* * Anonymous Doc

Monday, August 17, 2009

Another ethical issue, sort of.

I never really thought about before actually spending time in a hospital, but doctors are human, just like everyone else, and if you're nice to your doctor, he's going to be willing to spend more time dealing with you than if you're difficult, he's going to want to help you, he's going to think about you more. As opposed to just wanting to do the minimum he needs to do and get rid of you.

This obviously affects overall care. People who we don't want to deal with don't get as much attention, the nurses and doctors don't check in on them as frequently, subtle problems don't get noticed, and, if someone did a big study on this, I bet they'd find there's a real difference in overall outcomes between people who are pleasant to the hospital staff and people who are unpleasant.

It seems unfair, I guess. Some people in a hospital are surely unpleasant in large part because they're ill, and feel terrible, or because they're frustrated, or in some cases because they have dementia and don't even understand what's going on. And it's not like the big stuff gets ignored-- you crash, we're obviously going to call a code, we're not just going to let you die because we find you irritating. But yesterday on rounds we noticed, after a fair amount of extra time dealing with one of our more pleasant patients, that one arm looked a little bigger than the other, very subtle, but there was definitely some swelling. And, sure enough, we did a sonogram, and there's a blood clot in his arm. Almost certainly not something we would have picked up on if we were rushing to get out of his room, and it's a big deal. Had we not noticed it, absolutely could lead to a bad outcome, and we would have chalked it up to unavoidable complication, nothing we could have done. Except there was something we could have done-- we could have noticed it, like we did in this case.

The lesson-- you want us paying attention. You want to make it easy for us to care and notice things and spend time thinking about you. Otherwise we will miss things. oops.

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