Med Students/Residents Dealing with Diseases in the Family

[iamsam]

Hey everyone, given our knowledge of diseases and how the health care system works - how does one deal with illnesses in the immediate family? Like a grandparent with a neurodegenerative disease or uncle/aunt with cancer? It seems like we're in a unique position because of our emotional attachment and our knowledge of disease. How would one go about advocating for the best care of that individual? (ie. making sure a staff surgeon performs an operation instead of a senior resident) At the same time, how does one deal with the family who's constantly asking about things like prognosis, treatment options etc. I am aware that if an emotional relationship exists - that relative cannot be treated by youself but I believe there is still a role if you're in the profession to advocate for that relative. If anyone has ever gone through anything like this - plz post your thoughts and comments.

 

Thanks.

[MD2019_A]

I'd like to know about this too

[Lactic Folly]

As an "insider," you will have better access to the people who are involved in your family member's care, as they are essentially your colleagues with whom you share a workplace and interact with regularly. This is not unique to medicine.

 

The issue you raise of trainee involvement is an ethical one, and opinions differ. Some staff will automatically take over a patient's care when it is another physician's family member, and I speculate that the majority of trainees would understand and accept this quite well. However, other staff do not take this view, and in fact have let trainees participate in their own care as an example. I think that if you specifically requested no trainee involvement, that most would respect your wish, but it does raise an ethical issue regarding your own training and the many future patients in whose care you will be involved.

 

There is the concept of graded responsibility, meaning that trainees are granted the level of independence that is appropriate for them. In the short term, a patient may benefit from less trainee involvement, but in the long term, society would suffer from inadequately trained physicians, and the burden of inexperience would be passed on to the newly graduated, who should already have achieved a certain level of experience for independent practice, and unlike residents, have no backup supervision.

[Renin]

I spoke with the residents involved in my care, felt that they were compassionate people who were properly supervised and that they also understood that I was a colleague.

 

I think that certain things I would not want a colleague to see - like me giving birth! I want to scream in peace and if I poop myself ... then that should stay private! LOL.

[lostintime]

Don't go to an academic centre if you don't have to? I agree with the ethical dilemma though...kinda double standard if you don't wish it for your own family yet it's okay for another patient to get care from a resident vs. a physician. That being said, if it was my family, I would at least deep down hope that it would be the physician and not the resident as well.

 

But it really depends for what. I know for sure if it's something non life threatening or emergent, I'm okay with trainees. But that brings back to the ethical dilemma that trainees need to know how to deal with life threatening emergencies too.

[japlanet]

I've had some experience with this in the last few months.

 

In June, my boyfriend (26) went into DKA and got himself a brand spanking new type 1 DM diagnosis. That experience was really interesting for me (also very scary, of course) - we went to the closet ER obviously, one at which I had worked in December - so I ran into many nurses I knew, a fellow clerk, residents I had worked with - even my student advisor, who happened to be an ER doc, was there the next morning as we were still sitting in the emerg at that point.

 

I felt angry with the system - he was admitted to IM from emerg on Friday evening, but of course there were no beds. So he stayed in the ER overnight. The IM resident on did the history, etc, and told us that likely, he would be in the ER overnight with an insulin drip, and once his sugars stabilized the next day, he would be sent home and would follow up on Monday with endo. On Saturday, he had been d/ced from the IV, and was feeling fine, but we had no plans to leave, no one came to talk to us. I asked what the plan was - so the ER nurse paged the IM resident. A different resident (obviously) came down and told us that he would have to stay in hospital until Monday, since Endo wasn't going to see him until then. I said that was ridiculous, he can't sleep in the hallway of the ER (which is where they moved him once they took the IV out) for 2 nights. He can't sleep there. She basically said, tough beans. I was LIVID.

 

45 minutes later the endo staff came down, spoke to us briefly, wrote him a prescription for insulin, meters, etc and sent us home. I asked if the IM resident had called him in because I had made a fuss etc. He said no, he heard about us last night and was going to see us all along. So the resident was blowing smoke out her a**.

 

It took me a while to step back and, as one the ER docs told me, stop being a medical student, and just be his partner. Stop asking what his K is, stop watching the monitors for arrhythmia. Oh, but the one thing I didn't stop myself from doing was to keep turning off the alarm on the monitors. Apparently when a healthy 26 y/o athletic guy sleeps, and his HR goes down to around 40 bpm, the monitors believe he is dead and freak out.

 

This week, my aunt died from breast CA, and yesterday my grandfather was diagnosed with stage IV lung cancer, with liver mets.

 

I consciously stop myself from asking about symptoms, from asking what doses of what meds they are on, etc. It's more important to be supportive. Be a family member. They already have doctors. That said, if you think something is WRONG, don't be afraid to ask for a 2nd opinion.