This article
is based on an emotional lecture delivered by Dr. Philip Katz at the American college
of Gastroenterology 2016 annual conference at Las Vegas, Nevada.[1]
All of us as physicians have very little experience of what it feels like to be
on the ‘other side of the bed’. Dr. Katz
6′ 3″, 195-pound, 60-year-old gastroenterologist is a
Clinical Professor of Medicine at Sidney Kimmel Medical College at Thomas
Jefferson University, and Chairman of the Division of Gastroenterology at
Einstein Medical Center in Philadelphia, PA. Till now he has not spent a single
day in hospital as a patient.
"My
view from the other side of the bed has given me insight into a part of
medicine that I'd never experienced," Dr Katz said during the David Graham
Lecture he delivered here at the American College of Gastroenterology (ACG) 2016 Annual Scientific Meeting.
He was very
healthy, did not have any chronic disease, did not take any regular medicines
except statin to manage hypercholesterolemia. On evening of October 4,
2013, he had a sudden cardiac arrest, with barely detectable pulse landing him
in ER and subsequently into Cath lab necessitating multistent angioplasty. He went
into coma and also has developed flash pulmonary edema and required a balloon
pump and extracorporeal membrane oxygenation.
He woke up
from his coma ten says after his admission feeling lost, confused, disoriented,
perplexed and bewildered questioning himself that was it really happening to
him.
Eventually
while still in hospital he developed ischemic stricture, had two sigmoidoscopies
and needed surgery. During those two months in hospital, he lost 50 pounds,
could not eat or walk.
None of his hospital
colleagues agreed to do a primary repair for his stricture, so Dr Katz he
decided to take a second opinion from a specialist. The surgeon also advised
him against primary repair.
He ended up
into temporary ileostomy that got obstructed, requiring constant care. At 3 months’
ileostomy was removed only to end in an intra-abdominal hernia with suspected
incarcerated bowel needing an emergency repair.
The follow-up needed constant care from his colleagues, nurses and other
healthcare professional.
He took a
trip to Ireland only to suffer a G.I bleed landing him in hospital from the
airport. All in all, it took him 8 months to heal.
Do you
believe in miracles? I said, ‘I kind of have to.’ ... But I actually believe
I’m alive because of everything good about our profession, I believe I’m the
beneficiary of everybody doing their best — not just the best they could. To
me, that’s our obligation every day. To be our best no matter how freaking hard
our job is. Can it make you a better doctor? Probably. I believe I am. But I
wouldn't recommend this as a way to become a better doctor, not in the least.”
This 11-piece
advised he offered to his peers from the point of view of physician turned
patient.[2]
1.“The
lesson there is trust your colleagues. Trust the people who take care of you to
have good back-up,” Katz said. “It’s nice to be taken care of by someone you
know and trust. ... It may be difficult for them. My bias is it’s better for
you as the patient.”
2. “Avoid
assumptions about patient knowledge and health behaviors. It is difficult, and
challenging, but imperative to treat us as we would treat any other patient; To
assume they know nothing is maybe the best idea,” Katz said. “Ignore the
physician-patient’s background. ... Acknowledge the background and negotiate
care, but then treat them like any other patient.”
3. Remember
the niceties: “Utilize the nurses, the technicians, the med-techs ... even the
housekeeper can help by being nice and being comfortable and talking to your
patient when they’re in the room. It all matters.”
4. “There’s
a new normal. ... It’s crucial to remember there’s an aftermath even if small
in the big picture. It’s the patient who gets to live with what’s left,” Katz
said. “I am normal with minor exceptions but it still feels lousy to have those
exceptions. I can’t help it and it helps me take care of my patients to
remember that.”
5. “Our
systems are not patient-friendly and they never will be. We will not fix all
the crap going on in medicine today even though we have to try.”
6. “Explain.
Do not make excuses. Don’t apologize ... but be comforting and explain why that
needs to be done. It helps,” he said.
7. “Please
revisit your outcomes as a physician. We’re expected to be perfect. Obviously,
we can’t always be, but we can always be our best if we try. The end result is
important but we really need to learn how we got there because the next one
might not turn out as well.”
8.
“Understand and, in the best way you can, communicate honestly with your
patients. Validate their feelings; validate their illness.”
9. “We’ve
earned what we earn. We should not in any way suggest that we are not worth
what we get. We are worth more. Nevertheless, the expectations of us are high
and they’re going to get higher.”
10. “Respect
Murphy’s law because it is real. Respect the procedure that you’re doing every
single time you do it because you will never, never predict when you will have
an adverse event. I expected none of it.”
11.
“Compromise as little as possible in your life and work choices. Do as much as
you want to do as often as you can. ... If the glass is not at least half full,
get another freaking drink. If you have a real bucket list, do it when you
can," said Dr Katz. "You can always make another one. There's no rule
about only having one he said. Live life to the fullest. Have no regrets. Work
your butts off and enjoy your profession.”
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