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Dr Smith, the intensive care consultant, has a running not-quite-joke that my specialty admits the ‘worst’ patients – difficult, complex ones who often fail to make satisfying recoveries.
My team has several patients in the intensive care unit today, and Dr Smith goes rapidly through the plans for each one, checking what investigations and treatments are needed.
‘And what about that hopeless dribbling lump in bed seven?’ he asks. ‘One of yours?’
She isn’t, as it happens: Maria is in with a chest infection this time but I know her well. She’s a regular attender with cerebral palsy and severe learning disabilities.
‘Hopeless,’ in the sense that her underlying condition is incurable, and ‘dribbling’ is factually accurate but even so I bristle at the description. It must show, too, because Dr Smith quickly backs off and changes the subject.
Dr Smith is an excellent clinician. He has helped me out of a number of tight corners with unwell patients, and I happen to know he’s helped Maria out of some even tighter ones. I haven’t the slightest doubt that he would always give her the best medical care, and he’d never refer to her disparagingly in earshot of her family.
So, does it really matter what he calls her in private? Isn’t this kind of black humour something we medics rely on to survive the routine grimness of our job?
Yes and no. You need a certain kind of thick skin to work in critical care. You need quick wits, strong instincts and a head for detail, but you also need to be able to pour all your skill and care into a patient, and watch them die anyway, and then come back to work a few hours later and do it all again.
It’s natural that certain sensibilities end up a little blunted: natural, but not necessarily harmless. By allowing ourselves to dehumanise patients – always easiest with those who are visibly very different from us, and especially those who cannot speak – we gradually lose our ability to see them as people at all, and the decisions we make for them will be subtly altered as a result.
The last thing we need is more people policing our language. Doctors will always speak among themselves with a freedom that, now and then, crosses the line into poor taste. That’s OK. But we should all fear the day when we come into work and look at vulnerable patients and really do see nothing but hopeless, dribbling lumps. The day we can no longer see our patients’ humanity clearly is the day we know that our profession has begun to erode our own.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
Classic example of the 'slippery slope' logical fallacy in action.
Maybe this is to do with the fact that despite the poor outcomes your team persist on referring patients to ITU rather than manage them with anticipatory care plans and avoiding admission altogether.
you have to be able to let off steam somehow. The key is knowing which colleagues you can trust to allow you to let off steam. Surely the key here is that he is an excellent clinician. You have to distance yourself to a certain extent to be impartial. That's the reason doctors should not treat their relatives because emotion gets in the way of doing what is best for the patient
The last thing we want to do is police language... and then goes on to do exactly that.
I agree with the below comment.
By “dehumanising “ patients it becomes easier to make objective, critical clinical decisions. Our job is stressful enough.
It took me a year not to flinch when taking blood from a patient. In fact the patient told me to relax. I felt his pain and thus hesitated and failed and caused more pain. Once I viewed him as an unfeeling piece of meat, I succeeded.
It is the classic double think from George Orwell. I’m still squeamish but at work I’m not. It’s the only way to be.
Depressed to think I may be in the minority here finding this description despicable, regardless of black humour or distancing self.
"Depressed to think I may be in the minority here finding this description despicable, regardless of black humour or distancing self. " We all have different coping strategies for dealing with unending stress as we see the horrors that could engulf anyone of us. Surely the thing is to acknowledge that we are all members of the same team and that there are enough people ready to find fault with us without criticizing each other for our human weaknesses. Are we so rigid in our thinking that we cannot accept and respect and tolerate differences in each other. The other end of that scale lies with the Taliban and their ilk.
I find that kind of arrogance hard to stomach. If that is what it is. If it is "a coping mechanism" then he needs a better strategy. I hope he doesn't utter this filth in front of juniors. Shameful. Even on a bad day.
No human being should never be called hopeless lump.
No excuses for any doctor, any teenager, any one. My 6 y old son would never think/say such a thing.
Snowflake in action. Get a life and allow your senior to live and help you to learn how to be a Doctor.
If we were to sensitively and carefully describe every patient with multiple seemingly insurmountable problems 1. we'd never get our days work done 2. we would tie ourselves up in knots trying not to offend.
It's a long career, with many stresses. I somehow think this doctor cares very much for all his/her patients and an off the cuff remark is unlikely to reflect the effort put into each case.
It seems like we have an ever decreasingly acceptable pool of things we can say in day to day practice - even with colleagues. I despair, and wonder what the point is.
She is one for whom Christ died.
What matters is clinical skills. This is an excellent clinician by the author’s own admission.
Are we no more allowed to vent our frustrations in private. Can’t we have colleagues who we can vent our frustrations in private?
I have seen excellent clinicians leaving the profession because they genuinely expressed what they felt and got dissolutioned because of the way matters were dealt with.
Let us focus on bedside manners and clinical skills. Not private conversations.
"Classical example of slippery slope logical fallacy." Agreed. Hard to believe this was even worthy of writing about. Im sure there are bigger issues you can draw attention to...
If I thought that about one of my patients, then I would not use those words, which I consider to be entirely unprofessional. Being a skilled clinician is not enough just as being a compassionate clinician is also not enough. We work as part of a team and choosing to comment in this way about a patient takes the team in a poor direction.