Doctor-Patient "Privilege"

There are many aspects to taking care of patients. This whole doctoring thing has some pretty strange things associated with it. Each day when Kevin goes to work he sees people at their worst. No one wants to go to the ER, well maybe some drug seekers want to go to the ER, but everyone else does not. He sees people after they've been stabbed, shot, hit by a car, had a stroke or heart attack. It might even be the worst part of their week, month, year or life. No one expects the patients to be nice, they are sick, in pain, intoxicated etc. But each day the doctors, nurses, techs etc have to be nice, have to put on a smile and act like the only thing in the world they want to do is take care of the patient's problem. We are privy to all sorts of personal and family drama. As one patient told me today, some stuff is just "personal" and he did not want any one to get wind of his dirty laundry.

I had an interesting experience this week. I saw a patient with a major urinary incontinence problem. We are not talking about a small trickle, we are talking Niagra Falls. She clearly did not want to be at the doctors and the second we started talking about some behavior modification which might help her problem she pretty much told me to "F-off" with her body language and tone of voice. She was also a pretty heavy smoker, so the entire time I was in the room, trying to lead us in a lovely discussion about her health problems, whiffs of thick stale smoke and day old urine danced around me. Each time she moved it seemed like one of those motion detecting air-fresheners was going off although instead of mountain stream or fresh linen it was stale smoke and potent urine. The last place on Earth I wanted to be was sitting there in my short white coat having a chat with this lady and she certainly did not want to be there either. After she left, while I wiped down the chair with one of the industrial strength bactericidal handi-wipes, I started thinking. Why did this encounter even happen? This lady did not want to hear or even think about what my attending and I had to say. Neither of us particularly wanted to spend 20 minutes in a hot box of smoke and urine, that is for sure. So how did we end up there together? Why did she feel obligated to go to all the effort to make an appointment, ride the bus, wait for us to come see her just so she could get mad at what we were saying and torture us with her urine soaked clothing? Really what I think would have helped this lady more than anything is a hot bath, some fresh laundry and someone to help her manager her life at home. As someone who is also very stubborn I understand doing things your own way, but when I am older, I seriously hope that I am lucky enough to have people in my life who are still capable of making sure that I never leave the house in filthy clothes soiled from yesterdays urine.

Medicine is not all glitz and glamour and it is certainly not about make-out sessions in the call-room. It is really more about urine, feces, vomit, blood and ill-fitting scrubs. The Doctor-Patient Privilege is a complex one and once in a while neither party wants to participate. I hope that lady finds some new Warners.