August 30, 2012
BehindTheMedspeak: Why your doctor's ability to depersonalize is a good thing
On the surface, it would seem that having a doctor who treats you with distancing coolness and apparent indifference to your greatest concerns would be one you wouldn't want to have anything to do with.
Let me cut to the chase, and make what could be a 5,000-word essay brief: just the opposite is sometimes true.
Let us say, for example, that you are the second patient on a neurosurgeon's schedule, for planned excision of a meningioma (brain tumor).
You've had months of being worked up and tested — been seen by specialist after specialist, had countless blood tests, x-rays, MRIs, CT scans, angiograms, the works — and many sleepless nights, wondering if you'd wake up at all from the anesthesia and, if so, if you might be blind, deaf, paralyzed, any number of possible complications you've been informed of.
Your family is sick with worry.
You wait in the holding area, your IV in place, after having been brought over from the outpatient admission suite.
The nurse tells you it's time to go into the OR, the orderly comes to wheel you down the hall.
You're taken into the OR, the nurses and anesthesiologist flutter and fuss all around you, you're all set for anesthesia induction.
Your surgeon comes into the room, says hello, tells you things should go fine, and off you go into never-never land as the anesthesiologist pushes the propofol.
What you didn't know right then — and will never know, and had no reason to know — is that the surgeon's previous patient had bled into her brain during an attempted aneurysm repair, so much so that the surgeon had had to clamp a major artery to stop the hemorrhaging.
In doing so he'd sacrificed blood flow and oxygenation to the patient's speech center, to the extent that it was irreparably damaged such that she'll never talk again.
How did he know that?
She was mute after regaining consciousness in the recovery room.
The neurosurgeon had explained the complication to the patient's family, then gone and had a Coke before returning to the OR for your case.
Do you want him to be thinking about how what had gone wrong and what he might have done differently as he begins to open your skull?
Do you want him to be upset about his damaged patient to the extent that he can't concentrate while he enters your subdural space and prepares to delineate the boundries of your tumor under the operating microscope?
I don't think so.
I think you'd much rather he not think at all about what had happened hours ago to his previous patient.
In my country we call that depersonalization — thinking about a person as just a complication, an unfortunate statistic.
And in my neck of the woods, we like that in a neurosurgeon.
He can care all he likes and fret and ruminate on his mistake and lose sleep, however much he wants — but please, not while he's in my brain.
August 30, 2012 at 04:31 PM | Permalink
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Of course that's easy for me to say, in my profession, if I make a mistake, no one dies.
Posted by: tamra | Sep 1, 2012 12:23:51 AM
Was it, in fact, a mistake? Might he have prevented it if he had done something differently? If so, I would want him (or her) to ruminate on it, so that he learns from it. I'm all for depersonalization, but not indifference.
Posted by: tamra | Aug 31, 2012 11:59:13 PM
Kind of like being a cop. They do the best they can at a moment's decision. Every day, life and death . . .
Posted by: Kay | Aug 30, 2012 6:39:02 PM
Did you ever see a chest-cutter crack a chest, in his civvies, with the patient awake?
I have. Dissecting aortic aneurism blew - patient lived. Your retrograde amnesia meds spared the patient the memory. Not Mr. C (you remember Mr. C) and I, the CRNA & emergency perfusionist.
Cutting open an all-but-dead 30 something's chest takes a tad more than depersonalization...
Posted by: 6.02*10^23 | Aug 30, 2012 5:20:37 PM
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