Wednesday, December 5, 2012

Revealing What You Think: Medicine and Compassion

In a recent Rheumatology News article "Kiss My...," Dr. Larry Greenbaum writes of his frustration with an older RA patient.  There are no editorial comments or comments from other rheumatologists indicating support or criticism of what he writes about this patient or that he bills him more. (Update: Apparently Rheumatology News is deleting responses from patients.)

Author of the blog RA Warrior and patient advocate Kelly Young calls Greenbaum out on his attitude in her post "Don't Kiss Me," but indicates that she feels torn about writing about the article.  I appreciate that she doesn't want to create conflict between patients and doctors, but like her, I think that some not-so-uncommon attitudes need to be revealed because they affect our lives far beyond that medical appointment.  We can receive help and compassion that we can carry with us in our lives, or we receive dismissal in the place of reassurance, continued pain instead of concrete medical help, loss of hope rather than empowerment.

We can't close a door on our physical pain and walk away from it, and the words people speak have a power to them.  A student once said to me that other instructors don't realize the power they have, how they can make someone feel absolute despair with their words, or the opposite.  Doctors have this same power, and it is insolent if you're a doctor to pretend you don't.  (Edit: I mean ALL doctors here.) With someone's health, with an illness that carries itself into every part of daily life, you cannot be cavalier.  There are few inflammatory arthritis patients who don't have to give up something, who don't experience loss and grief.

As I wrote in a comment on Kelly's post, part of me is glad Greenbaum reveals what he thinks because it shows how far we have to go.  Unspoken attitudes are more difficult to address, even if common. I too am dismayed by the writer's attitude and tone.  It's also unethical to bill patients (and thereby often insurance or taxpayers as well as the patient) more because you don't like them.  That's the doctor's personal issue to deal with.  It's sad when doctors are so burned out that the extra time some patients require cause them to lose patience and compassion.

It's up to the doctor to listen empathetically but to redirect if time is running short and to set a couple of concrete goals that are most important to the patient before the end of the appointment, whether that's evaluation of new symptoms, pain control, investigation of DMARDs, etc.  It sounds to me like one of the patient's primary goals for the appointment was finding an empathetic rheumatologist, and that's important for a first appointment.  That the patient joked and that the doctor did not get the joke, even if they don't share the same sense of humor, indicates a fundamental lack of connection.

For those doctors want to practice more compassion, it seems like it should come more easily.  Connect with us and never allow yourself to objectify us, to reduce us only to a case study.  Let go of the disdain you show as we describe our symptoms or pain and try to attribute the causes for them.  We're all the same--we're people first, both doctors and patients. Degrees and status don't make one person better than another, than the patient or the person who bags your groceries or mows your lawn.  (And just because I use a wheelchair doesn't mean I lack a context, a life, an education, friends, even if you can't imagine it.)  Of course, a certain percent of people will never have compassion; they don't want to have it.  We probably have to write them off.  But I think and hope that most people do want to increase theirs.

After reading Greenbaum's article, I feel that I better understand the lack of compassion in the rheumatology department of our children's hospital and the attitudes expressed to us first by the staff and then by the doctor.  They don't understand his pain; they don't believe his pain. That's all there is to it.  This is the general climate of rheumatology as well as other specialties.