I'm currently working in pediatric ward and reading a book written by a sick person. It's more than enough for me to start thinking about doctor and patient relationship. I am used to see sick people, watch somebody fight their last battle and announce death to the family. Sickness and death for me are like regular paperwork lied in office table. It's merely work. But sometime in some 'idiosyncratic' days, I cannot stand not to overthink or overfeel it. This is the worst thing you may do as a doctor, beside misdiagnose.
During medschool, I learn about empathy. It is defined as the act to understand someone's feeling and behave appropriately upon it without getting ourselves involved either at heart or mind. If you, somehow, share the same feeling as your patients or their families and overwhelmed by it, that is called as sympathy. Doctors must not become sympathic to their patients, empathic is the farthest we may go, since growing sympathy is exhaustive and able to interfere our feeling and therefore, fogs our judgment.
However, sometime I have idosyncratic days of empathy and it happen when I witness relationship of pediatric patients and their parents. It is hard to limit the growing of sympathy when you are in a ward filled with loveable creatures and their constant guardians who hold hands and whisper kind words or sing lullabies. At this point, you may be wonder how sharing parents' feeling of these sick kid will lower medical care given.
Growing sympathy is dangerous not because it makes doctor deliver lower quality of healthcare, in fact it makes doctor become more motivated and hardworking. As consequences, they will provide over the top care, run more diagnostic test, give better or more medicine. All of these sounds good, though it is not. Overdiagnose is as bad as underdiagnose, and overtreatment is as equally as dangerous as undertreatmemt. Wu ji bi fan (物极必反), said Jackie Chan to Jaden Smith in Karate Kid movie, which can be translated "As soon as a thing reaches its extremity, it reverses its course. Things will develop in the opposite direction when they become extreme," or simply means "too much is bad".
Overdiagnose is relatively new problem in medicine. In older time, people will only seek doctor during life and death condition. Yet, today a kid with 6 hours of fever will be brought by their parents to ER for fear that their kid may have hemorrhagic fever. It is a good precaution to be alarmed of what fever may lead. We should congratulate government's health promotion center for this. However, 6 hours onset of fever will not change anything in terms of body response, which is mostly used in detection test, therefore the kid's lab test will be false negative. There are some tests that measure antigen (existence of substance other than our body component, for instance virus) which allow faster detection in lab. Nevertheless, even this test need 1 day window period to appear positive. If however, doctor who treat this kid develop some sympatic feeling, he may be order some lab tests, which is expected to be negative, and expose this kids to unnecessary harm.
The worst consequences of overdiagnose is overtreatment. In our 6 hours onset of fever kid with negative test result, an overcaution doctor may prescribe her/him not only with fever lowering drug but also with antibiotic which most of the time is unnecessary as most infection in children is viral. This is a double preventable unnecessary harm.
Overtreatment is not merely doctor's fault. Parents also contribute to it by becoming overcaution and demanding. Being overcaution about their kid's condition is parent's job, but usually parent doesn't stop there. They goes further by asking for certain drug prescription, antibiotic most of the time. Though doctor knows that antibiotic will only be useful for bacterial infection, facing this kind of parent can alter their decision. Drug is toxic if it is not targeted for the right condition. Even if it is given for the right disease, the adverse effect still can not be avoided. Therefore, drug use should be administered really carefully by weighing their harm and benefit.
Looking at this doctor and patient's pattern of relationship should increase our awareness of possible conflict of interest in medical care by unexpected parties. Whomever interfere doctors' judgement, either it's themselves or patients, should not be taken lightly. Every patient should be managed with best available treatment. Even if it means that doctor should isolate their own feeling or ignore patient's exaggerated worry.
Empathy can be seen as solution for this issue. It open windows of possibility of budding doctor patient relationship in just the right amount so that it won't affect any judgement.
