President’s letter: How we talk and think about our patients

Saturday, July 01, 2017 12:03 PM

by Katie Lozano, MD, FACR, CMS President

We’ve had a tremendously successful year at the state legislature engaging on behalf of our members. We continue to advocate for our members and our patients with our representatives and senators in Washington, D.C., and on critical issues such as the opioid crisis and federal health care reform. You’ll hear more about these topics in this and other issues of Colorado Medicine, Central Line email or text updates, and CMS ASAP e-newsletters.

While our health care system is in a state of flux, it’s important to remind ourselves why we do what we do. Our personal experiences as patients, volunteers and with family members often play a role in realizing our calling to practice medicine, and can shape how we fulfill that calling.

A nurse entered a patient’s room at a children’s hospital in the Midwest in 1980 and asked, “Where is my little diabetic?” A 7-year-old girl paused, halfway hidden behind the bathroom door, anticipating another injection and wrapping her mind around her new identity – “I am her little diabetic?” Her mother, a petite soft-spoken woman who had shown amazing resilience and strength as she dealt with her daughter’s new diagnosis of insulin dependent diabetes mellitus, promptly rose from her chair to respond to the nurse. In contrast to her usual cheer, genuine but carefully shown almost all the time for her daughter’s benefit, the girl’s mother turned into a stern teacher disciplining a wayward student, grasping the nurse’s wrist and saying in clipped, firm words and with rare fire in her eyes: “She is NOT your little diabetic. Her name is Katie and she is my daughter. You call her by her name.” All six words in the last sentence were said so emphatically that the nurse dared not cross her again.

This was a formative experience for me in many ways. Sometimes mothers are far better teachers than tenured professors, department chairs, administrators or even ethicists. And the lessons they teach us can have much more influence on how we care for and think about patients.

A patient is not an illness or a condition. Patients almost always have conditions of some type, either an illness or a health classification. They can suffer from those illnesses or conditions, endure them, overcome them, and even die from them. Patients may feel that they do not have the time or energy to do anything but fight a particular condition, and may think their entire identity is wrapped up in that single disease. Physicians should never reinforce that feeling.

However, I see this commonly in medical practice; we routinely characterize someone as an “-ic” of his or her disease. Regardless of our background, training and experiences, and regardless of what we did or did not learn from our mothers, our primary duty is to act in the best interest of our patients. The daily grind of work should not make it acceptable for us to characterize people as a “vasculopath,” “COPD’er,” “schizophrenic,” or “the syncopal episode in 3.”

All physicians and allied health professionals – from neurosurgeons, pediatricians, radiologists and physician assistants to advanced practice nurses, registered nurses, nursing aides, dieticians, speech pathologists, ward clerks, hospital and clinic administrators and staff – all of us have a duty to treat patients with respect, as real people rather than just holders or demonstrators of disease states. We’ve often heard that we have a “disease care system” rather than a “health care system.” Referring to patients as demonstrators of disease states reinforces this disease-focused, rather than health-focused, system.

My issues with how we classify, characterize and address our patients may seem trivial in the big picture of health reform, but when it comes down to it, all of us will find ourselves at some point as a patient rather than a physician, or at the very least as a family member of a patient. It is humbling to walk through the door of the hospital one day as a confident physician, and the next walk through the same door as an uncomfortable, insecure, scared patient or family member of a patient. I hope we are all lucky enough in these situations to have a physician and caregivers who see and talk about us as people, rather than body parts or disease categories.

Our top motivator to pursue medicine was and is to help people. It’s easy to revert to defining a patient by a disease, but to nurture the patient-physician relationship and grow personally and professionally, regardless of our specialty, we have a duty to think of our patients as people rather than disease states.