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Oh, for the comfort of a false reassurance

Oh, for the comfort of a false reassurance
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First Published: Fri, Aug 21 2009. 09 04 PM IST

ER: Anxious patients and family outside a swine flu screening centre in New Delhi. Manvender Vashist / PTI
ER: Anxious patients and family outside a swine flu screening centre in New Delhi. Manvender Vashist / PTI
Swine flu is upon us and we are petrified. To wear a mask or not: that is the question. Is it a simple cough or H1N1? How to deal with employees who display flu symptoms? Should they stay away from the office for seven days or should the firm have an in-house testing facility?
ER: Anxious patients and family outside a swine flu screening centre in New Delhi. Manvender Vashist / PTI
An epidemic is perhaps the wrong time to raise questions about caregiving. Hospitals are stretched very thin. Nurses and lab technicians are exhausted and have no time to think about their job. Caregiving—interesting word, isn’t it?
Recently, during a routine “Well Woman” check-up, my gynaecologist discovered a polyp in my body. She had to remove it surgically, she said, under anaesthesia. So I went to the hospital one morning, stripped of name, job and family. That morning, I was simply patient No. 524.
Sickness is a great unifier. Joy comes occasionally, sadness can be temporal but sickness and death spare no one. Sickness begets questions of “why me”, alongside a certain resignation. Some pray and philosophize; others are enraged and bitter when their body betrays them. Some people rise above their illness, declaring that their cancer is the best thing that happened to them because it caused them to pause and re-examine their frenetic life. But for the bulk of us, being a patient is hardly pleasant. It strips dignity and makes even the hardiest person handicapped—tied to doctors’ opinions, stretchers and lab test results.
As the doctor examined me, a nurse walked in and said that the patient who had come in earlier that morning had tested positive for swine flu. I panicked. The doctor took it in stride, nodding mutely as he continued fiddling with the stethoscope. Even though I come from a family of doctors, I have decided that doctors are fundamentally different from the rest of humanity in one key way: They deal with so many patients on a daily basis that they sometimes forget what it is like to be one.
Being a patient is to face scary words like polyps and wonder if your body has finally failed you for all the ravages you wrought on it. Being a patient is to read the face of your radiologist as he stares at an ultrasound and gauge whether he looks worried or calm. Being a patient is to wait and wonder—about lab test results, second opinions, mammograms and MRIs. Being a patient is to be vulnerable and to realize how much we take personal health for granted and how quickly that can change. That fear is especially compounded during an epidemic.
At the hospital, as I lay on a stretcher, I started a conversation with the nurse who drew blood with a deftness that caused me no pain. What, I asked her, was the correct response of health professionals towards patients? When she looked baffled, I elaborated.
“Most patients who walk into any health facility these days are worried,” I said. “What if you were taught that the first response was to reassure them, regardless of how sick they were. Just simple things like saying, ‘You are going to be fine.’ Or ‘Don’t worry. I am sure the tests will come out fine.’”
“But they won’t,” she replied. “Not all tests turn out fine. Not all cancer patients get better. Do you want us to lie?”
I couldn’t reply. But later, as I spent the evening snapping at my family because I was worried about whether the frown on the doctor’s face as he examined me meant that my polyp was cancerous, I realized that yes, I wanted them to lie. To paraphrase the Hippocratic oath, I wanted them to follow the following protocol:
u First, do not frown.
u Do not use strange words such as hemangioma without explaining what it means right away.
u Tell the patient—repeatedly and with assurance—that everything is going to be okay. Even if you are sure that it won’t be. Because even you—the doctor—cannot explain the power of mind over body, explained elaborately in neurologist V.S. Ramachandran and Sandra Blakeslee’s book, Phantoms in the Brain.
u Above all, soothe the patient.
The next day, as I went to collect my test results, I handed my handwritten dictums to the nurse and asked her what she thought of them.
She read them and shook her head. “Impossible,” she said. “We can’t tell the patients that everything is going to be okay with their biopsy when we don’t know for sure.”
“But until you know, until you find out the biopsy test results, why not make her feel better?” I pleaded. “You know she is going to spend a sleepless night anyway so why not ease her mind by saying something like, ‘Ma’am, I’ve done hundreds of biopsies and I can tell from looking at you that yours is going to be fine’.”
She shook her head, this time as if I was mad.
“What about reassuring patients?” I cried. “Doesn’t that have a role in healthcare?”
“Madam, if you want reassurance, go to your mother,” she snapped. “Our job is to swab and send tissue culture to the lab.”
Fair enough, I thought. But I ask you: In an epidemic such as this one, what is the best response between test-swab and result? When you walk into your hospital, coughing and sneezing, worried that you may have swine flu, should doctors and nurses say nothing and be matter-of-fact; or try as best as they can to reassure the patient somehow? Is reassuring a patient’s anxiety part of a health professional’s professional obligation? More importantly, will such reassurance improve a patient’s chances of recovery?
I don’t have an answer. Do you?
Shoba Narayan’s polyp was benign and is gone. Write to her at thegoodlife@livemint.com
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First Published: Fri, Aug 21 2009. 09 04 PM IST