Wednesday, April 15, 2015

The Elusive Magical Fairy Wand

“Reputation is what others think of us; character is what God knows of us.”
― Shannon L. Alder

Let’s face it, if medical professionals depended on the fickle fancies of their client-patients’ enthusiastic affirmations of ‘job well done’, we’d be in trouble.

Even theoretically, few would claim it’s possible to satisfy every customer, every time. People are fallible human beings with wishy-washy whims. Most of the time we don’t even know what we want. In an age of instant gratification with expectations of continual entertainment, it’s simply not possible to meet the standards. Healthy, happy people are often disappointed. How much more difficult it is to satisfy sick clients in mental and physical pain?

Perhaps if doctors had magical wands that they could wave in a graceful arc with cascading, twinkling fairy-dust floating down over the sick patient and instantly erasing all illness…  Unfortunately, I haven’t come across such a wand. However, if anyone does, please let me know!

So, it is not easy working with people who are suffering every day. I like to see people smile. I like to cheer people up. Generally speaking, I chose a profession in medicine because I wanted to make a positive difference in the world. Without my magical fairy wand though, I seem to encounter an awful lot of disgruntled, unhappy sick people.

Madam X sat across from me with a frown and crossed her arms. “Doctor, I’m sure there’s something wrong. I’ve gained 10 pounds and I haven’t changed anything in my life. I’ve never been this heavy before. I do the same things. I haven’t changed my diet. There’s something wrong with my thyroid.”

I glanced at her recent blood work on the computer and tilted the screen for her to view the results. “Your thyroid test was normal last month,” I reassured.

“That test isn’t always accurate though, doctor. I know there are other tests to check my thyroid that are better.” Madam X leaned back and stared defiantly at the normal lab results.

“Umm, this blood test for thyroid problems is very accurate.”

“I had a friend who’s test was normal but then her doctor ordered some other thyroid testing and they found out she had low hormone levels.” Madam X scowled. “Doctor, there is something wrong. This weight is not normal for me.”

“All your recent blood work is normal. Sometimes as we get older, our metabolism slows down a bit and it’s easier to put on weight. Diet and exercise are still the best ways to control weight and stay healthy.”

Mrs X shifted in her chair. She was clearly not convinced. “Doctor, there’s something wrong in my body that is making me gain weight.”

I shrugged. “I’m sorry. I know it’s not easy. We can talk about some ways to improve your diet and increase your activity. There are classes and groups you can join. I can suggest some local gyms.”

“No, I’m not interested,” Madam X replied. Her tone was increasingly becoming more frustrated with the way things were going. “I know how to eat and I already walk enough at work. There’s something else wrong inside my body. You’re just not willing to order the right tests.”

She left angry and frustrated. “I’m just going to have to find help elsewhere,” she gave me a pointed glare as she packed up her purse and put on her coat.

Clearly, not a happy customer.

Madam Y dangled her legs at the end of the exam bed while she fidgeted with the elaborate beaded necklace that hung round her neck. “What a beautiful necklace,” I exclaimed as I shifted our consult from the initial verbal history of the problem to the physical exam portion. Her earrings were beaded in a matching pattern with her necklace.

“Thank you, doctor,” she turned her head for me to examine the opposite ear. “My daughter makes them.”

“You have a talented daughter, very artistic,” I added.

She nodded in agreement while I listened to her heart.

“Does it pain anywhere where I press?” I asked while I palpated her abdomen to ascertain spleen and liver size.

“Right there,” she indicated as I put pressure over the lower portion of her stomach, below her umbilicus.

“Oh?” I hadn’t expected a positive to my query, having already gone through a review of problems:  high blood pressure, migraines, and sinus allergies. I felt my pulse do a double skip. Pain in the stomach can be a bottomless pit of inquiry (pun intended). A million different things can cause stomach complaints, everything from benign indigestion to life-threatening colon cancer.

“Yes, doctor, sometimes I get this annoying pain, not really painful but, well, sort of uncomfortable down where you were pressing.” She sat up as I finished poking around on her belly, having ensured there were no big masses or obvious fibroids.

I waited for her to continue.

She shrugged with a noncommittal smile. “It’s probably nothing, doctor, but I just worry, you know. It’s nothing new. Just every now and then. I keep forgetting to mention it to the doctor when I have my appointments.”

I nodded.

“Probably has more to do with when I eat too much or have too many sweets.” She folded her hands and gave an embarrassed laugh. “I know it’s not good for me but when I go out to eat. I always have dessert.”

I went throw my list of ‘red flags’ -- danger symptoms that could indicate a patient has some perilous medical condition potentially going on in their bowels. Madam Y thankfully didn’t have any of them.

“I can’t find anything on the exam or in the symptoms that you’re having that indicate we need to do more testing. From what you’re telling me, there are no signs that anything like a nasty cancer is causing the stomach pains.” I mentally reviewed my internal checklist and again came up negative for anything concerning. “You might want to keep a symptom diary and jot down when the pains come and see if there are any particular situations or foods or patterns to the pain.”

She was quiet.

I waited for her to disagree with my predictions and recommendations.

Madam Y looked down at her slightly protruding abdominal fat roll. With a wry grin she let out a sigh. “You’re right, doctor, I really just need to eat better. I eat too much. I don’t like the added weight. I’ve sort of ignored it but I know I should be more active at the gym and cut down on my calories.”

“Choosing more healthy foods and getting more exercise is always a good idea,” I encouraged Madam Y with her inner health resolutions. “Exercise is the best medicine. It’s the closest thing there is to a panacea. It’ll help the weight and your blood pressure and reduce your risk of diabetes later on in life. Exercise is good for digestion too. I bet it will reduce the stomach pains.”

Madam Y nodded resolutely. “You’re right.”

I have never considered myself to be a great cheerleader. No pom-poms or fireworks. I smiled and nodded my affirmation then closed out her visit and went to print off her the summary. As I rose to exit she suddenly stood up. “Oh, doctor,” she exclaimed with a huge smile, “thank you so much. I just love you!” She rushed over and enveloped me in an unexpected hug.

My eyebrows nearly jumped off my face in surprise! (Thankfully, they are still attached. I checked afterward.) To say I was shocked is an understatement. I was certainly caught off guard. Not the reaction I was expecting. I’m not complaining either, mind you.

“You’re welcome,” I stammered back in response as she released her hold of me.  

Clearly, she was a happy customer.

Happy and satisfied versus frustrated and angry. I really can’t take credit for either reaction. There are too many other variables within a person’s life that affect the outcome in our clinic visits.

Madam X and Madam Y, with their contrasting attitudes, are a reminder that satisfaction comes from within. It’s a mind-set that we choose. I cannot look to customer satisfaction surveys or patients’ words of affirmation. Medicine is fraught with sickness, suffering, and people with emotional and physical pain. The courage to carry on in the midst of it all comes from outside my work.

I work for Christ, and, well, He’s already given me His stamp of approval.

1 Peter 4:11

Do you have the gift of speaking? Then speak as though God himself were speaking through you. Do you have the gift of helping others? Do it with all the strength and energy that God supplies. Then everything you do will bring glory to God through Jesus Christ. All glory and power to him forever and ever! Amen