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The Ultimate Learning Experience

I originally wrote this blog entry on my other blog, back in April.  I am posting it here in response to a new blogger friend, RoseChimera, who I thought would appreciate reading about how my experiences as a patient will affect how I hope to practice medicine in the future.

E. has been home from the hospital for two and a half weeks now and I sometimes forget that he is actually almost four weeks old and that he spent the first week of his life in the NICU.  As much as I would love to forget the events of that whole week, there are definitely some important lessons that I hope will stay with me as I continue my journey in the world of Medicine.  Before I reflect on what the experience as a patient (or the mother of a patient) has taught me, I want to say that I am extremely grateful for the care that E. received while in the NICU:  We had some wonderful nurses and some very dedicated physicians and residents while we were there.

When A. was born, I remember feeling that my experiences in the hospital during his delivery and the two days I spend on the post-partum unit were exceptional.  I felt like the nurses, lactation consultants, residents, and physicians were all very helpful, doting, and concerned over the wellbeing of my new baby and I.  Unfortunately, I can’t really say the same about this hospital stay.  I’m sure the reason I feel this way has everything to do with the complications that E. faced and his eventual need to be admitted to the NICU.  In addition, this experience was probably different because as a medical student, I have a deeper medical knowledge base and I know a little more about how health care personnel are expected to interact with their patients.

 Throughout our entire time in the hospital, I constantly felt that I was not being “listened to” by the people who were responsible for E’s care.  The most obvious examples of this were the multiple times I expressed my concern over E’s well-being to my nurses over the course of the night before he was admitted to the NICU.  I really could not shake the feeling all night that something was not quite right and despite this, I was constantly told that my concerns were nothing to worry about.  It is very possible that this may have been the case.  However, not once did anyone actually take the time to consider why I was concerned and take a closer look at E.  This feeling is compounded by the fact that both my obstetrician and the labor and delivery nurse were concerned about E’s respiratory efforts immediately after he was born: In the short time that E. and I were still on the labor ward, NICU was called twice for a consultation on E., and both times they said he appeared normal. I am convinced that if someone had taken the time to observe him more closely when people, including myself, expressed concern, things would have turned out very differently and E’s condition would never have become so acute.

Somewhat related to my feelings of not being “listened to,” were the continual ways in which my questions about E’s condition and rationales for care were answered.  In reality, very few of my questions were ever adequately answered the first time I asked them.  The extent to which my questions were answered followed a strict dichotomy:  If the nurse/physician knew that I was a medical student, I usually got a detailed and acceptable answer, and if they didn’t know, I almost always got a canned response.  In my opinion, my level of education shouldn’t have had any effect on the ways people talked to me about E. and his care.  I realize that medical conditions and the associated medical jargon can be confusing to people not versed in the field.  However, this should never be an excuse for a doctor or nurse to let patients or their families feel like their questions and concerns are not valid.  Physicians, and all health care providers, should make every effort to answer questions to the satisfaction of the people asking them, and they should be able to do so in a way that accessible and understandable to the person asking the question.

Let me illustrate one of the more frustrating experiences I had with regard to this concern.  On a Friday, E’s doctor told us that he was very happy with how E’s x-ray looked that morning and if things were progressing as well by the next morning, they were going to clamp his chest tube and we’d probably be able to go home on Monday.  On Saturday morning, I was eagerly awaiting the great news that his x-ray showed more improvement and that they would be clamping the tube.  When I arrived at E’s bedside that morning, however, I was told by the nurse that the doctors were not happy with how the x-ray looked and they weren’t going to do anything with his chest-tube until Monday.  This was the only information that the nurse gave me and I was devastated.  It turned out that a different doctor was responsible for E’s care over the weekend and when I asked him why E’s care plan had changed, he smiled at me politely and said, “sometimes these things take time to heal.” I was choking back the tears as this new doctor walked away from me.  Not too long after this incident, the resident who had accompanied the doctor earlier came up to me, introduced himself, and asked me if I was the medical student – because he’d heard that the mother of the baby with a pneumothorax was a medical student.  I said that I was and then I told him that I was confused as to why the approach to E’s care had changed so much overnight.  He then took the time to show me E’s most recent x-ray and explain to me why the doctor had decided to take a more cautious approach with regard to clamping the chest tube.  While I was still saddened by the setback in our timeline, I felt much more assured that E. was receiving proper care.  Most importantly, however, I felt as though I was a recognized and respected person who was included in the care process for my own child.  This feeling is one that every person should feel with regard to their own or their child’s health care; it should not be some sort of privilege afforded to the small number of people who have the background or expertise to ask the right questions and understand the medical lingo.

