Tag: doctor-patient communication

Saying the D-Word

It was late in the evening, and I was ready to start my night shift as an intern in the intensive-care unit. I sought out my fellow intern, who was finishing his shift, so that we could perform signout–the ritual of passing the patients’ information from one clinician to the next.
“Mrs. Klein in Bed 15 might go,” he whispered.
“Go? Go where?” I asked. “It’s 10 o’clock at night.”
“I mean she might go

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Back Pain

Back Pain

A 77-year-old woman presents with back pain.
No trauma. No radiation. No red flags.
ROS* otherwise surprisingly negative.
Her exam is unremarkable, actually pretty darn good.
FROM, negative SLR, full distal strength, sensation and DTRs.*
After the usual cautions I reassure her,
prescribe activity, no meds and the tincture of time.
She is fine with that, appreciative and pleasant.
Then she says, “Should I

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Greetings and Salutations

Greetings and Salutations

I have seen tribesmen in the West African country of Mali meet each other on a narrow dirt path and stop to spend several minutes chanting highly scripted greetings. When they part, shortly afterwards, there is an equally elaborate farewell.

As a psychiatrist and medical educator, I’ve seen my colleagues carrying out a parallel ritual: Two doctors hurriedly passing each other in a hospital hallway and cheerily but tersely saying, “How are you?”–neither

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Last Day

Last Day

It’s my job to empty a plastic bag
filled with meds both past and present
and read out loud the labels of those we stopped,
and explain why, and while we’re on why
why he needs oxygen at night, and the rescue inhaler.
Between pills it’s my job to ask in a generic way
about life outside the clinic? He takes out his phone
because his story needs a prop.
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Shock Treatment

I sat in the cold, sterile examination room, anxiously awaiting my new orthopedic doctor–the fourth in two months. I was losing hope of ever finding a doctor who would listen to me. The first three had suggested that my pain was all in my head
I want someone to take me seriously, I brooded. I don’t want to be brushed off as the stereotypical hysterical female. My pain is real, and I’m not crazy. I

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Pharmacy Visit

You are a big man, a little heavy, but nothing
that can’t be fixed by daily, brisk walks
or swept away by a
dose of cancer and a blast of treatment.
You have been called from your glass enclosure
to help me.

A productive, bronchial cough
is still with me–too long.
Chinese practitioners call this a lurking pathogen
tossing antibiotics into my weary kidneys

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Unexpected

Christine Loftis ~

“You’re twenty-seven-and-a-half weeks pregnant.”

As I lay on the exam table, time froze.

How can this be? I wondered dazedly. I’m a second-year medical student. I’ve just completed a course in female reproduction and endocrinology. How could I have missed the signs?

I attribute my obliviousness to the surgery I’d gone through only months before: the removal of a twenty-seven-pound, mucus-filled ovarian cyst. My lack of menstrual periods

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Exit Interview

Tamra Travers ~

“I’m graduating and leaving our clinic in June.”

Over and over again, in the months leading up to this transition, I break this news to my primary-care patients. I have developed many meaningful relationships with patients over my past three years of training as a family-medicine resident in a large, urban health center in Manhattan. But now it is time to leave and move on.

The fluorescent lights

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Beginner’s Mind

Jessica Stuart ~

I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”

I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep

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Mad Man

Zach Reichert ~

In my third year of medical school, I started a rotation at the nearby VA hospital. Walking toward the polished glass doors that morning, I saw my reflection–clean white coat, assured expression to cover up how lost I felt. It was my second clinical rotation ever, and my first time at the VA.

I found my team and soon met a patient I’d be seeing for the next month. His

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What Did the Doctor Say?

Charlotte Grinberg ~

Here’s what they should have told you: “We found cancer in your lymph nodes, your liver, your lungs and your brain. It explains your weight loss, your difficulty breathing and your loss of appetite. This wasn’t just your depression, like you thought. It started in your lungs, and now it’s everywhere. This cancer has been growing for quite some time. You cannot, even with the strongest medications and the longest surgeries,

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Miraculous Recovery

Alexandra Lackey ~

During my third year of medical school, I completed a clinical rotation in surgery. I was certain that it would be horrible. I envisioned myself in the OR, getting lightheaded, passing out onto the sterile field and being yelled at by my attending physician. I worried that the medical knowledge I’d worked so hard to learn would be neglected in favor of memorizing the steps of surgical procedures. My parents, who

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