Journey to Kona Day 191: Caring Too Much

What of the traits that made me a good doctor was "caring too much."  I always took my patients situation seriously, and approached each patient as if they were my own loved one.  I remember a time when the daughter of one of my patients was insistent that I put her dad in the hospital.  Despite the fact that I could have made more money by acceding to her wishes, I fought hard not to admit him to the hospital, because I believed that would be more harmful to him.  One of the challenges of caring so much is the impact it had on my own mind and body.  I have always taken things so seriously, my ironman training has put me in better touch with myself.  I now know the toll that "caring too much" has on me.  I got a taste of that when I learned that an oncologist had decided to put my dad on some medications that might help him, but might also harm him.

Some doctors are so focused on treating a problem such as a specific cancer, that they forget to focus on the whole person.  It's why I am so passionate about real person-centered care, and why when the dust settles after Kona, I will focus a portion of my energies on editing a geriatric medical textbook that highlights the need for this approach to care in older adults.

One of my favorite "caring too much" stories had to do with a patient of mine who was falling, incontinent and confused.  This is a classic triad consistent with normopressure hydrocephalus, which he in fact had.  The treatment, which had inconsistent results, but nevertheless was worth trying because the alternative was worse, was a shunt.  My patient was insistent that he didn't want anything done.  At the same time, he continued to be insistent that he be the sole caregiver for his wife, who had Alzheimer's Disease.  It certainly didn't help that his disease was clouding his judgement.  I also took care of his wife.  He didn't want to place her in a nursing home, but he would have to shortly if he didn't get treated.  I finally decided to have him come in with his daughter, whereupon I "ganged up on him," and with his daughters help and support, literally forced him to have the procedure.  It was more of a forcefully strong encouragement that if he didn't, he would have to put his wife into a nursing home, which he didn't want to do.

He had the procedure done, and when he came back to see me, doing much better, by the way, he told me that he'd never forgive me for forcing him to have the procedure.  I told him that I respected that, and that I hoped he'd feel that way for a long time!  Being a doctor is an imperfect science, and an art.  I had to make a judgement call that did in fact respect my patients wishes and goals.  He was just not able to balance the conflicting goals that he, himself, had.  I will always remember this case because it would have been easy to do nothing as he said he wished.  Sometimes doing the right thing is hard, and sometimes we can never be sure if we've done the right thing.

Since I'm no longer practicing, I tend to "care too much" when it comes to the health and well being of my family, especially as they encounter a non-person centered healthcare system.  My clinical judgement is still intact, and I bristle at doctors who don't take the time to evaluate a persons goals and preferences before they make a treatment recommendation.  It would be easy for me to sit back and not care, but it wouldn't be me.