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The Medical Professionalism Blog

Healthy as a Horse No More: My Recent Patient Experience

I knew that I would come to rue the day I wrote my post on my EKG claiming I was a healthy individual with no apparent illnesses. On November 3, I had my first surgery in 40 years – a procedure for a detached retina (vitrectomy with a scleral buckle and pneumatic retinopexy; I read that off a brochure I received). I am not an expert patient and my impressions are of a single incident but I felt compelled to write about my particular patient experience along with my personal observations.

First, for acute surgical procedures, our medical system works very well and its quality probably matches or exceeds any place in the world. I was first seen by a retina specialist at 8:00 a.m. and successfully operated on without incident by 4:30 p.m. I was discharged by 7:00 p.m. My surgeon was excellent and his bedside manner was terrific.

The day prior to the surgery, I saw an ophthalmologist who gave me the initial bad news, “You have a detached retina.” Like the lead character from the movie and play, Wit, I didn’t hear everything the physician said for the next 10 minutes. I had to ask him to repeat everything he said in the past ten minutes. I went from thinking about meetings I needed to cancel to being blind in both eyes with a tin cup in hand in what felt like minutes. I admit to being anxious and afraid even though I knew this most likely would all turn out just fine. But the moment when I leapt from being healthy to ill was a real shock, something underappreciated by most.

During the day of the surgery, I was seen by lots of practitioners for my pre-op work-up.  Most of the clinicians did not introduce themselves by name or tell me what kind of practitioner they were. Mistakenly, I thought the second eye technician was an optometrist. None of them asked me what I wanted to be called by. Of course, I started to ask for their names and training.

There was alternative procedure mentioned but the surgeon recommended not doing it (and it turned out it was the right call). But I didn’t appreciate the “if this was my father or mother, this would be what I would recommend” caveat. I’m not his father, I just met him! He might choose to be more aggressive treating his father, whereas I might want more conservative treatment.

The safety movement was in full display at this institution – I counted 10 times being asked what eye was affected, right or left, even after the surgeon pasted a mighty black mark above the eyelid of the right eye – annoying, perhaps, but understandably necessary.

None of the fellows and attending surgeon sat down to speak with me eye-to-eye (how ironic) – they stood up. The subordinate relationship as a patient was quite apparent and not empowering. It wasn’t until a follow-up visit with a senior surgeon that a physician sat down when talking to me. He was shocked when I told him he was the first.

Patient education was lacking – not much written material was provided on what to expect when healing. The fellows had more time to talk with you about when the gas bubble would disappear and regular activity could presume. Once home, there was no one to talk with about what was normal or abnormal in the healing process except for the physician on-call. Later, I was told there was a daytime number to call – too late.

All and all, I received excellent surgical care but not patient-centered care.

Update: My current status is that my gas bubble has disappeared and my eye sight is still blurring but everything is progressing normally and I am feeling great.

2 Comments to Healthy as a Horse No More: My Recent Patient Experience

  • Mia's Gravatar Mia
    February 7, 2012 at 12:15 am | Permalink

    What a nice reminder to me to always sit down with my patients. Role modeling is so powerful in medical training, and I will never forget an attending physician who taught me in medical school — she always sad down on the bed of all of her patients when they were in the hospital, and held their hands. Maybe a bit much for the first appointment, but her heart was in the right place.

  • January 12, 2012 at 10:46 am | Permalink

    Thank you so much, Daniel. I’m glad your eye is doing better, and I’m grateful for your sharing your experience.

    A couple of “empowered patient” questions :-)

    — Did you have a chance to look for a patient community? So often they/we have answers to things like what to expect, and if you have side effects (or normal problems), they can have answers to non-medical issues.

    — Did you ask any of the “stand-up” docs if you could talk at eye level, so that they’d understand what you want? Often I find clinicians have no idea how they’re coming across and are more than happy to respond.

    Good for you, asking them who they were! I hope you’ll forward this post to your best ally there, as constructive feedback.

    I hereby give you an e-patient badge :-) for posting this – for sharing your experience so others can learn.

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