Everyone is special to someone

Sometimes, in the midst of thinking about another patient or the upcoming test or even what’s for lunch, we forget that for each patient we encounter, this may be the worst day of his or her life. This may be a day that this person and his or her partner, child, parent, or best friend will remember and talk about for years to come. While in this profession, a day in the hospital is just another day at the office, many people are afraid of hospitals (with good reason, as we’ve seen demonstrated throughout the week). For that patient, this is not another ordinary Tuesday.

As we are familiar from countless psychology studies, it is nearly impossible to maintain a heightened awareness of everything at all times. That is simply not how the human mind works. It is in our programming to make repeated tasks a habit…like riding a bike. Well at some point, many of the actions we take in the hospital each day become like riding a bike, but the very level of comfort that makes us efficient is what sets us up for disaster. This is where checklists and reminder screens and alarms come into play and keep us in check, designed for that inevitable “autopilot” moment. However, we are not simply robots and there are some things that truly draw our attention and wake us from the sleepless task-oriented task at hand. The first thing that comes to mind is a condition, or a critical lab value or crashing vitals. But as Dr. Roger Leonard so profoundly mentioned during our group discussion yesterday, “Informed consent is a red-flag moment that deserves full attention, just like critical lab values or critical vital signs”.

Sadly, this seems like a novel point of view compared with the treatment of the topic up to this point in my education and the little training surrounding it. The informed consent is a monumental event, but as I learned yesterday in the film, even more than an event, a process. It is an ever-evolving conversation that is grounded in a multi-directional communication between all interested parties, including the traditional players such as the physician and the physician and, oh yeah, sometimes the patient but mostly the physician. NO! This is a conversation with the patient and anyone and everyone who is there supporting that person through this difficult time and may have a clearer head while making potential life-altering decisions with unsure outcomes. It also involves the physician, but should welcome the input and assistance of other members of the healthcare team, especially the bedside nurses, who are there with the patient hour after hour, long after the initial informed consent conversation has ended, when the patient is finally able to think clearly enough to have questions.

The informed consent conversation seems to be the very reason that we became doctors. It is the beautiful opportunity to sit down with a patient and guide and advise them through a challenging decision for which they commonly have little expertise. It is an experience allowing you, as the physician, to learn about your patient’s values and goals of care. It may be one of the only functions performed by the future physician that cannot ultimately be replaced by evidence-based algorithms and surgical robots. These dynamic and unpredictable conversations are what make us human, and I hope we can realize their importance and return them to the pedestal of our work on which they belong. This unique interaction is the reason I chose to go into medicine.

Which rotation along the path of training makes us lose sight of our priorities? I don’t want to be a robot, ever.

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