Thursday, January 10, 2008

Caring For Loved Ones

One of the more frustrating things that come with a medical education is having people expect you to give advice or fix them right away. I’ve had Wife’s friends and coworkers call me, unexpectedly and unacknowledged, to ask me if their doc was crazy, or if they should be doing this for that, etc. I’ve told all of them a very similar message: I don’t give advice over the phone or in person, I’m a medical student, go see your doctor. I have stated and firmly believe that you shouldn’t give advice to people without being their doctor - regardless of the relationship. It can come back and bite you in the ass.

That being said, it’s harder when it’s your family. Both my kids were sick recently (10 days of hacking cough and 2 days of violent food poisoning) and I’ve been trying to take care of them as best I can. Since they’ve been sick with illnesses that would resolve on their own I’ve really just been dolling out comfort care. But it upsets you, to know that you’re looked at to fix them and that being post haste. Plus, on top of that expectation is the very real notion that you're not believed.

“What good is your medical education if you can’t take care of this?”

"I didn't really believe what you were saying, but I guess you were right."

I’ve heard those statements before and will most likely hear them again. It’s hard to tell your loved one that they just have to “suck it up” and deal with it for a while – there’s nothing that can be done beyond supportive care. Certainly you feel that you want to be proactive and heal your family, but at the same time you must realize that in order to be a good husband and father you have to distance yourself from your medical training – at least to some extent.

I've had conversations with my mom about my dad's cancer, if it's progressed, and similar topics. She recently asked me, while out for an interview, to come with them to a follow up appointment where a new growth was going to be discussed. Because this subject was well beyond my training, I went and asked only a few pertinent questions. My goal was to be a support while trying to not interfere with the relationship developed between my dad and his doctor. Mostly I was there, I think, to make my mom feel better and certainly not second guess the treatment plan. They were glad I accompanied them, but I understood the hazards that were in place at my being present and tried dutifully to avoid traversing them.

There’s a slippery slope that can develop if we get too involved in caring for our family or friends. Regardless of your experience I feel that we can get too emotionally involved and attempt too much without the guidance of other, perhaps more appropriate, physicians and nurses. I’ve had times where I felt guilty for wanting to take Daughter to her pediatrician because I felt there was something that they could do - anything - just make her happy again. I've also had times where I've felt ashamed for presenting with an illness that, in retrospect, was an easy diagnosis that did not require a sick visit.

Between all of these cases she's been OK, but it still bothers me. Stepson's dad has taken him to their doctor after I've told him there's really not much more they can do - too which I've found some degree of anger directed towards him. Regardless of whether or not I was accurate I have since realized that it's not his job to trust me (nor I him) as I'm not their physician. And because of these understandings, based on pride and shame, I realized that I was too involved in the care of a loved one and could have made mistakes shadowed by emotional attachments.

A perk of medical training is being able to take care of people around you, but it is imperative that all physicians realize there's more undertaken while caring for a family member than a regular patient. Important findings could be minimalized by a desire to avoid a tough discussion or diagnosis and bonds that were once strong can be broken forever. I personally have decided to never provide healthcare for my family that would normally be part of their doctor visits.


Psychotherapist said...

I can understand your hesitation about diagnosing friends and family. Therapists get the same sort of thing. Everyone comes to us with their problems and wants our opinion about their family members' mental illness or condition or whatever. There's a reason our code of ethics doesn't allow us to treat family or friends.

You've taken a respectable and, in my opinion, correct position.

Doc's Girl said...

I think it's an understanding with those close around you... Friends and family around me think I get the "doctor by osmosis" thing because I'm dating one and it really upsets me. To the point where I have to pretty much make myself sound stupid! "I'm NOT a doctor, I DON'T know. etc."

Then, I don't really want to refer them to Jason because he just spent 13 hours at the hospital, you know? But, they're all trained now. They usually only ask him about orthopedic stuff now. :-P

I hope your kids feel better!

But, just like the last commenter, I think you are very correct and hopefully people will come to respect it.

Anonymous said...

I grew up in an extended family that included many doctors and RNs, and medicine just was not a topic of conversation at gatherings, large or small (except for the nurses, amongst themselves!). Or maybe it wasn't only when children were present. That might have been the case. The medical ones did seem to keep their personal and professional relationships very separate. But not until I moved far away did I ever, nor did my children ever, have a primary doctor or pediatrician or whatever that wasn't from within the family.

psychotherapist said...

I should mention that I also get a lot of medication questions from family members, etc. And while I know what the meds are supposed to do and possibly some side effects of the meds, I am not a medical doctor and have not been trained in pharmacology of any type. I have to tell people that constantly.

I feel like a parrot sometimes: Ask your doctor, Ask your doctor.

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