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11 pieces of advice from the physician-patient
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LAS VEGAS — In an emotional lecture at ACG 2016, Philip O. Katz, MD, gave his colleagues a look into what a patient experiences and how to best treat a peer.
“My view from the other side of the bed has given me insight into a part of medicine that I had never experienced,” Katz, chairman of the division of gastroenterology at Einstein Medical Center and clinical professor of medicine at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, said during the David Graham Lecture. “Do you believe in miracles? I said, ‘I kind of have to.’ ... But I actually believe I’m alive because of everything good about our profession, I believe I’m the beneficiary of everybody doing their best — not just the best they could. To me, that’s our obligation every day. To be our best no matter how freaking hard our job is.”
After an unexpected cardiac arrest, a barely-there pulse necessitating an immediate trip to the cath lab for multiple stents and a 10-day coma, Katz experienced months of gastrointestinal complications.
Katz was in the hospital for 60 days, was down to 155 lbs, from his current 205 lbs, and couldn’t walk and couldn’t eat. He had Clostridium difficile infection, which later recurred. He was diagnosed with ischemic stricture, had two sigmoidoscopies and needed surgery.
“I was trying to figure out what was wrong with me and it wasn’t working even though I thought I was in control of my faculties,” Katz said.
When none of his local colleagues would consider primary repair, Katz decided to be transferred and even the expert to whom he transferred agreed.
“I didn’t realize what I looked like and how risky it would have been,” he admitted during the address. “I’m a hell of a good doctor, but it was kind of difficult taking care of myself.”
He ended up with a temporary ileostomy that bled and obstructed, requiring care from the local colleague he had previously left in his transfer. It leaked in Hawaii and was removed at the 3-month mark only to be followed with an intraabdominal hernia with suspected incarcerated bowel repaired by an on-call surgeon.
Still months later, Katz suffered a GI bleed after a trip to Ireland. All in all, he said, it took 8 months to recover and become “some element of normal.”
Peer-to-peer advice
After his experiences, Katz offered 11 pieces of advice to his peers, from the point of view of the physician-patient.
1. “The lesson there is trust your colleagues. Trust the people who take care of you to have good back-up,” Katz said. “It’s nice to be taken care of by someone you know and trust. ... It may be difficult for them. My bias is it’s better for you as the patient.”
2. “Avoid assumptions about patient knowledge and health behaviors. It is difficult, and challenging, but imperative to treat us as we would treat any other patient; To assume they know nothing is maybe the best idea,” Katz said. “Ignore the physician-patient’s background. ... Acknowledge the background and negotiate care, but then treat them like any other patient”
3. Remember the niceties: “Utilize the nurses, the technicians, the med-techs ... even the housekeeper can help by being nice and being comfortable and talking to your patient when they’re in the room. It all matters.”
4. “There’s a new normal. ... It’s crucial to remember there’s an aftermath even if small in the big picture. It’s the patient who gets to live with what’s left,” Katz said. “I am normal with minor exceptions but it still feels lousy to have those exceptions. I can’t help it and it helps me take care of my patients to remember that.”
5. “Our systems are not patient-friendly and they never will be. We will not fix all the crap going on in medicine today even though we have to try.”
6. “Explain. Do not make excuses. Don’t apologize ... but be comforting and explain why that needs to be done. It helps,” he said.
7. “Please revisit your outcomes as a physician. We’re expected to be perfect. Obviously we can’t always be, but we can always be our best if we try. The end result is important but we really need to learn how we got there because the next one might not turn out as well.”
8. “Understand and, in the best way you can, communicate honestly with your patients. Validate their feelings; validate their illness.”
9. “We’ve earned what we earn. We should not in any way suggest that we are not worth what we get. We are worth more. Nevertheless, the expectations of us are high and they’re going to get higher.”
10. “Respect Murphy’s law because it is real. Respect the procedure that you’re doing every single time you do it because you will never, never predict when you will have an adverse event. I expected none of it”
11. “Compromise as little as possible in your life and work choices. Do as much as you want to do as often as you can. ... If the glass is not at least half full, get another freaking drink,” he said. “Live life to the fullest. Have no regrets. Work your butts off and enjoy your profession.” – by Katrina Altersitz
Reference:
Katz PO. David Graham Lecture. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.
Disclosure: Katz reports no relevant financial disclosures.
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