I’m supposed to help lead a session today with some preclinical students and discuss the challenges of being on the wards as it relates to maintaining perspective and understanding patients outside of a strictly medical realm. I’m starting to posit that it’s almost a physician’s duty to be compassionate, if only for the fact that we contain knowledge about a person’s disease or medical state that most other people don’t. I think an example will highlight this:
I saw a patient yesterday in clinic who was on chronic high-dose steroids for rheumatoid arthritis. He was totally Cushingoid from his steroids–he had a big round face, major abdominal obesity, thin skin, extra hair growth, and had fractured multiple bones because of the osteoporosis from steroids. And I thought to myself, “You know, I bet when she walks around, or is pushed around in her wheelchair, most people just assume she’s obese, call her fat, and think she just has no control over the food she eats.” Most people wouldn’t necessarily recognize a person with these features–or even realize that these features together equal a medical syndrome. Because we understand her disease process, we absolutely must show compassion–if we don’t, and we supposedly understand her condition, how can we expect anyone else to? (I’m of course not assuming that I understand what it’s like to have a chronic disease, or live with any of these symptoms daily, but just that we understand the pathophysiology behind it, and realize the cause is not primarily a character flaw.)
Or the Middle Eastern man who took tiny steps, wincing with pain with each; no one else could tell he had an enormous, incredibly painful rectal cancer. Or the woman with throat cancer who had to have her neck opened up to remove the lymph nodes, and had her shoulder and neck nerve (Accessory Nerve, CN XI) cut on both sides? Unfortunately these people are probably just assumed by passers-by to be weirdos, freaks, geeks, mentally retarded–the epithets go on and on. But it’s the health professional, who understands the disease, prognosis (chronic pain for many years? 3 more weeks to live?), and challenges of patients that must show care.