The things that truly matter…
Sandra V. Navarra
Dec 2022 DOI 10.35460/2546-1621.2022-sp18
Every Patient is Unique, and “time personally spent with the patient is the most essential ingredient of excellence in clinical practice”. Voltaire (1694- 1778) wrote “The art of medicine consists of amusing the patient while nature cures the disease”, and modern-day Patch Adams reiterates “You treat the disease, you win or lose; you treat both the patient and the person, you always win no matter what the outcome”. Emphasizing the importance of shared decision-making, Dave deBronkart notes that “Medicine should let patients help improve care, share responsibility, and think for themselves”. Patient advocacies like PEARL© (People Empowerment for Arthritis and Lupus) and LUISA© (Lupus Inspired Advocacy) focus on patient-centeredness as key to improved patient outcomes and achievement of optimal patient well-being. For these patients, life can be fulfilling despite a debilitating condition.
“Ultimately, patients need to find their own solutions and motivation and must take responsibility for their health; we must empower them to do just that”. Even in the terminally ill, the patient’s feelings deserve to take precedence over the actual diagnosis. Let me share my personal experience and humble tribute to a patient named Frederick: “No more needles nor biopsies please…” We sensed his frustration after the battery of tests, procedures and physician-specialists he had gone through… still without a diagnosis. Here was a young man at the pinnacle of his career, recently married and ready to start a family, fully in control of his life … until this illness. The months of hospital confinement was an intricate intertwining of extreme science and delicate art, a roller-coaster ride through major as well as seemingly trivial yet crucial decisions i.e. starting steroids despite failure to arrive at a definitive diagnosis, painstakingly explaining the need for intubation in a fully awake patient, distinguishing the fine line between aloofness, aggression, sedation and simple narcotic side-effects and/or drug-drug interactions, and finally insisting to transfer out of the depressing confines of intensive care to a regular room where he can be with his loving family. It was a truly profound experience to witness this young man transform from the turmoil of uncertainties to anger to denial to stoic acceptance and valiant display of tranquility – despite being paralyzed from waist down! Wherever this ride takes us, it will ultimately be Frederick who will take control and make things happen in his time, in God’s time.
The Patient is the Best Teacher. The Patient Partners© educational program of Rheumatology actively involves patients with chronic inflammatory arthritis i.e. rheumatoid arthritis, spondyloarthropathies, who are trained and certified to teach musculoskeletal exam, and lupus patients who share their individual struggles and triumphs over their chronic condition. The program “doesn’t force students to give patients a diagnosis, instead, it allows them to experience their patient’s life and gain skills to be more effective caregivers”  – these are valuable learnings which are not obtained from books or lectures even by esteemed professors. Some feedback from appreciative medical students: “No matter how debilitating, these patients continue to live their lives to the fullest, transforming sheer disability to positivity” and “the program is not something I usually catch within the four corners of the classroom; from experiences like these I learn about the things that truly matter, inspiring us future doctors to strive hard in order to make our patients’ lives comfortable as best as we can.”
The Practice of Medicine is a continuous Interplay of Science and Art. Artificial intelligence (A.I.) has come to permeate our lives in ways previously unthinkable, providing us with the remarkable convenience of diagnosis and management options at the tap of a finger. However, along with the conveniences and opportunities brought by A.I., are the risks and challenges… including the consequences of instant gratification leading to instant frustrations, and the many ways digital health is affecting the doctor-patient relationship. Imagine a patient blatantly telling you ‘I already diagnosed myself on the internet, I’m only here for a second opinion’ !?!
How then to stay relevant – and keep sane? Learn from, rather than dwell on, your mistakes. It is said that a person who never made a mistake never tried anything new. “I can is 100 times more important than I.Q.” . To share a few pearls gathered in training and clinical practice: (1) The best time to make mistakes is while still under supervision of people who are more experienced, but remember not to commit the same mistake twice. (2) Make the most out of each patient encounter no matter how mundane or ‘toxic’; never dodge unusual, challenging and complicated cases that will define you as an astute physician, the next chance to see a similar patient will likely be in your clinical practice where you must establish your credibility as a certified ‘M.D.’; (3) I advise trainees to remember the mnemonics ‘I.A.P.’ to guide management decisions in clinical practice: Initiative in self-directed learning, constantly search for relevant resources and references. Anticipate and recognize possible consequences of your decisions including drug side-effects and drug-drug interactions. Prioritize decisions such as medications over diagnostics, refrain from ordering a test unless it will impact your treatment decision; (4) The practice of Medicine is a lot of common sense. For instance, a well-written prescription is utterly useless if the patient does not, or could not afford to, take the medications. Be the sensible physician who treats the person and not the laboratory test. Be a good communicator striving to earn and enhance the patient’s trust and confidence by actively engaging her/him in clearly laying out immediate, intermediate and long-term plans tailored for the individual patient.
Serving Others is the Best Medicine. A pair of doctors recently published “Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself”. Backed by scientific evidence, the book makes us rethink our notions of self-care entrapped in a narcissistic sense of entitlement, and realize that focusing on others is a “potent antidote to the weariness that so many of us feel in modern times. Kinder people not only live longer, they also live better. Science actually shows that serving others is not just the right thing to do, it’s also the smart thing to do”.
The COVID-19 pandemic has created unprecedented havoc in our lives and brutally forced us to confront our vulnerability and mortality. On the other hand, it has compelled us to recognize that every person is created in the image of God and worthy of our respect and care. It has made us better appreciate the true beauty of the world around us and “revealed a vast sea of kindness and benevolence in our midst, led to countless acts of selfless heroism, and impelled many of us to use our greatest strengths to serve humanity, giving our lives new, inspiring meaning”. It is thus crucial not to revert back to our pre-pandemic wasteful self-serving interests. As educators, we must remind ourselves and our students to appreciate our most essential needs, uphold our highest values, and fervently renew our commitment to care for Mother Earth and battle climate change. Good things await those who hope: “To us Christians, the future has a name, and its name is HOPE. It is the virtue of the heart that does not lock itself up, does not dwell on the past and not only survives the present, but is able to see tomorrow” .
Be Grateful, be Humble. Life is a gift. “Don’t go around saying the world owes you a living. Actually the world owes you nothing. It was here first” . Remember that ”someone is sitting in the shade today because someone planted a tree a long time ago”. Always be grateful for your countless blessings, and the countless opportunities to pay these forward…
In the conundrum of this restless world, we need to focus on the things that truly matter. “It is only with the heart that one can see rightly; what is essential is invisible to the eye.”  Many times, it simply depends on the choices we make.
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