Brian Thedy Patient Centered Ethics: Pathography

Jan 21, 2022 at 08:54 pm by pj


     Today should be relatively straightforward, just another typical day of rounding and seeing patients in the office, I thought to myself as I sat at the computer and reviewed the day’s patient census for both the clinic and the hospital. We had two patients in labor as well as a full day of scheduled outpatient obstetrical visits in the clinic. I was looking forward to seeing my first patient in the hospital; I had been helping to take care of her for the past four weeks leading up to her delivery, and it was finally time for her to deliver her first baby after weeks of patiently waiting. I entered her room and exchanged pleasantries with her and her husband, whom I had heard many stories about, though had yet to meet in person due to visitor restrictions implemented several months prior to help curb the spread of COVID-19. We discussed subjects I considered to be routine; her laboratory studies on admission came back normal, her fetal heart rate tracing was stable and reassuring, and she was in latent labor. I told her we would check back on her later that day to see how she was progressing, but that she was in good hands with the nurses, who would keep a watchful eye on her and her baby.

      The day progressed as expected, until we received a call that she was having recurrent late decelerations on the fetal heart tracings, and that we should head to the delivery room to evaluate her. After a brief discussion at the bedside amongst the medical team, it was agreed that a cesarean section would be the best course of action, and our patient was given a typical surgical consent before being wheeled back to the operating room. As she was prepped for surgery, my doctor and I performed our standard presurgical scrub, entered the operating room, and like a well-oiled machine, each member of the surgical team assumed their respective positions for the procedure. Much like each cesarean section I had been involved with before, the surgery progressed along in an expected fashion, starting with making the same measurements for the Pfannenstiel incision I had seen numerous times before, to delivering her baby boy, to closing that same incision using the same type of suture materials and suturing techniques as in each previous case.

      The next morning, as I prepared for another day of rounding, I recalled how brief our interaction had been from the time we received the call about possible fetal distress to the time the decision to operate was made, and then when the cesarean section was ultimately performed. In my mind, the entire interaction felt rushed, and perhaps even impersonal. I decided that in addition to the postoperative questions I would have to ask, I wanted to hear about her experience from her perspective. Much like the day before, I asked how she was feeling physically, but I then asked how she felt yesterday and today emotionally. She described how everyone had always told her the miracle of childbirth was supposed to be one of the happiest experiences of her life, and she had been anticipating finally being able to meet her firstborn child. However, she had also been experiencing conflicting emotions leading up to her admission to the hospital; she had been both excited and fearful for the delivery itself, she was certain she and her husband had everything situated at home while being simultaneously apprehensive about the possibility of having forgotten something, and how she felt on edge for the duration of her labor prior to having the cesarean section. She confided that these emotions made it difficult for her to process the events that were happening, and that she couldn’t recall what was discussed as soon as each seemingly identically dressed person, face obscured by a facemask, exited her room. She continued to elaborate about how even after her delivery, though she was elated to have had the baby, she was still having these thoughts and emotions. Additionally, she felt that since it was her first baby and she did not have a lot of medical background, it seemed as if when medical professionals walked in and spoke with her, it often felt as if people talking at her, not with her in a manner she could understand.

      This experience helped me to realize that routine events and interactions medical professionals have with patients each and every day can be, and often are, interpreted in a completely different manner than a physician may realize. This interpretation is based on each patient’s unique emotions, stressors, and life situation. Learning about my patient’s perception of medicine and her delivery helped reinforce the importance of the practice of taking the effort to explain and ensure that what is being discussed makes sense to the patient, because it can make the difference between a memorable experience to the patient or an experience that they might not recall or wish they could forget. Even everyday encounters encompassing what is seemingly routine to a physician can be life-changing for a patient, and as physicians, we must be cognizant of this fact each time we enter a patient’s room. Medicine can be impersonal to the patient and it is our duty to alleviate as much of the anxiety as possible by taking the time to sit with a patient and their loved ones, explain medical conditions and results in a manner in which patients understand, and ensure that we answer any questions they may have.