Being patient.....

Well after almost 5 years of surgery free life myself, I am facing now the biggest surgery of my life...bilateral total TMJ replacement with custom prostheses just for me! I'm only the fourth patient in BC to have this procedure but I trust my surgeon to do it well. My angst isn't about his ability as much as it is the health care system to support his work. He does not do it alone. As patients we rely on doctors, nurses, technicians, pharmacists, therapists, dieticians, clerks, and cleaning staff just for this one procedure, all be it quite complicated, but these are also required for an appendectomy. Our system relies on many folk to get it right and do their best. Do I trust them?
In some ways, I would say, yes. But then there is a part of me that feels that it only takes one miscommunication to get it terribly wrong. If the pharmacist or tech make an error, the wrong medicine can make me sick. If a clerk makes a mistake I might get an extra xray I don't need. If the dietician makes an error I might get food I cannot tolerate. If cleaning staff inadequately clean the O.R. I could get infected. These are examples that could make my stay good or bad, smoothly or seriously go wrong.
In medical school we teach our doctors that they are part of a team and cannot deliver good health care on their own. We emphasise communication skills as a necessity to being a good doctor. Not only must they be able to talk well with their patients but also other members of the team. However, do we teach this latter skill well?  I'm not really sure. Until we incorporate something like the Inter-professional Health Mentors Program (see my last blog) into the whole of the medical school class, many will still not get this training (formally) in our medical school.
Where else can students learn this skill if not for a specific inter-professional program? I do believe students learn this through modelling of some excellent faculty and preceptors that we have associated with our school. Compared to the old fashioned hierarchical approach to health care whereby doctors were at the top and cleaning staff were more or less treated as servants, we now see doctors on a team talking pleasantly to staff rather than barking orders. However, we do see a bark occur at times under stressful situations. Nurses can now give their opinion to a physician without fear of being fired for insubordination. However, we seldom see a true equality of  team members occur just yet. Physicians are now modelling an acceptance of the other members to the team for students to see and hopefully practice in their own clinical practice or on the hospital wards.
With more and more inter-disciplinary clinics popping up for all various types of health conditions from neuromuscular disorders, to cardio-vascular diseases to paediatric asthma  patients, trainees are seeing how doctors can get along with their various allied health professionals. It's encouraging to see these develop. Some have been going on for decades. It's not particularly new but has not been prevalent until the increasing need to provide quality, "patient-centred",  health care with less and less resources has pushed for this model.
So... as I face another complex surgery I do feel like I am safe and will get some of the best health care in the world. I am so fortunate to not only teach in a fantastic medical school but also experience the benefits of that training first hand as a patient.
Am I nervous about this upcoming surgery? I'd be a fool to say, no. However, I am optimistic it will all go well. Not only do I need a good surgeon and a good health care team, I need to be a good patient. I need to be cooperative; I need to adhere to post-operative health plan; I need to have a good sense of humour; I need to have friends and family to take care of me; I need to have hope! Without hope, all these other things are not worth the effort.