How a patient with a kidney stone changed how I treat all my patients

Early in my career I was working on a routine Sunday at my job as a hospitalist. I had picked up an extra shift and came in to start rounding and seeing patients. I took over care from my partner and reviewed my list of patients; then I got to work seeing them. It was a standard variety of diagnoses… sepsis, renal failure, COPD exacerbations, and one patient with ureterolithiasis. I went from room to room seeing patients. Eventually in late morning I made my way in to see the patient with the stone that had migrated from her kidney down to her ureter. It was stuck there causing a blockage and back up of urine flow.
I introduced myself and quickly launched into the plan of waiting for the urologist to come in and do a cystoscopy and possible stent. I checked the patient over and told her because it was the weekend we weren’t sure when urology would be in to see her. And I left.
I went about my day and eventually urology came in and did put in a stent into her ureter. The nurse let me know the patient was done with her procedure and cleared to be discharged, and so I wrote the orders and she left.
After discharge the patient’s family called to the hospital to say they were very unhappy with their care. They had seen four doctors, from the ER to time of discharge, and not one had explained what a kidney stone was, what the treatments were, and what the patient should expect going home. The patient herself was upset and scared and still in pain, which no one had told her was normal. She told us that we had all treated her as is her condition were no big deal, when to her it was a painful, terrifying, once in a lifetime experience.
The patient was right. Each of her doctors had seen so many kidney stones come and go they barely registered on our radar anymore. To us it was a common, simple, quick diagnosis and easy treatment plan. To the patient it was a waking nightmare of being in constant severe pain, not understanding what was happening or going to happen next, and being sent home with no idea what would happen when she got there. I had failed this patient, we had all failed her.
Most people will only see the inside of a hospital if they or a loved one are seriously ill and in need of immediate treatment. Hospitals are intimidating and frightening to the average person. It’s easy to lose sight of that when you’ve been in and out of hospitals your entire adult life. To us practitioners, a simple diagnosis like kidney stone, pneumonia, or pancreatitis is routine. Something we see all the time and are so familiar we we could treat it with our eyes closed. To a patient, those same conditions can cause severe physical discomfort and emotional distress.
When we stop putting ourselves in our patients shoes, we lose the ability to empathize with them. It puts us at risk for becoming callous and uncaring. This patient taught me that every complaint and diagnosis should be given my full attention. That I should be ready and willing to answer any and all questions until my patients understand their condition. That there is no “routine” diagnosis or hospital admission to a patient. Even though it was difficult, I am so grateful to that patient and her family for the feedback. It has helped to shape me into the doctor I am today… one who takes her time and listens and engages patients in their care.

 

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