“Dialogue is a therapeutic intervention.” – Dr. Robert Alexander
Buckman, M.D.
Me: “Veo aquí en su otra oficina, el
medico allí hizo un procedimiento de los ojos, algo que se llama “iridotomía
láser”.”
Paciente: “Sí.”
Me: “¿Le dijo por qué lo necesitaba? ... ¿Le dijo él que Usted tiene ‘ángulos estrechos’?”
P: Bueno, no.
Me: Entonces, hoy, vamos a empezar
con lo que Usted entendía y entiende del procedimiento.
P: Bueno, es que, me dijeron si no
tenía el radioláser, perdería la visión. Duraba menos de un minuto en cada ojo.
Me: (After examining the patient)
Sí, veo el resultado del láser – ¿Está bien
si le explico la razón necesitaba el láser?
P: Sí.
Me: Bueno, una iridotomía láser se
le hecho cuando tiene ‘ángulos estrechos’. Este significa que el espacio entre
del iris (la parte colorada del ojo) y la córnea es mínimo. Es decir que, la
zona que actúa como filtro para el fluido dentro del ojo es muy estrecho. El
fluido no puede escapar, y la presión dentro del ojo se incrementa. Esta es una
forma de glaucoma se llama “ángulo estrecho” o “ángulo cerrado” y puede
resultar en ceguera.
P: Le entiendo.
Me: Su medico ha prevenido esta
forma de glaucoma con el procedimiento.
In order to renew one of my state
medical licenses recently, I was required to take a certain number of hours of
an online course on end-of-life care. My immediate thought was, end-of-life
care? But I’m an ophthalmologist! I never see patients at end-of-life. And as a
general ophthalmologist, the worst news
I have to deliver is a diagnosis of glaucoma or macular degeneration, not
terminal illness. Even with these diagnoses, there are
treatment options and/or lifestyle changes I can recommend that help. And give
hope.
When searching for such an online
course, I came across the University of Texas’ MD Anderson Cancer Center
website and found several end-of-life continuing medical education programs,
created and conducted by the late oncologist Dr. Robert Buckman. The purpose of
these videos is to teach physicians how to effectively and respectfully deal
with all the emotions and fears of their patients dealing with terminal illness.
It is no easy or pleasant task to tell someone his chemotherapy regimen failed,
or her cancer has come back and is now at end-stage.
In these doctor-patient scenarios
involving Dr. Buckman himself and a patient-actor, one particular theme is
emphasized repeatedly. It is that of the
importance of dialogue. Instead of
starting the patient interview with a monologue of explanations and assuming he
knows what the patient is thinking, Dr. Buckman always begins by asking the
patient her own understanding of her
illness – its course, progression and treatment – up to the present point in
time. In this way, he can pick up where
the patient leaves off and fill in any gaps in understanding.
After watching several of these
videos, I began to realize that what I do everyday in my practice of
ophthalmology is very similar. Particularly for patients who transfer to me from
other practices where they’ve received previous treatments and/or surgeries, I
always like to start with their own understanding of their eye condition. I do
this before I provide them with information from my exam. In this way I can be
sure that true continuity of care is provided. And as I always say, if I’m
doing this in English for my English-speaking patients, then I do this in
Spanish for my Spanish-speaking patients as well.
Starting the patient dialogue this
way helps me be a better doctor for my patient. If I pick up where their
comprehension of their eye condition leaves off, then I am more likely to get
my points across clearly and concisely. The patient feels heard, has any
lingering questions addressed and is therefore more likely to be compliant with
continued care by me.
A patient told me recently,
Paciente: Me gusta lo que dices.
Me: ¿Cómo?
P: Me oyes a mí. Me siento que tú
tienes un entendimiento de lo que digo yo.
Me: Bueno, gracias. Está bien, hago
aquí una cita en un més, para ver si las gotas funcionan para Usted.
P: Está bien, (con la tarjeta de visita
de regreso) pase un buen día.
Me: Igual.
In
memory of Dr. Robert A. Buckman, MD 1948-2011
Link to MD Anderson Cancer Center
CME/Dr. Buckman presentations on end-of-life care:
http://www.mdanderson.org/education-and-research/education-and-training/schools-and-programs/cme-conference-management/online-cme/md-anderson-online-cme-activities.html |
| Even in the desert, Life. Moab, Utah |
