When at the end of my 24 hour shift my patient’s epigastric pain changed to a STEMI? As I explained to him and his wife what was going on and how dire the situation was given his prostate cancer? As I told them the high risk of bleeding to death on our way to the city to see the cardiologist? As he kept sneaking his thumb over to touch my hand that was on his leg while I talked to him? Tough old coot was scared at the odds I gave him, worried about his wife, worried about his chest pain, worried.
These are patients who are used to the doctor just telling them what to do. I won’t do that. I’ll present the options as I see them, and likely bias the discussion one way or the other, but I ask them to make the decision. Sometimes the decision is to let me decide, then I check if they are relieved or distressed with that decision and adjust accordingly. Not by the book med school ethics, but patient centred. Luckily my patient’s wife was able to decide for all of us.
I’m worried too. I hate sending my patients to the city with another doc but I’m not safe to still be caring for him. Very happy I kept doing serial ECGs though and trust my gut when I think something is wrong.
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