Reflections in Medical Practice: Thinking Things Over
Physicians reflect back on what has transpired with their patients, thinking about what was done well and what could have been done better. Often the reflective contemplation, thinking about the process of relating to that patient, making a diagnosis and selecting a therapy or improving skills is of benefit toward future interactions and decisions. Time is often made short for the physician, diseases are not always uniformly expressed, memory and experience is limited and mistakes and misjudgments are always possible. If time is limited, nevertheless at some point in a physician’s life, as part of the professional duty, reflection should be included. ..Maurice.
The Story of Some Doctor’s Reflection
A Poem By Maurice Bernstein, M.D.
I am some doctor and Mary is my Patient
Did I know Mary was
So Sick when I first
Saw her
Then?
She comes to me and asks for Help
Did I take the Time
To listen to the entire
Symptom Story
Completely?
There was a phone Call from Doctor Smith
Did I interrupt Mary
To take the call
As though more
Important?
Then there was time left only for a Snap Diagnosis
Did I treat Mary for the flu
With some
Antibiotic?
Of course the Diagnosis was a Blood Clot to the lung
And why shouldn’t I
Have made that
Diagnosis?
And now Mary is fighting for her Life and I Reflect.
More on reflection in medicine on a previous thread.
Graphic: Photograph by me of a pool, Descanso Gardens, La Canada-Flintridge, Southern California
posted by Maurice Bernstein, M.D. @ 3:51:00 PM
2 comments
2 Comments:
"Mulling it all over in the light of day, I'd like to believe that they were right--but I feel at least partially culpable. And as the night's events go round and round in my head, there's what I come up with:"
Read the whole story on Pulse ("Second-Guessed" by Andrea Gordon) of this family medicine physician for her obstetric duty on-call night and what happened that night and the reflection she engaged by mornings light. Life as a doctor is complex and nothing is the same or guaranteed to be easy. ..Maurice.
Today, my visitor, Doug Capra, wrote the following comment which I thought was most appropriate for this thread and the examples of what could be called premature decisions which a doctor makes but later reflects with professional concern.
Doug wrote:
An interesting comment in the New York Review of Books (May 24, 2012 issue). Dr. Jerome Groopman is reviewing the book "Immortal Bird: A Family Memoir" by Doron Weber. It's a personal family medical story -- a tragedy. Groopman wrote "How Doctors Think" among other works. He has focused on cognitive traps, thinking errors that cause serious, sometimes fatal mistakes in medicine.
He's commenting on a mistake a doctor made, not telling the patient's family about what could possibly happen after an operation, i.e., the possible or potential negative events that could happen even years later. The doctor didn't omit this information consciously, but rather she was "so encouraged" by the patients success that she didn't want to believe or want to believe anything negative would happen.
Groopman writes: "I have been in the same place...My empathy for an exhausted, feverish cancer patient caused me to omit an intrusive physical examination. Taking a shortcut to spare him discomfort, I missed an abscess deep between his buttocks. The patient soon went into shock from sepsis. Fortunately, he survived my error."
..Maurice.
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