The Luckiest Patient is the One Who Gets the Most Caring Clinicians
Not the most competent ones
As the seniormost class in medical school, the final year students have some level of control and power inside a medical or surgical ward.
It was our duty to know all the patients (although that hardly happened), and at the very least, contribute towards the ward round by presenting these patients to the consultants. The more you participated, the more you gelled into what was expected of you when you graduated.
The consultants knew the conditions, but we knew the patients. We were too blind at the time to know how valuable it is to know both the patient and the condition. The former cannot be graded. The latter is the reason people pass and fail in medical schools.
One evening, when attending to the patients on the 6th floor of Kenyatta National Hospital, a floor notorious for bike riders who got into accidents, we realized something about this special group. They would lie in the ward, with mechanical tractions for months, or external fixators, waiting for their time to go to the theater. The reason? Nobody cared to follow up on their cases.
When I say nobody, I mean little was done to fast-track otherwise simple theatre cases. While scouting the ward for a patient to present during that week’s major round, a young man revealed this truth to us. They knew each other in that ward because they had been living there for months. Some of their conditions were simple enough to be resolved in an afternoon.
As the senior class, we began to agitate this case to our supervisor and consultant for it to be addressed. We pushed across different levels of hierarchy relentlessly, until the patient got a spot in theatre by the end of the week. It was the first time we saw our power as medical students. We never would have if we didn’t care.
The research world and the truly competent
When you get into medical school, you have great ambitions. You recognize that you sit in a hall full of some of the country’s smartest people, hoping to change people’s lives.
You have been a star since childhood, and this time around, it’s not going to be shaped by some examination or national competition. Your goal of achieving the cure of cancer is just within reach.
Just.
Few ever get to such a point. Finding the cure for cancer may need the help of a physician, but odds are it will not be achieved by a medical doctor. Research scientists are hardly doctors.
Before graduating in any specialized field in medicine or surgery, students need to satisfy certain research conditions. I used to help some of the graduate students when I was an undergrad, since I was familiar with the research process. Their attitude towards research is usually sour by the time they are done.
Their goal is just to be done and get the degree. The alleged freedom that comes with specialization typically trumps the drive to conduct research. Most prefer bedside care and attending to patients.
Outlier groups would push themselves to actively seek out these research questions and work their way towards their solutions. Patients who cannot be helped or who die because of solvable conditions are enough motivation. These are examples of the clinicians who care.
They don’t have to be the next Nobel laureates. They don’t have to be extremely good. They just have to care. The clarity and polishing come through taking action.
The research world, however, is not flooded with clinicians but with research officers. These officers worry about their next pool of funding. Without funding, they won’t eat.
Funding, however, is almost guaranteed if you publish enough papers. Even better is if they are papers published by high-impact factor peer-reviewed journals. Better yet is if you get cited more per paper besides merely publishing.
Centuries ago, research would have been driven by primary interest. Scientists would be freed from the worries of funding by seeking a solution to a problem merely because they became obsessed with the problem, not a coveted prize or the need to feed their families.
Regardless, these researchers are competent. They know their way around the ethical committees, they are familiar with some journal editors, and have networked enough to guarantee producing several papers every year.
But the ambitious clinician who doesn’t know how to navigate through the research world is not going to find the cure for cancer. Those who care enough, however, will wade through this muck of insecurity and ignorance until they start making significant steps. The caring clinicians are the truly competent ones since caring drives competence.
I knew of one such clinician scientist, as they are called. Professor Hassan Saidi published monumental scientific papers by night and performed surgery by day. Conditions not amenable to prevailing treatment regimes, a skewed number of a particular case or outcome after treatment, or even a peculiar case could interest him to dig further.
He became the youngest professor in the university’s history, without even holding a PhD. He cared enough to poke at questions, publish the results, and teach the students who would eventually replace him. I was one of the lucky students to see someone who truly cared.
I may wax poetic about doctors and scientists because I exist somewhere in between these worlds, but there’s a cadre that gets overlooked — the nurses. A nurse who cares will lose sleep if the patient is not getting better.
Where I work, we handle several cardiac patients with all manner of heart conditions. The nurses on the ground who cater to these recovering patients are on another level — they are good.
Sometimes, the patient’s condition can worsen so fast that they hardly have the appetite for their midday meals. They will consult both the ground doctors, the experienced nurses, the registrars, and the consultants. They will do anything they can to rehabilitate patients to normalcy.
When such outcomes turn bleak, after moving heaven and earth to avert an almost inevitable demise, you can see how their days are affected.
Recently, we had a case of a Pentalogy of Fallot, a disease I had only encountered in books. A competent clinician will know the condition. A caring clinician will know more. They will know the patient’s family. They will strive to solve the mysterious cases. They will lose sleep because of the worsening state of an admission. They will make calls, send texts, and share with anyone they deem worthy of consulting just so that a patient’s outcome gets better.
The patients who get these clinicians are the luckiest.
What I’m trying to say is…
When Dr. Dre had firm control of the West Coast, signing Eminem looked like a risk. Yet, Eminem was at his lowest. The olive branch from Dre was all he was asking for.
They never knew each other as friends, nor grew up in the same neighbourhood. But Dre took a chance on him when everyone on his label told him not to. Dre cared not just about the rapper, Eminem, but about the art.
Dre cared so much that he felt he could not release a song until the beat was just right.
Competence can be measured. Caring cannot.
When you live in a country where the health system has been fractured at its core and survives like a chronic, septic wound, competence doesn’t quite help the patient.
I know of many competent doctors who couldn’t care less about a patient because they would not be paid for their services. Indeed, doctors should be paid and adequately compensated.
I also know of doctors whose competence is the last thing they consider — they only want the patient to get well. Caring drives their competence to ever greater levels; caring improves competence.
But lucky are those patients who get the most caring clinicians.
This song inspired some of the lines used in this article. Source — YouTube