I could probably write twenty pages about the other events that happened in our short hospital stay that have made me reflect on how I want to approach my patients when I am a physician.  While nothing could have ever made me feel completely at ease or take away the heartache that I felt while my infant son was in the NICU, there are small things, that if done differently, could have made the situation much less harrowing for my family and I.  The way in which my concerns were brushed off as insignificant made me feel like I was a nuisance to the nurses.  Visiting my son in the morning, after a long, sorrow-filled night without him at home, and having to wait fifteen minutes for an update on his condition so the nurse could “finish her charting” before talking to me filled me with anger and loathing.  Having a doctor spit out a generic, nugatory answer to a question that I had about my son’s condition rather than take the time to make sure every question and concern I had was addressed left me feeling alone and uncertain.  Feeling like a nuisance, anger, loathing, loneliness, uncertainty… All of these are feelings that I never want to elicit in my future patients.  They are not only distressing, but they result in a negative experience and, most importantly, they are very easily avoidable.  Every instance that contributed to my negative in-hospital experience could have had completely opposite results if only the people involved made a conscious effort to put themselves in my position and attempted to understand what I needed from them at that moment.  It doesn’t take much time to show patients kindness, empathy, honesty, and responsibility when it is needed.  These small gestures might require a little more effort, but they certainly make for a superior patient experience and will most likely leave a lasting, positive impression on the patient when they look back on their experiences.   When I think of some of the wonderful physicians I’ve had in recent years, I realize that what makes them so good at what they do, and what makes me remember the positive ways they’ve impacted my life is that they always made the extra effort and put in the necessary time to ensure that I never experienced any of the feelings or emotions that I felt in the short week that E. was in the NICU.

Meet Rose Chimera: http://rosechimera.wordpress.com/

11 thoughts on “The Ultimate Learning Experience

  1. Thank you for re-posting this for me to read regarding our previous conversations….and for your new readers too! I have to admit, I have read it twice. I understand it fully but it has caused a whirlwind of emotions and thoughts which I need to process before I fully respond. Otherwise I’ll write a novella here in the reply section…I wanted you to know that your effort was not wasted in the reposting. I will tell you this, your experience has reminded me of my experience with my daughter and I’ve decided to blog about it..later. I’ll get back to ya on this….

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    1. I really appreciate how our own experiences can affect other people in so many unpredictable ways – even people that we’ve never met. I’m glad you enjoyed reading!

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  2. As I promised earlier….

