A Doctor You Can Trust: Sympathy and Empathy Concluded

By | June 25, 2012


We want our patients to never leave like this.





























Last week, I saw a new patient in consultation whom had been referred to Schlesinger Pain Centers by a local spine surgeon, with the diagnosis of failed back syndrome for a spinal cord stimulator trial. My staff warned me that this was likely to be a very difficult patient. As promised the patient was morbidly obese with multiple comorbidities and drug allergies and the suspicious nature that so often results from unsuccessful prior medical care. After a couple of minutes of verbal sparring I asked the patient why she was here. The patient was completely taken aback and began to apologize for having been difficult or argumentative. I stopped her immediately and told her that I was not the least threatened or offended by anything that she had said. Furthermore I told her I knew why the surgeon she had been referred by the surgeon, but I wanted to know what she herself hoped to get out of the visit. I told her this was just a consult and before anything else could be done we needed to establish whether I was an appropriate doctor for her and whether or not she was an appropriate patient for the clinic. I told her that some of her imaging studies were of poor quality would need to be repeated before any decisions could be made. Next I explained that I virtually never proceed directly to neuromodulation trialing. I told her that I needed to determine whether or not she was an appropriate candidate for an intrathecal pump trial or a spinal cord stimulator trial and most importantly that some of her earlier forms of therapy might have to be repeated, in order to prove that no form of therapy simpler than a pump or a stimulator would suffice in treating her chronic pain. The patient agreed but looked warily at me and asked if I liked her and would take on her care. To the second part of her question, I responded that as long as she did all of the things we had agreed upon, I would take on her care. As for the first part, I told her that she was a pleasant enough woman and while I do my best to understand my patients, I try very hard to neither like them nor dislike them, since that is not part of my job and that either the positive or negative emotions would only impede their care.

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