THE HARD WAY

Yesterday, I learned a valuable lesson.  I should have learned it in medical school.  Since they never teach you how it feels to be a patient, you would think that I would have learned it from observing my patients during the 34 years I practiced medicine.  I didn’t!

In medical school and in practice, we learned that treating patients with medications carried significant risk.  We were taught that it was our duty to review those risks with the patient prior to giving them the medication.  We were taught the risks of surgery and other interventions as well.  We were taught to discuss benefits and risks of almost everything we do.  We should have been taught that everything we do has an impact.

We learned that tests had consequences and to look for false positives and false negatives.  Shoot, just coming to my office carried risk (I might uncover something you didn’t want known).  So, what am I talking about?

When my mother came to live with us, it became apparent that her memory was failing.  I shared my concerns with her and sent her for Neuropsych testing.  I explained that Neuropsych testing was a 4hour exam (quoting google) “to understand cognitive strengths and weaknesses, neuropsychological testing (further) evaluates:

Attention and concentration

Verbal and visual memory

Auditory and visual processing

Visual spatial functioning

Language and reading skills

Sensory development and sensory integration

Gross and fine motor development

Social skill development

Executive functioning

Emotional and personality development”

What I didn’t take into account in my ordering the test was the amount of anxiety such an awesome test could provoke.  I didn’t take into account how worried a patient might be coming out of the test and waiting for the results.  I didn’t know because, despite having ordered hundreds of Neuropsych evals, I had never had one.  She had to wait 3 weeks for her results!  Knowing her the way a son knows his mother, those must have been horrible weeks.

I had forgotten how bad test anxiety could be!  I rediscovered that anxiety over the last few weeks.   I was going to take a test that would compare me to my peers and uncover my weaknesses.  Had I known what I now know, I would have done a better job at preparing my mother and my patients for what was to come.  At the very least, I would have asked my patients how they felt about taking such a test.

The doc responsible for interpreting my test did an excellent job at describing the test and how it is graded.  She explained that the test was meant to establish a baseline on which any future changes could be evaluated.  She explained that nobody gets 100% right.  She explained that my results would be compared to the results of my peer group and she would review them with me in 1 week.

If my peer group is comprised of chimpanzees, I did great!  Seriously, I came out of that test feeling like I was an idiot. The examiner said, “I’m going to give you a list of numbers and I want you to repeat them in reverse order.  Ready?  Six, nine, seven, eight, one, four, nine, seven, five, six, one, one, two.  Now repeat those number in reverse order.”  I’m sure someone can remember all those numbers and reverse them, but I can’t.  The more tasks I couldn’t complete the more my testing anxiety increased.  Eventually, my mouth went dry, my brain froze and my performance worsened.

I’m sure my peer group went through the same phenomena.  I’m sure my mother did as well.  I bet she came out of the test thinking she had Alzheimer’s.  I did, at least, until my memory came back online and I remembered all the times as a youth when I came out of an exam thinking I had failed it and instead aced it.

The moral of the story is simple.  Doctors are taught to think as doctors.  What if doctors were taught to think as patients as well? I think they would be much better as doctors if they understood the effects they and their tests had on patients.  I know I would have been.  I know that, having been through this experience and the myriad of experiences I’ve had since becoming a chronically ill patient, I would have spent far more time preparing my patients for this test and its aftermath.  Oops, I’m playing “woulda, coulda shoulda” game (click on the underlined words) again.

In this case, the “woulda, coulda shoulda” game that I have cautioned some many mothers against has a purpose.  I think that an integral part of a doctor’s education should involve learning the patients’ point of view.  This blog will eventually become a book designed to give doctors and patients alike1 a unique view of chronic illness, a view born from my long tenure as a doctor and my newfound view as a patient with an ongoing, neurodegenerative disease.

Now for my daily joke:

I’m not saying my ex is fat…

But my memory foam mattress took a year to forget her.

I’m including the following joke because, just the mention of sex, increases my readership:

Did you know too much sex can cause memory loss?

I read that in a medical journal on page 34 at 3:23 pm last year on Wednesday November the 7th.

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