Earlier this week I tweeted about the wisdom of my first ever boss. Dr Kemp was a fantastic, old-school doctor and I couldn’t have wished for a more supportive or inspiring Consultant in my first FY1 job. I’m sure he is a major reason why I pursued a career as a Physician. At the end of our attachment he checked the rota for a date when none of his team were on call and invited us all to his home for dinner with our partners. Just a demonstration of how lovely he was.
One of the titbits of his wisdom that has stayed with me for nearly 8 years now is his analogy of a medical admission to painting a picture rather than ticking the boxes. He hated the protocol driven Medicine that was starting to dominate practice at the time, and was a great believer in letting time help aid diagnosis. He would also always revisit a patient’s history with the brilliant skill of being able to pick out information, sometimes from the fairly distant past that was crucial in working out what was happening. I used to listen in awe at the back of the ward round, wondering if I could ever come anywhere near to emulating him.
There is the age old debate whether Medicine is an art or a science and most people seem to plump with somewhere in the middle, but I wonder whether we should explore our artistic tendencies a little more in the quest to improve patient care. Another boss who has been incredibly influential in my career taught me to start again and always come to my own conclusions, to paint my own picture. Of course there will always be boxes to tick in the modern day NHS, but perhaps alongside the box ticking we could get our paintbrushes out a little more often.
If being ill has taught me anything about being a doctor it is the importance of seeing a patient as a person and not merely a condition or disease sat in a hospital bed. It is amazing what you learn about people if you just ask. I have looked after a world record breaking knitter, an Olympic cyclist and a lady who had eleven children in the last few months. The disease focussed clinicians may see these facts as irrelevant, but I think they are central to understanding the person, how their pathology impacts on them and why they are special to their family.
When was the last time you stopped and had a conversation with someone on the ward just for the sake of having a conversation? We all blame being too busy on not doing this but are we really? Do we not have 10 minutes to sit down and explore someone’s worries? Having a chat can be therapeutic in itself. I know this. A few months ago when I was struggling with the uncertainty of my prognosis and the effect this was going to have on my career I had a long chat with my Oncologist. There was no examination, no diagnosing, no investigations and no prescribing; just talking. And it helped. It really did.
I see all this as painting the picture. It takes years to be able to paint a masterpiece, but the apprentice learns from the master and surely that is the model of how we all develop as clinicians. I’m going to invest in some more colours for my palette and remember to get my brushes out on Monday….
drkategranger 
I know what you meant but I did smile about the lady who had 11 children in the last few months!
I was diagnosed with advanced colo-rectal cancer in September 2004. which after surgery and seven months Folfox recurred in October 2005. HIPEC peritonectomy and I’m still here with a stoma which I hate but hey, you can’t be too picky can you?
I’ve been incredibly fortunate in having medicos who listened and talked to to me, my wife [my primary & phenomenal carer], my kids and my family through all stages of my treatment & hospitalisation. This helped everyone enormously.
I’ve also been blessed with some wonderful GPs and local medicos [in Canberra] who have also been capable of talking and listening. We have heard of friends and acquaintances in similar medical strife who have not had the advantages of being able to talk openly to their medical support and not being listened to by the medicos. I reckon we’ve been lucky in finding the right experts but also being capable of questioning everything we’ve been told, not in an adversarial fashion, but as a means to improve our understanding of problems and possible solutions.
Hi save just to say that I have had the same sort of experience here in all the hospitals I have had treatment in. All the. Staff have been really good and i could not have had better treatment. It makes this awful illness a little easier to cope with, even when its bad news as it so often is.
I like your post, Kate. My mother had to take me many times as a young baby and child to hospital; she used to say drs and other staff would adjourn to a corner of the room and discuss but not with her. I know that alone used to make her feel bad.
You’re absolutely right, Kate, and I wish every doctor and med student could read this. My Dad passed away last year and in the last 15 months of his life, he spent time in hospital, rehab and hospice. The doctors who stand out in my memory are the ones who talked to him and to me. The doctors who took those 10 minutes (and more sometimes) and just talked to me about what was ahead and how best to prepare for it. The hospice doctors are best at this, which isn’t surprising, and it seems to come most naturally to them. But two other doctors stand out in my memory. One was the doctor assigned the first time he was admitted to hospital. A day didn’t go by that he didn’t talk to me and guide me though the unfamiliar and the unknown. When he had a night off, he checked Dad’s progress on his computer at home and called in to both me and the nursing staff. And that was at 11pm on New Year’s Eve. The other doctor I remember was one of Dad’s longtime specialists who was not involved in this illness. When he heard that Dad was sick and had been moved from the hospital to hospice, he called me several times to check on Dad and to try and support me and help me understand what was going on. I may forget the medical abilities of other doctors, but I will never forget the kindness and caring of these doctors as they got out their palettes and painted a picture.
What you say is so true, but not just when someone is ill. Loneliness is such a big problem today and if we can all spare a few words to share with a stranger, show an interest, notice someone is there rather than the current preoccupation with mobile phones, texts, emails, we can all spread a little light into other people’s lives and into our own.
Lets hope all the new FY1s take this lesson with them as they start their new career this week.
