Yesterday I told a woman she has Alzheimer’s Disease. I knew it from the start. She came in with her daughter, seemed very confused, disoriented, lost. She was no longer gardening; she claimed to have spoken with her mother, who died 30 years ago; she didn’t recognize her grandchildren. And she couldn’t even remember me, her doctor.
For the most part, I find standardized patient exercises to be forced. Contrived. You know how you’re supposed to act, know you’re being videotaped, know the
patient actor is going to evaluate you. And he or she knows their name, their symptoms, and anything else they’ve been told to incorporate into their story. Yesterday was no different, if only a bit less organized. We went through the motions, asked the questions, listened attentively. They even had another group of people playing the patient’s family members; some wanted to help the patient, others didn’t care, and the husband was playing up the physical and emotional exhaustion. He even got a few tears going on command. As a former theatre dweeb, I was impressed.
My group met after the patient left to come up with the diagnosis; we were told that we “ran multiple tests, and all other causes of dementia came back negative.” We decided we would call the patient and her daughter back into “our office,” tell her the diagnosis, and then bring the rest of the family in to help figure out the best way to care for the woman. My classmate and I were doing a “team interview” of the patient, and when she returned, we kind of bobbled back and forth. Explaining the tests we’d run, our differential diagnosis, and finally, I decided to be the one to say it.
“The cause of your memory problems is Alzheimer’s disease,” I remember myself saying. As the last words left my mouth, I felt an abrupt change in my attitude. The emotion and the reality had both kicked in. My two previous standardized patients had been “heart burn” and “arthritis,” and both paled in comparison to Alzheimer’s. I had just given a terminal diagnosis. Insignificant little me. I had predicted the future. Prognosticator of prognosticators. Great Seer of What Will Be.
In my spare moments over the past two days, I’ve thought a great deal about this: about the diagnosis, and about the diagnoser. The former can be such a double-edged sword. And it runs the gamut. From “that’s normal” to “it’s cancer.” And while most of the time you can predict the reaction, sometimes there’s solace in just being heard by a doctor. Relief in merely knowing that this is something that has been seen before, or something that at least comes with a plan of action. But no matter what the disease, the diagnosis always comes with a response, shown by the patient or not. From changing the way one lives life to complete and utter denial, the diagnosis–only a couple words long, and merely words, at that–can profoundly change someone. What a frightening power.
The power, of course, comes with responsibility. But who says that doctors are the best ones for that job? If there’s some sort of correlation between scoring well on science tests and relaying emotionally-weighted news, I haven’t read it. Granted, most medical students come in with an interest in the cliched “helping people” part, but that’s not to say that any of us will actually be any _good_ at it. Who am I to tell this person how long they’ll live? And, in the future, I guess the answer will be, “I’m her doctor.” And so, we learn how to break the news. We practice. See one, say one, teach one.
There’s more to the doctor-patient relationship than just revealing oneself to a doctor. It’s the trust that the doctor will make the best diagnosis possible. Because they both must realize, on some level, the amount of power it can wield.