Perspective. It’s a fascinating concept, any way you look at it.

job_interviewThe story sounded familiar, uncannily familiar. It had been a long day of interviewing applicants for GP training and the answers being given were having an increasingly ‘I’ve-heard-this-all-before’ flavour, but I’d definitely heard this particular example earlier in the day.

Both applicants described a specific hospital-based incident in which a lack of teamwork almost resulted in patient harm. The details were identical, until it came to the story’s climax.

Each applicant clearly and convincingly described how he unilaterally saved the day, despite being hampered by his colleague’s incompetence. I have no idea whose version of events was accurate. Maybe one (or perhaps both) was deliberately trying to mislead, but I got the impression each genuinely believed what he was saying.

Perspective. It’s a fascinating concept, any way you look at it.

I’m sure we’ve all had the experience of hearing two somewhat conflicting sides of a patient’s story, usually from different family members. They’re generally not too difficult to reconcile and/or the differences are inconsequential, but occasionally they throw up a real challenge.

I had an elderly patient with advanced dementia, who was cared for full-time by her daughter. Everything seemed to be rolling along happily enough until the other daughter visited from interstate. There were the usual familial disagreements about what should happen to Mum, but in this case the second daughter came to me with some pretty serious allegations of elder abuse.

The son, with a third version of events, got involved, as did a neighbour, whose story conflicted with everyone else’s. The relevant authority dipped its toe in and then hastily withdrew it, claiming there was “no clear case”. It was right — the case was anything but clear.

As it happened, in the midst of the bickering, claims and counter-claims, the matriarch at the centre of the drama conveniently brought the matter to a close by getting pneumonia and slipping away quietly and quickly in hospital.

Blessedly, she was without any significant assets for her offspring to contest, and they were civilised enough to not involve any lawyers in the division of her crocheted tea-cosy collection.

In my own family, differences in perspective are fodder for amusement rather than Grand Canyon-scale rifts. My 92-year-old paternal grandmother has always been a stoic, capable woman with a make-the-best-of-a-bad-situation attitude.

Over the years, the rose-coloured tint in her recollections has intensified to more resemble a bright scarlet, and her remembered role in past events has her firmly ensconced in the driver’s seat. Now in her twilight years, she happily sits with her increasingly positive memories and regales her fellow aged-care residents with her achievements (over and over again!), feeling progressively surer that she has lived the best and most heroic life possible. That some of her stories bear little relation to the facts as remembered by other family members is of no consequence.

Mind you, these ‘facts’ are all a bit wobbly anyway. My father is always right (according to him), my mother remembers the emotions attached with great clarity (but not always the event specifics), and my brother claims to have forgotten almost everything that happened to him before the age of 18.

And me? Born with the Pollyanna gene, I’m probably more like my grandmother than I care to admit. I’m certainly not at the believing-black-is-white stage yet, but I would quite like to be by the time I reach my 90s.

It strikes me as quite a pleasant way to see out my days: a legend in my own lunchbox, utterly convinced that my life has been near-perfect.

First Published in Australian Doctor on 30th August, 2013 On Perspective

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-perspective

Mobile Phone Etiquette

mobile phone“So what’s the verdict, Doc?  Give it to me straight.”

“It’s not good news I’m afraid.  The tests revealed…”

A particularly grating ringtone emanating from my patient’s groin cut me off.  Taking the offending phone out of his pocket, he motioned for me to pause while he took the call.

Despite a ‘Please turn off your mobile phone’ sign in reception, I’ve had patients answer phones while undergoing PAP smears, skin excisions (once as I was injecting lignocaine!), ear syringes and ECGs, but this one took the cake.

“Hi mate…  Yeah, now’s fine.  Fire away…  Sorry mate, no can do.  I’m over in Perth at the mo’…  Yeah, for work…”

Five minutes and ten seconds later he hung up and casually said, “Sorry.  Good mate.  So, where were we?”

“Before we discuss your results, I need to ask: Do you know where you are?”

He looked at me as if I’d asked whether or not he believed in Santa Claus.

“ ’Course!”

“When patients show signs of being disorientated, especially when combined with inappropriate  behaviour, I need to rule out serious causes.”

“Huh?”

“You just conducted a five-minute social phone call during a medical consultation…”

“I said I was sorry,” he interjected.

“…just as I was breaking bad news.”

“Are the results, like, really that bad?”  His brow suddenly creased.  “C’mon, you can’t keep me in suspense.”

I did.

“And during this phone call, you indicated that you were in Perth, whereas in fact, you’re on the other side of the country.”

“I was just getting out of helping Johnno move house.  Anyhow you shouldn’t listen in on private phone calls,” he replied indignantly.

“Should I have stepped out of my consulting room to give you privacy?”

“Well no, just not listen.  Look, just cut the bullshit.  I said I’m sorry.  I won’t do it again.  Now can you please tell me my results already?”

I was ready to ask for suggestions as to how I could turn my ears off on demand, but didn’t want to waste any more of my time.

“The tests have revealed that you have two sexually transmitted infections,” I said, matter-of-factly.

“What?!  She said she’d just been tested and given the all-clear.  I can’t believe she lied to me!”

I refrained from mentioning kettles and name-calling pots and proceeded to discuss the specifics.  Afterwards he said, “There is no way I’m going to let the missus find out where I’ve been.”

….

It struck me recently that, as phones become increasingly hi-tech, it’s probably going to become increasingly difficult for this bloke to get away with geographical inconsistencies.  A friend was demonstrating his new latest-and-greatest Smartphone at the time…

“… and it’s got Google Latitude so you can log on and see where I am at any moment.  This phone is absolutely wonderful,” he gushed.  “The only downside is the microphone.  If I hold the phone close to my ear, the other person can’t hear me speak, but if I move it down to my mouth, then I can’t hear.  The speaker-phone function is pretty useless too – muffles the sound terribly and neither of us can hear.  I just love the phone though.  Perfect for my needs.”

“A phone that can do anything except allow you to converse with others, eh?  In other words, it’s a perfect phone for all your non-phone needs.”

“Making calls are not what phones are about anymore,” he bounced back, without even a hint of irony.

I only hope my friend is right, and that one day soon the mobile-phone-induced consultus interruptus is also rendered obsolete.
(Identifying details have been changed to protect patient privacy)

First published in Portraits of General Practice, Good Practice magazine, June 2014, page 15