When I read your post I thought of my GP.He does paint a picture and my family and I are so very fortunate to have him as our General Practitioner.His job surely isn’t an easy one with thousands of patients and regardless of his own pressures within the practice he will do whatever is best for his patient.
I have said to him in the past that he reminds me of a village doctor in the olden days…he used to know everyone,from young to old and always ready to dispense some advise where
medicine wasn’t needed and yet ready to climb out of bed at 3 in the morning to help the midwife to deliver a baby or sit with an old man in his last hours.
As you state: “The disease focussed clinicians may see these facts as irrelevant, but I think they are central to understanding the person, how their pathology impacts on them and why they are special to their family.”
With a box ticking obsessed NHS there is every need for Physicians such as you and my GP….so go and get your palette and brushes out.I am sure it will be a great picture and absolutely priceless to your patient.
Dear Kate……as a retired GP, I have had many discussions about the raritiy of finding a doctor, especially a surgeon who is both good at the job, and ” nice”. So iwaa very struck by you remark in the BMJ of feb 15th that you have yet to meet a compassionate doctor who was not also competant. They exist, believe me, and they escape censure often because they are so kind and charming and compassionate that neglected or mis-diagnosed patients don’t complain.
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My mum was ill with pancreatitis, which she never admitted and must have been really brave to never complain The 2 doctors in A&E took the time to speak to mum like a person and also and took the time to discuss the illness once 100% diagnosed Her registrar in the 2nd hospital was fab and encouraged mum to have an endoscope and rewarded her by buying an orange juice when she woke I could never ever repay him for that act of kindness and the pleasure and warmth that brought to mum. The 3rd hospital all the consultants were amazing and all worked very hard for mum I will always appreciate their efforts. Where mum was let down so badly was the nursing staff – they complained as mum didn’t ask for pain relief, stated they were too busy to pop in to ask how she was, compalined if she needed an extra blanket, if she needed the loo – how sad and hurtful to display that behaviour to another human being – so yes it costs nothing to smile and listen, quietly. God bless.
Hi Kate
Brilliant to read you as always
Am sure you’re aware of this but…
‘… whilst clinicians are trained to think mechanistically and draw conclusions using patho-physiologic rationale and deductive reasoning, the study of medicine is not only a mechanistic and quantitative science, but an interpretive art. Interpretive research asks questions about social interactions that can be addresses by qualitative methods. Hughes (1990) ’. Hughes J, 1990. The interpretive alternative. In: Hughes J (Ed.) The Philosophy of Social Research. New York: NY Longman
So agree with you, my husband has only seen his oncologist twice once for a few mins at diagnosis to sign consent and once for thirty seconds during treatment when his mobile went off and he left to answere it and did not return. Making usfeel unworthy of his time, thecancer had returned after 5 years and there were less ticky boxes then, how sad that professional s have lost the art of conversation to gain information . I am a nurse myself and will leave when I can no longer treat people with interest , care and respect.
Reblogged this on deejoda and commented:
For those healthcare professionals…remember its all in the title ‘care’ – I always wonder, if you do not care, go elsewhere and ‘not care’. Spread the love people
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What a wonderful blog post, highlighting a discord in my work and personal life. Your writing strikes me as reminiscent of Trish Greenhalgh and Siddhartha Mukherjee, as well as the narrative medicine myself and a colleague are ‘teaching’ in our ILA masterclass with medical students. Sadly I don’t know how do this with my own doctors! I am on follow-up now 20 months post chemoradiation and I don’t feel I can talk to my consultant about my concerns about the (potentially debilitating) long-term side-effects because she sees me as a ‘quick and easy patient’ (which is rational given the one-and-a-half-hour clinic wait) and is very much focused on the biomedical. I think there needs to be a masterclass for patients on encouraging doctors to open up narratives 🙂
Totally agree Kate. We need to keep our paints fresh and at the ready. I think it was William Osler who said
“It is much more important to know what sort of person has a disease than what sort of disease a person has”
That was Parry. Parry’s dictum, originally made about the treatment of endometriosis.
I have to say none of this rang true for my work place, and I’m extremely grateful for this. We talk if people need it, we sit with families until they understand or feel supported. I’m sure we fail sometimes but on a whole I think we tend to every need and unfortunately patients are shocked when they leave us and go to a larger ward, this upsets me but I feel at least they have some one to one time for a while. Although what I have learnt is sometimes I do this to my own detriment. I’m a nurse but that dosn make me fit and well, or invincible. I often can go a 12 hour shift with no break so that I can care for someone to a high standard, or be the familiar face a greiving reletive needs. But I myself have a longstanding health problem that flares up with lack of rest and stress on my body. So sometimes I must take a break, I just find it hard to find that balance when we are so in demand.
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Good post. I learn something new and challenging on sites I stumbleupon everyday.
It will always be exciting to read articles from other writers and use a little something from other websites.
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I’ll be sure to bookmark it and return to read more of your useful info.
Thanks for the post. I will certainly return.
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Dear Kate, as you might have spotted, your post inspired me to sign up to WordPress, to become a blogger myself. And my first ever post was a reblog of this post. So thank you! For being inspirational. I know your post set off a change in me and I am a better paediatric trainee because of you.