Trust (Part Three)

courtesy wikimedia commons

courtesy wikimedia commons

Boy do patients trust their physicians. I write this, truly, without a drop of sarcasm. (And that last line without one, too. No, seriously.)

Despite the variation in the patients we see every day, it’s often easy to clump them together. “Oh, another cocaine chest pain,” or “Pregnant vag bleeder,” or “Fever, headache, rule-out meningitis.” But every so often there’s something special about the patient — perhaps their name, face, or mannerisms — that makes the patient encounter a little deeper, a little more personal.

Recently it was another one of those “Fever, headache, need-to-LP” patients for me. My “younger than her stated age”, stylish, yoga-enthusiast patient spoke with a cute slighty-European accent, and with her neck stiffness, I figured I had to stick a needle in her back. While I was consenting her, talking through the procedure, and how I avoid the spinal cord, it dawned on me that this was a pretty remarkable amount of trust she was giving me by signing on the line. This idea of trust was something I thought greatly about in pre-clinical medical school, where the patient is an abstract concept. A theory, an idea. A “doctor-patient relationship.” But as I go further down the rabbit hole of becoming a full-fledged, root’n toot’n attending, this trust is something you simply acknowledge and accept. Waxing philosophic does not a successful procedure make, and certainly does nothing to treat or diagnose meningoencephalitis.

Putting myself in her shoes for a minute, she’s meeting a young, ravishingly handsome, courageous and beneficent physician for the first time.* She’s never met this person — for all intents and purposes, a complete stranger — before. He says he’s going to get me feeling better (yes please), do some blood work (okay, I guess), give me some fluids (sure, fine), and also stick a long needle in my back in between my back bones to make sure I don’t have meningitis (wait, whaaat?).

*This is, of course, how I assume most people view me, not as the “dorky, way-too-young-to-be-sticking-a-needle-in-me, wow-you-have-a-lame-sense-of-humor YOU’RE my doctor? guy with slightly wrinkled scrubs” view of me with which I am sometimes confused.

I’ve gotta say, that’s a leap of faith, and an amazing level of trust in the medical profession that exists nowhere else. While we as physicians often struggle with trusting parts of a patient’s story, or what their body is telling us, it’s much more often than not that a patient gives up a lot of autonomy and lets us as physicians do whatever we think is right.

It’s often those patients that lack our trust that I find myself often labeling “difficult,” even though it’s usually a wrong diagnosis, poor treatment or bad outcome in a hospital or by a physician that made them skeptical to begin with.

With great trust comes great responsibility, and that’s the simple lesson that we all know yet can always use the reminder: we’re professionals. We try to do right by the patient, help more than hurt. We put their needs ahead of our own. Thanks, random patient, for bringing that reminder back into view. And I’m glad you don’t have meningitis.

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