Even though it’s sometimes hard to see a patient as more than just their disease, I’ve really started to think about how this is, for most people, just a tiny little part of their life. You forget that you’re seeing a patient at their worst–sick as stink, post-operation, and feeling crummy. They haven’t showered in days, they’re eating crappy hospital food, they’re too weak to do more than lay in bed most of the day, and they’re away from their families, their cultures, and their homes. Sometimes they’re unconscious, or so drugged up that they’re not even with it. And because this is almost all you see of the patient, it’s not uncommon to make what’s called the fundamental attribution error in psychology–believing that a person’s actions or behavior is due to the patient’s own personality than it is due to the situation he or she is in.
Even in clinic, seeing the patient before they’ve had any sort of procedure or treatment, the attribution error can stick. The clinic is usually running late, so the patient has been waiting for awhile; he or she is probably nervous about seeing the doctor and learning what kind of treatment will be necessary (especially when they know they’re in a surgeon’s office for a reason); he or she might not be feeling well, and any other number of reasons. So if the patient (or a family member in the room) is crabby when I enter the examination room, I automatically assume it has nothing to do with me or the other person. I’ve learned to take no offense. I automatically give the person the benefit of the doubt. It’s not uncommon for patients to get a disappointed look on their faces when I enter the room anyway–they’re expecting to see the surgeon, and then I introduce myself as “the medical student on the team.” (I do think, however, they are slightly relieved to find out that someone as young as me will not be performing the operation.)
This all came about because of a sick-as-stink patient we’ve had on our service recently. He’s been in and out of the ICU, unintelligible when he attempts to talk, and pretty much out of it–due to his own neuro issues or the psych drugs we give him to keep him calm. (He’s been pulling out his drains.) One day, however, I guess a family member must have brought by a little collage of photos of the patient and his family. I couldn’t believe it was the same man. Him as a 30 year-old with his wife. Him in his 40s riding a horse with his daughter. Him with his extending family at a 50th birthday party. Scanning from picture to picture, none of them matched the dehydrated, sickly, wasted man lying in the bed next to me. All this time I had thought of this patient’s life as culminating in his surgery, cancer, and hospital stay, and I hadn’t even realized it. The egotism of my idea of the man blew me away.