Empathy can be taught in medschool and it is best given with small frequent dose. It means that empathy should be put continuously in every module with short amount of hour. Students may get bored and thus, lazily join the course. However, eventually after the end of medschool, they will find its beneficial effect in delivering medical practice. Thus, I encourage all medschools to incorporate this teaching in their curriculum.
During medschool, I learn about empathy. It is defined as the act to understand someone's feeling and behave appropriately upon it without getting ourselves involved either at heart or mind. If you, somehow, share the same feeling as your patients or their families and overwhelmed by it, that is called as sympathy. Doctors must not become sympathic to their patients, empathic is the farthest we may go, since growing sympathy is exhaustive and able to interfere our feeling and therefore, fogs our judgment.
However, sometime I have idosyncratic days of empathy and it happen when I witness relationship of pediatric patients and their parents. It is hard to limit the growing of sympathy when you are in a ward filled with loveable creatures and their constant guardians who hold hands and whisper kind words or sing lullabies. At this point, you may be wonder how sharing parents' feeling of these sick kid will lower medical care given.
Growing sympathy is dangerous not because it makes doctor deliver lower quality of healthcare, in fact it makes doctor become more motivated and hardworking. As consequences, they will provide over the top care, run more diagnostic test, give better or more medicine. All of these sounds good, though it is not. Overdiagnose is as bad as underdiagnose, and overtreatment is as equally as dangerous as undertreatmemt. Wu ji bi fan (物极必反), said Jackie Chan to Jaden Smith in Karate Kid movie, which can be translated "As soon as a thing reaches its extremity, it reverses its course. Things will develop in the opposite direction when they become extreme," or simply means "too much is bad".
Overdiagnose is relatively new problem in medicine. In older time, people will only seek doctor during life and death condition. Yet, today a kid with 6 hours of fever will be brought by their parents to ER for fear that their kid may have hemorrhagic fever. It is a good precaution to be alarmed of what fever may lead. We should congratulate government's health promotion center for this. However, 6 hours onset of fever will not change anything in terms of body response, which is mostly used in detection test, therefore the kid's lab test will be false negative. There are some tests that measure antigen (existence of substance other than our body component, for instance virus) which allow faster detection in lab. Nevertheless, even this test need 1 day window period to appear positive. If however, doctor who treat this kid develop some sympatic feeling, he may be order some lab tests, which is expected to be negative, and expose this kids to unnecessary harm.
The worst consequences of overdiagnose is overtreatment. In our 6 hours onset of fever kid with negative test result, an overcaution doctor may prescribe her/him not only with fever lowering drug but also with antibiotic which most of the time is unnecessary as most infection in children is viral. This is a double preventable unnecessary harm.
Overtreatment is not merely doctor's fault. Parents also contribute to it by becoming overcaution and demanding. Being overcaution about their kid's condition is parent's job, but usually parent doesn't stop there. They goes further by asking for certain drug prescription, antibiotic most of the time. Though doctor knows that antibiotic will only be useful for bacterial infection, facing this kind of parent can alter their decision. Drug is toxic if it is not targeted for the right condition. Even if it is given for the right disease, the adverse effect still can not be avoided. Therefore, drug use should be administered really carefully by weighing their harm and benefit.
Looking at this doctor and patient's pattern of relationship should increase our awareness of possible conflict of interest in medical care by unexpected parties. Whomever interfere doctors' judgement, either it's themselves or patients, should not be taken lightly. Every patient should be managed with best available treatment. Even if it means that doctor should isolate their own feeling or ignore patient's exaggerated worry.
Empathy can be seen as solution for this issue. It open windows of possibility of budding doctor patient relationship in just the right amount so that it won't affect any judgement.
Empathy can be taught in medschool and it is best given with small frequent dose. It means that empathy should be put continuously in every module with short amount of hour. Students may get bored and thus, lazily join the course. However, eventually after the end of medschool, they will find its beneficial effect in delivering medical practice. Thus, I encourage all medschools to incorporate this teaching in their curriculum.
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