Sometimes you have to be cruel to be kind

It’s 9.15pm, Thursday night, and I am on-call again in the acute medical unit. The day was long, unforgiving, and peppered with moments that had chipped away at my morale. The longing for Friday was growing stronger by the minute but sadly the list of jobs in front of me, contextualised in the chaos of the unit, was telling me to forget about Friday. Athough Thursday night, Friday felt utterly unattainable right now. I let out a sigh as I try and remove the negativity that was sweeping into my mind, and find some way to motivate myself….

“Excuse me”…

[“Oh bugger” I hear myself say inwardly] As I look up there are two people standing in front of me.

“Can you tell me where our mother is?”

This I CAN probably do – although I have no idea who she is. “Sure what’s her surname?”

They give it to me and I glance at the packed list of names on the AMU board. “She is in bay 2 bed 4. I am afraid I am not looking after your mother however so best to ask the nurse to direct you to the team looking after her. All the best” – I smile and look away starting to refocus on my list as they say “thank you” and wander off in the wrong direction..

“Other way” I smile and point down the hall.

Do I want to do a rectal examination first on the patient with abdominal pain or clerk in the drunk? Decisions decisions…

Before my slow brain can process this question I sense two people once again standing next to me. I look up and smile but inside I am just a little bit frustrated. “Is everything, alright?” I ask my two returning relatives.

“We were wondering if you could tell us about our mother? Maybe look up her blood results and tell us them?”

Oh dear, this is going to be awkward. I pause and look up before saying:

“I am really sorry – and while I can see how frustrating it is for you – I cannot do that.”

“But you could” the son quickly quips…

“Again I am sorry but I am not looking after your mother, know nothing about her case”

“We are just asking for the results though” the daughter and son chime together persistently.

“No. I am sorry but a result means nothing in isolation. It could be falsly reassuring or falsing worrying out of context.”

“We need your help”…pulling at my emotionally heart strings – which after the day I have had were a little loose and not particularly responsive.

I recapped again everything I had just said and in the end had to be very firm and blunt.

This, readers, is not an easy thing to do. If you read this and think I am being cruel, I can see you point. There are however responsibilities that I have. Professionally I knew that a blood result in isolation means nothing. A prime example is a raised white cell count. That means infection right? Well it could but it could also mean the patient is on therapeutic steroids, stress, or an allergic reaction for example. How do I know? I know, at this point they ask me – nothing about the patient. Say I do tell them and then it’s completely wrong? What if they finally talk to the team that are actually looking after their mother and they say “but the other doctor said…” – how does that make my relationship with my colleagues? I’ll tell you – strained.

On the other hand, I COMPLETELY get it. If I was looking for information about my mother in hospital, I would do exactly the same – hound every doctor I see until I get information. But, I am not – I am a doctor and as such I have to act responsibly as one. I never saw the two people again and of course I hope they found the information they were looking for and that their mother is alright. However, I have not regret over the way I dealt with that situation and if it comes up again – I would do the same.

Doctors will face these kind of emotional dilemmas a lot. It just goes with the job.

See you next week.

Dr Nick

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4 thoughts on “Sometimes you have to be cruel to be kind

  1. I don’t think you were being cruel or unkind. I think it is hard for relatives wanting to know more and trying to get anyone to tell them anything to reassure is hard. Plus you busy and under pressure. You just happened to be there but as you say in isolation a result means little. Also confidentiality- maybe patient restricts who gets told what. Maybe as busy as you are you could have asked them to wait somewhere and asked a nurse to help them?

  2. Good reflective practice! You should join the GP VTS scheme (which requires at least 2 good quality reflections per week!) but of course, you are right…sometimes it may seem that we are being obstructive, but I guess the patients relative just sees it as a result. But we both know it’s not just that…if something is wrong with it then a can of worms has opened…if they know you’ve looked you can’t say ‘it’s fine’ if it’s not, because that really would be ethically bad, very bad…and if it’s not fine, who knows what the cause might be. Not a job for the on call doctor unless an emergency. The same goes for the requests “oh doctor, could you just…” from other staff…if it’s an emergency, or you “can” then great, but if you can’t, or don’t feel comfortable, don’t feel pressured into doing something you’re not comfortable with. It’s your name, your signature your licensure.

  3. Of course from the other side, I’ve hounded every doctor I’ve come across for snippets of information about my own results….but I don’t feel aggrieved that I didn’t always get them. Most of the time I did, but I suspect that’s partly due to my profession. Telling a doctor they have a bug which has a 30% mortality rate is probably ok….because really, they knew I was a bit “detached” and that I’d spend all night researching it from my hospital bed anyway without getting overly stressed, more interested….(which I duly did…morbid, but reasonably medic-like behaviour)…but I had the awareness and knowledge and access to information other patients may not have had. It’s a tricky one and not always clear what the best thing is to do. In this case, I think you did the right thing for sure.

    • Hi Bembeezled

      Thank you so much for your last two comments and I am so sorry it has taken me so long to reply! It sounds like you have had some challenging medical experiences yourself and that, as a doctor, we are almost at risk of making ourselves more vulnerable – they say knowledge is power – but is there a tipping point at which too much knowledge of all the minor details, complications (with the smallest chance of actually occurring) etc cloud our mind. I hope that you are well now and that your medical career is moving along nicely. It is so nice to have positive comments from a doctor as I am very reluctant to expose this blog to my colleagues.

      very best wishes
      Nick

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