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Doctor Files

Power of a Kind Word and a Cup of Tea

September 23, 2002|PAMELA M. DAVIS | SPECIAL TO THE TIMES

I saw the attending physician and a junior resident coming down the hall at the end of a long day. I asked where they were going. "To make tea" was the answer. Intrigued, I followed. Was the resident feeling ill? Was this a social visit? It didn't feel like the 9 a.m. coffee run.

I joined them in the small staff room. The attending physician was heating water, gathering a cup and a tea bag. The resident physician looked resigned and tired. They both looked discouraged. Clearly, these two physicians weren't going home for a while.

"What happened?" I asked. Although I was ready to head out the door to dinner, as the director of the family practice residency program, I am always on the lookout for problems.

Resident physicians in family practice spend three years after medical school learning the art and science of family medicine. Attending physicians are their teachers and mentors. Seventeen years in medical education has taught me to look for interactions like this one, where the lives of the physicians touch the lives of their patients in unique ways. Our specialty encourages physicians to use the latest in medical technology, but often the warmth of a personal relationship is where the real healing starts.

"It's the woman who wanted the iron shot," the resident said with a sigh. I remembered hearing about her the week before. The emergency room doctor wanted to bring this young woman into the hospital for treatment for low blood count (anemia) from heavy menstrual periods. Instead, we opted to care for her in our office. She wasn't sick enough for hospitalization; she just needed iron. She didn't like (or couldn't take) iron pills and demanded iron shots. She said her past doctors had given them to her. Why wouldn't we?

The attending and resident had agonized over this patient and her medical problems. They weighed her anemia, her fatigue, her family problems, her many children and her clear dislike of iron pills. She seemed sick and sad, not just from her anemia. A recent immigrant with many responsibilities, she radiated helplessness.

The physicians knew that iron was just a small part of her treatment, but it was what she focused on at present. They realized that a slightly more expensive version of iron might be easier on her stomach, but it wouldn't be covered by her state-funded health plan. She demanded the shots. Why wouldn't the doctors give them to her?

Requests for shots are common from patients originally from other countries. In many countries injections are used often, presumably making it easier to ensure that people get the medicine. The resident looked up iron injections in the medical literature, wondering why almost no one uses them here anymore.

The list of problems was staggering, especially the one about an immediate, possibly fatal allergic reaction. In addition, the patient must be observed for at least an hour and must have daily injections, not just one. It seems that the woman had never followed through with the full therapy. No wonder she was still anemic.

After finding medical records to prove she had no past allergies to the shots, they decided to give the iron injections a try. At least her health plan covered them. The physicians knew she needed iron somehow.

That brings us back to the hot tea. The patient had just received her first iron shot, and after all the warnings and discussions, she felt immediately sick. The resident and attending physician evaluated her extensively. Ultimately, they determined this was not an allergic reaction but, rather, the sickness that comes of being tired and frightened.

Patients want the best that medicine has to offer, but physicians and patients need to learn that often the best is a kind word, a gentle hand and a listening ear. Too often, in our highly technologized medical care system, both parties feel the answer to all problems lies in a test or pill.

This patient was so focused on her diagnosis that she wasn't aware of her own exhaustion and need for someone to care about her. The senior physician knew that although her blood count was low, her spirit was lower. Seeing the patient's reaction to the shot and knowing her resistance to discussing her feelings, the senior physician offered another direction. She directed the resident physician to leave the patient with the nurse while they proceeded to find a more suitable treatment. "What she needs is hot tea," the senior physician said.

"Something warm, soothing, to help her feel better." They returned to care for their patient in the best way they knew, carrying a steaming cup of tea.

*

Dr. Pamela M. Davis is program director of the Family Practice Residency Program at Northridge Hospital.

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