The Patient Patient: Tolerating Symptoms and Palliative Care
I pay you money to try and fix my head
I lie on your couch reveal what’s in my bed
You scribble in your pad
'Patient feels sad'
"Just take this medication
And if it fails to work
Then try a razor"
Well, the doctor-patient relationship need not go the way of the Val Emmich’s lyrics in the “Patient Patient”. But all patients should know that there are times when there is no cure and the patient has to patiently tolerate their symptoms. This does not mean there is no treatment. It does mean that there is presently no cure but it also should mean that palliative treatment is available. Palliative treatment represents “comfort care”, providing a systematic attempt to reduce the discomfort and the debility of one or more symptoms by medications but also by providing physical therapy, psychologic and spiritual support. Palliative treatment need not be confined to end-of-life terminal illnesses or hospice care. Palliative treatment can be extended to patients with symptoms of chronic diseases or even acute processes where definitive and curing treatments themselves are not available or where the use of such treatments pose a risk greater than the consequences of the illness. Patients should be informed and recognize that unfortunately even palliative treatments may not necessarily relieve all the symptoms completely, particularly if there is medical need or patient’s request not to be so deeply sedated that the patient is put into a coma. So.. patients may have to patiently, but with medical assistance, tolerate their symptoms
The “no cure” outcome is a difficult result for physicians to manage. In the past, from experience in childhood and the training in medical school, the goal of treating illness is cure. In the past, very little was taught about how to manage the patient’s symptoms when there was no cure. When a physician, after many attempts to cure his or her patient, without successful results, the issue in the doctor’s mind is “what’s next?” Would “next” be reexamining the whole illness and trying to establish another diagnosis? Would it be to do more tests or try out more treatments? Would it be to refer the patient to some specialist for diagnosis and treatment, thus also relieving the physician‘s intellectual and emotional burden? (The referring probably should have been done much earlier.) Or just to continue the doctor-patient relationship with the tone of “there is no cure but try to tolerate your symptoms.”--and hopefully not with Emmich’s words “..then try a razor.”
Though the concept of palliation was part of the management of patients in years past, it was untaught, informal and not a consistent medical practice. In recent years, with the development of the hospice end-of-life management, palliation has become virtually a science and medical specialty with a duty to spread the knowledge and guidance to all physicians. For more about palliative care, read the Wikipedia article on the subject.
What makes a “good doctor”? What makes a "bad doctor"? I think the answer would come from the patient about how he or she was treated when there was no cure. ..Maurice.