Understanding perspectives important to practice of medicine
by E. Jeanne Kroeker, MD —
A few years ago, an optometrist I know was giving a presentation to a nonmedical audience. This optometrist, Lowell, was in the midst of facial fluorouracil topical treatments for actinic keratoses. He was a fair-skinned Caucasian male who had spent too much time in the sun in his previous 70 years, and he had many facial skin lesions. After three weeks of fluorouracil application, his whole face was a patchwork of peeling, flaking, hyperemic spots, and someone sitting near me commented that it looked like “raw meat.”
Lowell explained his uncharacteristic appearance to the audience and described his ongoing treatment. Then, he stated that his face was assessed very differently depending on the perspective of the observer. For him, his wife and his friends, his face looked fairly horrendous and a bit shocking. But when Lowell walked into his dermatologist’s office, he was greeted with cheers and congratulations, his doctor exclaiming how good his face looked and how well the treatment was working.
Almost 15 years ago, when my daughter was 9 years old, she announced on a Sunday afternoon that she had symptoms of polyuria and polydipsia. We had taught both of our children to recognize the symptoms of diabetes after their father had been diagnosed with LADA (latent autoimmune diabetes of adults) just six weeks prior. On that fateful Sunday, my daughter had a random blood sugar of 483 and was subsequently hospitalized with new-onset Type 1 diabetes.
I can’t tell you how many times during that hospitalization we were told how good it was that she knew to be alarmed by her symptoms, that she never went into DKA, or that she had no major complications at the time of diagnosis. As a doctor, I knew that these were good things. But from the perspective of a parent, there was nothing good about her diagnosis or our experience in those first few days.
I had a patient in the office this month with a scan showing a liver mass that might be an abscess or a malignancy. I caught myself about to tell this woman how fortunate it was that this mass was located where a CT-guided biopsy would be possible. It suddenly occurred to me that, from her perspective, needing any sort of a liver biopsy was devastating, and knowing the biopsy would be “easier” was not really going to make her feel better about having this liver mass. She would not likely see the planned biopsy from my perspective, and I should not expect her to. I know that I can provide the best care if I adopt her perspective and guide her from that point of view.
It is easy, as physicians, to focus on the benefits of the treatments we offer without always being fully aware of the toll these treatments can and do take on patients and their families. We have the windshield perspective, and while we can see the end of the tunnel, our patients often have only side-window perspective and are still staring at the tiles in the tunnel wall.
As the COVID pandemic enters its third year in our community, variable perspectives of the pandemic’s impact on medical care are challenging to see and accept. It can be confounding and frustrating to encounter and address the alien perspectives of our patients, the media, other physicians and health care workers, hospital and clinic administrators, our families and others. Please know that you are not alone in this challenge. The members and the leadership of MSSC will continue to try to support you in any way we can, regardless of which view you see out your window in this very long tunnel.