday, January 8, 2011

We're Not Taught to Do That in Medical School

Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate over superiority is old, tired, unimaginative, divisive, and wrong-headed--for reasons that are too obvious even to list. Does it get perpetuated because it garners comments?  

The New York Times recently ran a column by one of its editors, "In Praise of Nurses."  Nothing wrong with gratitude for nurses, who are certainly under-appreciated or mistreated, both in real life and in media portrayals of them.  Where it gets gnarly, apparently, is how to praise nurses in a vacuum, without comparing them to physicians, and without the snarky jabs.

To generalize: Nurses are warm, whereas doctors are cool. Nurses act like real people; doctors often act like aristocrats. Nurses look you in the eye; doctors stare slightly above and to the right of your shoulder. (Maybe they’re taught to do that in medical school?)
The rhetorical question begs a response.  So... this is what we learn in medical school about how to interact with patients.  Keep in mind this highlights solely psychological factors.  How we learn to put together the relevant information to generate a differential is another story for another time.

-Consciously keep "patient as a person" in mind while we conduct our interviews. While starting, we even had a separate category entitled this, which would often include vocation, home life, and hobbies.

-Ask for a patient's explanation of his/her illness. "Why do you believe that?" is usually a good question and leads to better care.

-It's not an interrogation.  Seat ourselves during the interview at a slight angle to 180 degrees, so that we are not directly facing the patient.

-Body language, body language, body language.  It's like a first date.  Encourage conversation; it's information you need.  Make direct eye contact, nod, say "mmhmm" or "go on."

-Attend an AA meeting.  Watch alcoholics who have been sober for decades counsel alcoholics who have decided yesterday to quit.  "Today is a new day."

-Listen to victims share their domestic abuse stories. Ask questions. Listen some more. It happens at the most unexpected times to the most unexpected people.

-Learn how to take an appropriate and sensitive sexual history.  Don't assume anything--married or not, "straight" or not, "educated" or not.

-Make a home visit to a patient.  We see "disease"; he experiences "illness."  What is it like?

If something is going wrong with the author's doctors, unfortunately it is in spite of what our dedicated and caring preceptors teach us in medical school.

16 comments:

  1. Doctors win the battles. Nurses win the wars. At least when it comes to patient compliance and the ability to effect long-term change.

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