Thanks to Dr. Richard Ward and Dr. John Foote, the guest experts on the EM Cases podcast that inspired this article.
Explore This Issue
ACEP Now: Vol 35 – No 11 – November 2016
Dr. Helman is an emergency physician at North York General Hospital in Toronto. He is an assistant professor at the University of Toronto, Division of Emergency Medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of Emergency Medicine Cases podcast and website.
Pages: 1 2 3 | Single Page
One Response to “Pearls for Treating Patients with Sickle Cell Disease”
September 3, 2019
Sarah akhtarDr. Cifu’s piece published in the Journal of the American Medical Association (JAMA) and aptly titled “Advice for a Student Starting Medical School” does just that. Dr. Cifu’s lessons are a reminder that practicing medicine is a lifelong craft that we must work to perfect by bridging clinical acumen with an aptitude for the human condition.
In the piece Dr. Cifu shows us that his consistent efforts to provide proper care for a patient were not made in vain even though they were consistently denied. As a reader I was reminded that the clinical interaction can only be as effective as the patient is ready and willing to accept. However, the physician can show their support even when the patient is not ready. It can be done with guidance regarding consequences of an action or inaction as well as developing a strong relationship that will provide unwavering support when the patient changes their mind or is forced to come to terms with the extent of their condition.
Like Dr. Cifu, I have learned some important lessons during my third-year clerkships. An unexpected encounter I had during my Ob-Gyn rotation with a G4P3 African American female has forced me to be cognizant of the biases I carry into the encounter and to think about how to best engage with them. The middle-aged female was laying still in bed and moaning when I entered the room. Unfortunately sickle cell disease had left the patient with avascular necrosis of the hip. The patient was given an oral medication and expelled it due to her “nausea” and was insisting on an IV medication for the pain. Prior to this, I had the experience of observing an interaction with her partner who dumped ice water on her due to a small disagreement. He then spat on her and then left running with her cell phone. Between the abusive relationship, chronic pain from avascular necrosis, and the pregnancy I had felt truly conflicted about how to support this patient since the resident I was working informed me that the patient was just malingering prior to my speaking to the patient. To this day, I still wonder if I would have fallen for the “malingering” or if I truly believed that she was malingering. I tried to advocate for the patient, but I know that my experience is limited and that my empathy can blind the clinical acumen. I have also learned that not embracing the biases commonly held is many time strongly discouraged and might get you labeled as naïve.