Medicine For People!

March 2016


Sharing Our Humanity

Contents

  • Embarrassing Problems
  • All God's Chillun got Hemorrhoids
  • Trust
  • Confidentiality
  • Sharing our Humanity

Sharing our Humanity

Embarrassing Problems

An abscess is a bad enough problem all by itself, but there are parts of the body where the abscess has to get pretty darned bad before you'll go ask for help.

Last week a man came in with one near his rectum. In this location, the odor of the drainage is definitely not something you wish to share with your neighbor. As most people do, he expressed his discomfort that my nurse and I had to be exposed to this. We explained that when we put on our office uniforms in the morning to come play doctor and nurse, we expect to be doing just this sort of thing and please not to worry about it. In fact, regular readers of this newsletter will recall our newsletter which includes a charming story by Johnny Moses, a Tulalip Native American storyteller, guaranteed to make you smile about Western civilization's arbitrary and negative attitude towards our organs of elimination.

All God's Chillun got Hemorrhoids

As it happens, over a lifetime more than half of all people will have trouble with their anus at some point, usually a hemorrhoid. This is just one illustration that every one of us lives through some kind of embarrassment related to our biologic selves.

In fact, early on in my career someone told me that the best thing that can happen to a doctor is to develop gray hair and hemorrhoids. Why? The gray hair will make him appear that he knows more than he actually does, and the hemorrhoids will give him a look of concern.

Trust

Sharing embarrassing facts about ourselves with our caregivers may not be easy, but it is vital to competent and efficient medical care. When you trust your physician and your physician trusts you, you will be subjected to fewer tests and he can give you more accurate treatment advice. This trust goes both ways, and it's not always there. For example, a woman of childbearing age with pelvic pain could be suffering from a tubal pregnancy. If the woman thinks her physician might judge her, she may not be completely candid about her sexual activity. For this reason, we are trained to always do a pregnancy test in women of childbearing age. It's not because we don't trust her; it's just that if we fail to do that and she is in fact pregnant, she could die from an unaddressed tubal pregnancy during the examination.

Sometimes doctors don't trust their patients to do what they are told. As an example, when I was training at Kaiser Hospital in Oakland California, I noticed that the obstetricians always told women to delay intercourse for about two months after childbirth. Most women can have intercourse much sooner than that and most do, so I asked about it. The senior physician replied, "Well, we figure if we tell them two months, they might hold out for one month."

I disagree with this practice. People can detect dishonesty. Physicians need to set a good example for their patients so people can relax and feel easier about sharing their own sometimes embarrassing truths.

Confidentiality

Many of my patients bring problems to me that we were all taught are best left unspoken. Everyone who works in my office knows it isn't easy to place trust in someone else. We also know that in a small town, people will find out if we betray that trust. We ourselves have medical issues that, in accord with social convention, we like to keep private, too. So even if you think you might be embarrassed about something, remember that this is business as usual for me and my staff, and we're not going to tell anyone else.

Sharing our Humanity

The most difficult thing for a physician to admit is that he or she doesn't know something. It took me many years to trust people enough to tell them that I, esteemed medical school graduate that I was, might not have the answer to some particular question.

Eventually, just as my patients found the courage to share their own humanity with me, I found the courage to share my humanity with them. To my surprise, when I said "I don't know," people didn't call me a fraud and storm out of the office. In fact, most people didn't bat an eyelash when I said I needed time to find out the answer for them. And please don't tell me it's because they have low expectations! In serious truth, my sense is that they are vastly relieved when I trust them enough to share my limitations with them.

And you can trust me with the abscess that turned up in the wrong place, or the memory loss, or the touchy personal issue. Whatever it might be, your request for help constitutes a vote of trust and confidence in us. That compliment has always been a reward that outweighs anything else.

Newsletter edited by Jody Bower.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.