    What makes doctors think they know more than the mother? Even with E being first born, you carried the child for 9 months. You bonded with the child before any introduction into the world.
    It’s a horribly frustrating feeling/experience to know something is wrong with your baby and not be listened to when you try to explain your “impression”. Certainly it can’t be a fact because you’re just a mother, having given birth. Like a silly woman who is in the midst of old fashioned thinking men who know what’s best for you and your baby.
    “I really could not shake the feeling all night that something was not quite right and despite this, I was constantly told that my concerns were nothing to worry about. It is very possible that this may have been the case.”
    However, your obstetrician and the labor and delivery nurse were concerned about E’s respiratory efforts immediately after he was born” so you know or should have known you were RIGHT! There was something wrong. That you couldn’t diagnose the problem does not in fact mean a problem doesn’t exist.
    I am wondering now, if because you were in that “industry” if you knew just enough to get you into trouble…I mean that lightly. That you knew enough to know something wasn’t right, and you knew as a mother something really wasn’t right. Were your fears dismissed because you were a newly delivered mother? Or were they dismissed because someone didn’t want to admit they were wrong?
    I agree, your level of education shouldn’t have had any effect on the way people talked to you about E. nor should it have in any way prevented discussions with you about his care.
    Let me illustrate one of the more frustrating experiences I had with regard to this concern. On a Friday, E’s doctor told us that he was very happy with how E’s x-ray looked that morning and if
    Is there a more horrifically lonely hurtful feeling then having to go home without out your baby? To have to visit him back at the hospital? I can’t think of any. This alone should have afforded you some consideration, some compassion, some respect on the part of those that refused to listen to you when you voiced your concerns.
    I can relate, somewhat, in that my daughter was having seizures, just started one day due to a high temp of 105. Took her to the ER and a doctor told me that she had a cold, put her on a vaporizer she’ll be fine. What did I know, right? A new mother and all…but gee, she’s not sniffling, she’s not coughing, there’s actually no symptoms of a cold. But being a young wife to a man who was low ranking in the US Air Force, with a new baby, I did as I was told. I didn’t think the doctor was right, but when they finish with you, tell you to go, you have to go.
    Within hours after that ER visit my daughter went into a grand mal seizure…ok this is NOT a cold!!! I knew I had to reduce her temperature asap so drew a bath of lukewarm water and placed her in it…adding cold water a little at a time. It worked to bring the fever down but now I was scared! I took her back to the ER the next morning, hoping that idiot doctor had gone home. He had and a different doctor, much younger by the way, looked at my daughter. He just LOOKED at her. Feverish, non-responsive and he told me he was pretty sure he knew what was wrong but wanted to do some tests to be sure.
    The tests required drawing of blood. I could hear my baby girl of 5 months old screaming her head off in terror. Screaming and screaming but I was barred from the room where she was. She screamed for 20 minutes easily….finally a nurse came out to fetch me. I walked into the room where she was and there were about 5 people in there. My little baby girl laying on an exam table, exhausted from illness and terror. The people in the room…God bless them….were all looking as bad as she was. They were soaked in sweet, clearly rattled; absolutely distraught….they mirrored what I felt. That they were so upset at what they had subjected my daughter to….a simple blood drawing isn’t always that simple as you probably know.
    As it turned out, the young doctor was right, there was something wrong with my daughter; her kidney’s had just shut down. She didn’t have a cold! The idiot doctor in the ER just blew me off….like it seems some doctors blew you off. What do we know, we’re JUST the mom.
    A week or more in the hospital to treat her and she was able to come home.
    Why her kidneys shut down no one seemed to care or even ask. I did, as that just doesn’t happen without a reason does it? Why I cared about the source rather than the symptom and no one else did will remain a mystery to me forever.
    I think as in all things we sometimes encounter caring, compassionate people and we sometimes encounter just the opposite, though it’s in the same setting.
    I understand now why you’re determined to be vigilant and make sure that you remain connected, a caring and compassionate person as a doctor. I appreciate that…for all your future patients, you will be a God send…from your own life experiences you will understand the fear that some of your patients may have. You will also understand the need to be HEARD and you will hear them if for no other reason than you remember when your baby boy was ill and you didn’t felt heard. As a treating physician you are to heal and you will want to heal, certainly do no more harm by ignoring or shirking off a patients concern. Perhaps that is the lesson you were meant to learn from the experience with E……? Learn from it and then apply it when its time?
    I was touched by your story. I am glad that you were able to bring E home and I presume all things turned out well. But that experience changed you in ways that you will never forget AND changed you in ways that will help you help others. It’s all sort of like a circle of life!

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    1. Thanks, Rose! I’m glad that my story allowed ou to reflect on your own experience. I really appreciate your thoughtful ideas about what I wrote and how if affected me. I only hope I can remember it all for years to come, when I am on the other end!

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      1. I actually have no doubt whatsoever that you’ll remember everything. And apply it. You’ll be fantastic on “the other end” because you’ve lived things others have not. You’ll remember.

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  3. I couldn’t agree more. I’ve had both bad and great experiences while in the hospital. I’ve had several surgeries myself over the years, and you can tell almost instantly how your care will go, whether a doctor will take the time to talk to you like an equal, or whether they’ll pat you on the head and be condescending.

    I was lucky my son’s surgeon and the nursing staff at Maine Med were top-notch–they went out of their way to answer any concerns I had and reassured me they were doing everything they could. One doctor drew diagrams for me to help me visualize my son’s surgery, to make it clear to me what was going to happen and when. This took a huge load of worry off my mind. He never made me feel like I was bothering him with questions, he even encouraged them.

    As you know, being a mom seeing your child sick is a helpless, terrifying feeling. The good thing about your experience is, you’ll become one of those ‘good’ doctors. We need so many more of those!

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    1. I’m sorry you had to go through such a difficult time but I’m glad to know that things worked out. Having good doctors who care about you and show you that you are important makes all the difference!

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