Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning to write a post about some of the more subtle difficulties of rotations. But after spending time reflecting on a few patient experiences, I realized I can’t write that entry. Instead, I’m going to write the opposite of that entry, because I think some doctors out there need this reminder.
I think life for a patient in a hospital is incredibly rough. You must be thinking, “Well that’s obvious. They’re sick, suffering, and in a hospital for crying out loud.” But I think people in the medical profession sometimes forget how rough it is, because they are so caught up in the business of treating the disease, not the patient as a whole. And the patient experience can be very dehumanizing. Think of it this way: patients relinquish control over their own bodies so that you can run tests on it, cut it open, and inject drugs into it. Patients make themselves vulnerable to physicians because they trust us, and that trust is not something we should take lightly.
For this entry I want to talk about the little things we as doctors do to patients regularly. I’m not talking surgeries or life threatening procedures. Think more along the lines of daily blood tests or the type of diet we put patients on. For doctors, ordering a morning CBC (blood test) is as easy as clicking a checkbox in the patient’s medical record. Sometimes we forget that this means the patient wakes up to a needle stick. I get my blood drawn once a year and still dread it. And morning rounds. As tired as we are to be rounding at 5 am, I can’t help but think about how tired the patients must be. Imagine being woken up while it’s dark outside to have your surgical wound poked while a team of residents and students are staring at you and asking questions. I sure wouldn’t be a happy camper.
One of the things we do most often in the hospital is to keep patients NPO – in latin it means “nil per os” which translates to nothing by mouth. I know few things with certainty in life, but 25 years of being me has taught me that I transform into a grumpy uncooperative and irrational person when deprived of food. Patients go for days without food, and we expect them to still lovingly embrace our clinical decisions when they’re in that state?
I am playing a bit of devil’s advocate here because you know (or I hope you do) that I am fully aware of the importance of rounding and morning labs and keeping patients NPO. I know these things, among other even more unpleasant procedures and interventions, are absolutely necessary for the patient’s health…most of the time. What I’m proposing is for doctors to try showing a little more empathy. Many of my patients don’t understand why they’re NPO, and they’re understandably angry. Perhaps explaining clearly why and for how long they need to refrain from eating will help frame their thinking. More patience during morning rounds when patients are slow to wake up or cranky from lack of sleep would be appreciated. Give them some time to wake up and answer your questions while alert instead of mumbling answers in a fog of sleep. Just be aware that everything you do and order affects your patients in a very real and sometimes painful way.
Sometimes on rotations, I get exhausted thinking about how little sleep I got the night before or how hungry I am from missing multiple meals during long surgeries. But whatever I face in the hospital is nothing compared to what patients are going through. Again, this must seem so obvious to some readers, and perhaps it is more obvious to readers who aren’t in the medical field. But sometimes in the chaotic daily routine of hospital work, you can forget this humbling thought. And if we can go forward with empathy for little things that you wouldn’t think twice about earlier, then maybe we can make the hospital a slightly better place to be.
Too true. Unpleasant things are sometimes necessary, but if a patient feels cared for, and knows the purpose of the interventions, they are generally more compliant and just in slightly better moods. In our hospital we sometimes have surgeries being pushed back and back due to a shortage of ORs, and then doctors don’t understand why the patients begin to lose weight and decline… until they realise they haven’t given the patient an opportunity to eat!
Exactly. We lose sight of diets sometimes in the face of everything else that’s going on.
Exactly. We lose sight of diets sometimes in the face of everything else that’s going on.
So I developed Crohn’s disease when I was 11. My first hospital stay was 16 months, followed 2 weeks later with 8 more months. I was NPO for 6-8 weeks at a time. TPN and lipids and one popsicle a day, because I begged for them.
What was dehumanizing is what I would do for 3 french fries or a packet of 2 crackers. I remember standing in the hall with my two IV poles and 7 pumps waiting for the food trays to come up. Then when the aid was delivering them I’d steal small amounts of food off of the food cart (writing this is making me cry)I knew it was just going to make me hurt but I was going to hurt anyways. The 250mg of demoralizing they gave me every 150 mins did nothing to stop the hunger pain, though it did provide minor relief to the cramping.
People dont know what being seriously sick is really like. I guess this was just preparing me for what would happen later in life. Later I in life accidents would cause 28 broken ribs, broken neck 3rd degree burns vs arms legs and hands, punctured lung and brain damage (among other things) these things pailed in comparison to the suffering I once experinced.
I have some sort of PTSD in regards to food now. I eat like I spent my life in prison, which in combination with the total colectomy and Illeostomy, left my diet habbits atrocious, as I spent my young adult life trying to maintain a 6,000 calorie a day diet, and all the problems that come with that.
Long story short, a few days of NPO isnt bad it’s not desuppressors. What is dehumanizing are things like, promising to let someone eat, just to tell them no before the meal is delivered. Which happened all the time. It’s the carrying your inflamed scrotum down the hall in one hand because they hurt to dangle, what’s dehumanizing is sticking someone two dozen times because a fresh blood sample is need that isnt going to show a bloody change from the last 97k white blood count that was done two days ago. (On immune suppresors).
What is dehumanizing is ignoring the fact that if someone has to go through this level of litteral shit, they deserve a break once in a while..
My heart breaks reading about your experience with Crohn’s followed by the accidents. Being a patient is REALLY REALLY hard – I completely agree with you. It is so important for doctors and other healthcare providers to hear from the patient’s perspective so that we can empathize and deliver kind and caring care. Thank you for sharing your experience. I wish you the best.