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We had a patient who wasn’t really engaging. It isn’t professional to call a patient difficult, so you can choose a different word, but he was slow to move through every step of his journey.
Initial recovery, rehabilitation; they were coloured by reluctance. During morning handover, one of the more junior doctors went through the main outstanding issues of all our patients. When we got to this man, he added a seemingly curt acknowledgement of the lack appetite to move on, and it went like this: ‘I think he likes being here.’
And he continued the handover.
It took me a couple of seconds to register the comment, but once I had I could no repress a response so I stopped him, mid-sentence, and I said: ‘That man is here because he tried to kill himself, I doubt he likes being here, I doubt he likes being anywhere, that’s probably the problem.’
There was silence from the six people at the table, and he looked at his paper, didn’t respond but sort of shrugged at me half nonchalantly. It was clearly more bravado than anything else.
We moved on.
I regretted it immediately. Not my point, I was right. It was unprofessional handover behaviour for such a junior doctor, or any doctor. We had just changed jobs and so I hardly knew him.
My response was reflexive. It was rebuttal intended to knock him down and what had I achieved? He was exposed, perhaps, but definitely not engaged. Either I had made him embarrassed or I made him resentful; either way it wasn’t what I wanted to achieve.
I registered his comment as flippant but actually he may not have even meant ‘like’ in the true sense of the word. After all, it would not have been surprising if our patient had attached some fear to moving on.
Maybe it was just a poor choice of word to articulate a perfectly reasonable observation. I should have mentioned it afterwards, at least then I would have known.
And who was I to judge? I’ve made throw away comments. It has been necessary for me to make a friend of that particular humour we engage in. Sometimes it is just how you get through the day. In truth, I felt like this was different, but was it really?
The more years I spend as a doctor, the easier it is to point out the mistakes of those more junior. The point is though that you see them, probably because you’ve been there and made them. Often because you know better, but then again you are supposed to.
The type of senior I want to be would have swallowed the indignant portion of my response and engaged this doctor afterwards. But I guess there is still time for me to become that person and maybe the consultant in the room was looking at me knowingly and thinking, I remember when I was exactly like that too.
By the Secret Doctor
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I am not sure I agree that your guilt is warranted. Moving on without commenting on a throwaway (potentially damaging) comment done as part of a handover, normalises that comment - not only to the person who said it, but also to the others in the room. If this comment was written in the case notes and something later happened to the patient and case notes were reviewed the doctor who wrote it would be in a legally dodgy situation.
In my opinion , from the summary of the story above, you have stood up for the patient, not knock a collegue down.
I absolutely agree with the comment below.
The throwaway comment called for an equally reflexive throwaway response.
I think that stigmatisation of mental health difficulties in the general acute hospital setting is a big problem. Why not go back and discuss the context of your throw away comment with your colleagues? I'm sure they would understand the context. Your reflex reaction was appropriate in response to their more damaging comment. I think its ok to show emotion sometimes, so long as thats followed up with a more logical point.
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