Patient Histories: A Cautionary Tale

Today the girls had a doctor’s appointment. It was supposed to be just a quick pop in for a needle. My doctor was running late, which is very rare for her. So a medical student came to take me in. I cringe sometimes when I have to deal with students, or the very junior residents. When I was going through my nightmarish pregnancy, I learned to take everything they said with a grain of salt as they were inclined to present worst-case scenarios. The older doctors (with some notable exceptions on both sides!) are much more measured and more accustomed to dealing with high-stress scenarios. But I also recognize that dealing with these docs-in-training is a necessary part of being treated in a teaching hospital.

So the student flips open the very THICK file and says “Oh, so they’re preemies?” I knew it was going down hill from there. She hadn’t peeked beforehand into C’s two-inch thick file. “Did you have a complicated pregnancy?” I said yes. “What were the complications?” That alone would fill a page of notes, but I whittled it down to the main issue. “Were they ever hospitalized?” Um, they were 30 weeks! (It says that on pretty much ever page of their files, I’m sure.) I’ve never heard of a 30-weeker who was not hospitalized, at least briefly. And then “Oh, I see she had an intracranial hemorrhage. When did that happen? When did you find out? How did they diagnose it? What caused it? Why did she have a chest tube?”

Why, why, why did I not cut her off and tell her tersely to read the file? I don’t know. Because I have that uber-Canadian desire to be nice, and not to offend anyone. The questions kept going. “What symptoms does she have?” (I am sure there are at least two reports about her physical challenges, including a report from a developmental paediatrician.) And then my favourite: “Do you have any concerns?” I think it’s safe to say I have a lot of concerns. But I don’t feel like getting into them when I came for a 5-minute shot appointment.

Just to cap it off she asked several questions about her facial birthmarks. The med students always love to ask about the birthmarks, which are completely benign. Once a student even said, right in front of me, “Doctor, what are those facial lesions?” It’s not like I forget they’re there – I’m used to people asking questions about them, especially at school. But I’m not sure why a doctor needs to comment on an unusual facial feature when you’re there for totally unrelated reasons?

I answered all the questions. In fact, I think I educated her. It didn’t seem like she knew the kinds of challenges these babies face – pulmonary hemorrhages, routine head ultrasounds, chest tubes, respiratory distress. She had lots of questions about it all.

And then I got home and wept. I mean, if I had been there about myself, or even one of the other kids, I’d probably have been grateful for her attention to detail. But I’m fragile when it comes to C. Those events, just a few short months ago, were incredibly traumatic. They are almost more traumatic in the reliving as they were at the time, since at the time I didn’t really understand the implications.

I have to deal with a lot of medical professionals – physiotherapists, early intervention consultants, follow-up clinics and various specialists. And I can deal with them. I can tell them what they need to know. I can point out the positive. I’m always happy to update friends on what’s going on too. I cope really, really well. But I hate looking back, and thinking about those early days and how much they will define her life, and how she almost died, but instead just got a brain injury.

I called the doctor’s office when I got home. I cried on the phone. My doctor apologized and took responsibility. I’ll probably never see a medical student there again. And hopefully the med student will have learned a lesson: (1) Read the file. And (2) More questions don’t mean more thorough care. Sometimes it’s better just ask “What can I do for you today?” In which case I could have responded “We’re here for the flu shot” and my morning would have been defined by this happy face.

2 thoughts on “Patient Histories: A Cautionary Tale”

  1. Oh Hilary, huge hugs. That just sounds rough. Your Cora is amazing, both girls are tough little fighters. I’m sorry that person made you relive the terrible stuff, you’re so right that you shouldn’t have to relive that at all. Especially in that situation. Here’s hoping it never happens again and that sensitivity training is a part of her next course. ;o)

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