Wednesday, 24 June 2009

Tension

Just occasionally patients show some sign of understanding that their doctor may be stressed. I was stressed last night, and finding it hard to cope with patient demand. Sometimes patients will come in with a relatively simple problem, listen to my explanation, accept my proposed treatment, and leave. That is one end of the scale. At the other are patients who pour out their needs in an incoherent flood, refuse to consider my alternative way of interpreting their problems, will not accept my reassurance or treatment suggestions, and frequently end up demanding second opinions. That may sound unkind. Of course patients have a right to express their distress, but in such consultations the normal rules of conversation go out of the window. Such patients are so centred on themselves that they have no thought for the person opposite, but plough on with their demands and brook no argument. The technical term for this is “the entitled demander”, I believe.

Last night I found myself floundering in my chair as a patient demanded explanations that I could not give about his chronic illness. In fact I quite like him and normally we get on very well, but last night my morale was low and he overwhelmed me. Because I thought we had a fairly good relationship I eventually laid my cards on the table and said “I'm sorry, but I'm not on top form tonight and I can't say anything helpful”. His immediate reply was “well, if you were on top form, what would you say?” But after a minute he seemed to grasp the position I was in, and agreed to leave things for a few weeks and see how they went. I was grateful for that.

I was still feeling a bit stressed this morning when half-way through the session I saw a Polish lady in her eighties. She used to see my partner who retired a few months ago, and now comes to see me instead. Like many Polish women of her age she suffered a lot in her early life but made the best of it and never complains. It may be because I subconsciously appreciate this, but we have hit it off. I think she sees me as a long-lost son or grandson, and I have even managed to persuade her to take some of her medication. As she got up to go this morning she made for me rather than the door. This happens to me occasionally with elderly ladies, and I confidently expected to receive a kiss or a little hug. I was wrong, for she moved around behind me and started massaging my upper back muscles. She kept going for several minutes, and extended the massage to my neck and forehead. It felt expertly done, and she told me she had learned this while training to be a nurse during the war.

I did wonder about the ethics of allowing a patient to massage me during a consultation, but as she was almost old enough to be my grandmother and I am no spring chicken myself, I figured that the GMC would not be too concerned if they found out. What I realised as soon as she started was that my back muscles were extremely tense, and must have been so all morning. Although I wasn't aware that I had been tense during the consultation she had obviously picked it up, and done something practical about it.

She really did me a lot of good, because I will pay more attention to my posture and avoiding excessive muscle tension in future. But she also got rid of all my stress and tension, and restored my faith in human nature. In the NHS patients do not pay the doctor directly for their consultations, and it often feels as though we spend all our time giving to patients. From time to time patients will offer a little gift back to their doctor. Today I received a large gift indeed.

20 comments:

Anonymous said...

What a lovely account but a good thing that you are not one of the Dr Browns the GMC knows as they seem to have no sense of humour nor appreciation of humanity and would probably interpret your acceptance of physical contact from an elderly woman as an improper alienation of her affections from her kith and kin. Glad to know you are no longer stressed.

Work is very stressful where I am just now. We are a group of people working together some of us for the first time and with unfamiliar patients who are all anxious and worried about themselves and their kids. We are all looking after each other as well as our patients and appropriate physical contact is very important.

Good to see you back Dr Brown. If you wrote more would you be less stressed?

Maggie said...

What a lovely story - thank you for that. Good to see you writing again too. :-)

Best wishes from sunny(ish) Liverpool!

Dr Andrew Brown said...

Anonymous: if the GMC are worried about alienation, what will they think when the elderly patients start dying peacefully in my surgery leaving me large sums in their wills? Fortunately all I need do is fill in the probity section of my revalidation form correctly and I will be beyond reproach.

I am reminded of Ogden Nash's contribution to this debate:

One would be in less danger
From the wiles of a stranger
If one's own kin and kith
Were more fun to be with.

But being serious for a minute, you are a hard-working, dedicated, perceptive and warm-hearted doctor, and your team and your patients are lucky to have you.

I don't know if I would be less stressed if I blogged more. It lets me get things off my chest but has its own demands.

Maggie: thank you very much for your kindness. I'm glad to contribute to the blogging world occasionally.

Dragonfly said...

Glad to see you back.

Anonymous said...

Just found your blog. What a heartwarming post. You write with a thoughtful, gentle sensitivity and warmth, that is a pleasure to read. I look forward to reading more.

steph said...

I've a friend like that lovely Polish lady. She can spot tension a mile away and doesn't hesitate to remedy, no matter where she is!

Sorry to hear about the cause of your tension but thanks for sharing this excellent story!

cogidubnus said...

Wonderful post...heartwarming only partially describes it...thank you for sharing this with us...it's part of the other side of the door we don't usually see...

littlemissdreamer said...

While randomly browsing the net I happened across your blog, and I have to say I find it fascinating and amusing, so I hope you don't mind, but you've just added another regular reader to your list

:-)

Jellyhead said...

I'm sorry to hear you've been stressed, but very glad you had some respite from it all.

And yes, there are some patients that seem so overwhelming to deal with, and then there are patients that bring a certain light with them when they enter the room.

I wish you less shadow and more light!

Will Meecham said...

At the risk of assuming that my comment on another site might be valuable here, I am appending what I wrote in response to a post on Lake Cocytus.

The good psychiatrist told a story about a demented woman in a nursing home who was make affectionate gestures toward other women in the home. Here is my comment:

I am a physician but also have severe mental illness (no longer practicing). I don't know much about care homes or geriatric psychiatry. I do know, however, that affectionate touch is healing for people, even (or especially) when its goal is not primarily sexual gratification.

Could this woman be craving hugs and caresses, without necessarily being driven by an urge to engage in sex? Maybe just human touch would be good for her, and others in her situation. I hope that if dementia strikes me in future years someone will set me up with occasional human contact, perhaps in the form of professional massage.

Even in the present day, there have been times when my psychiatric symptoms felt overwhelming, and therapeutic massage brought me back to a place of peace. (I realize, of course, how fortunate I was to be able to afford such services.)

Obviously, keeping things safe and appropriate is the first priority in your care setting. And society has neither financial resources nor widespread will to do something like provide (e.g.) chair massages to residents in facilities. But in a perfect world, we would recognize how much better we feel when someone comforts us by touching our bodies. I doubt this effect diminishes with advanced age or dementia.

Will Meecham said...

Addendum: my hyperlink to Lake Cocytus failed in my posted comment. Trying again.

Geoff said...

Are you going to employ her in the practice? Sounds like a useful person to have around!

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Petra said...

Dr Brown, are you OK?
Nice, all these messages from Japan or so... but not really; of course they are links to viruses and stuff like that.
I hope you are fine and enjoying your (probably busy) life as a GP...

Professional Medical Education said...

Brilliant story. Thanks for sharing!

XE said...

Woah, spammers much? Hope you're well Dr. Brown!

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Tenon_Saw said...

I read this post not long after you put it up and found it again today. That's the sort of kindness I wish somebody would show me, but then I am on Fluoxetine.

Dr Andrew Brown said...

T-S: We could all do with a little kindness from time to time, whether we are on fluoxetine or not. Fortunately there is more of it about than you might think.