Abstracted from Being Human – Stories from Family Medicine
To cure sometimes, to relieve often, and to comfort always.
It is said that Ambrose Pare gave us that insight 5 centuries ago. We have advanced a lot since. Our patients live longer lives and are generally stronger and better off. However, the givens of human life remain – suffering, pain, and death. What M Pare said all those years ago rings true today.
Not the End yet
Mr See was a sorry figure lying rigidly in his hospital bed when I first met him. He had been admitted 3 times in 3 months and had now developed a deep sacral (buttock) sore in the 3 weeks preceding his latest admission. He had Parkinson’s disease and, according to his son, he had not spoken in 10 years.
It turned out that Mr See had had a difficult few years. He had spent some years in a nursing home, but his only son had recently engaged a helper to look after him at home. Unfortunately, much of the care had been untutored and haphazard, resulting in Mr See’s repeated admissions and now his sacral ulcer.
As Mr See got better, we had a long conference with his son and presented options for care, including post-discharge home support, caregiver training to the family, and financial aid. It was a relief to him that such support was available.
As for Mr See, he became more cheerful as he got stronger. One day, as his son visited, he proclaimed loudly, this is my son!
Commentary
When there is no hope for cure, care continues. The patient must not feel that she is “discharged”. This is the end. It’s all over. The family doctor can collaborate with the patient (collude with, even, against fate!) to make the best out of this. He can be the nexus of care, the coordinator, and the advocate. His mindset affects the patient’s response to her afflictions.
Compassion for a fellow human affliction is a key to the holistic care provided by the doctor, quite apart from the medicines prescribed, laboratory tests ordered, office surgery done, or medical leave issued. His care bag includes a listening ear, comforting touch, a heart to empathize with, and a commitment to a steadfast relationship with his patient.
Does the family doctor need a GP clinic? Perhaps the question is not so much, where is his clinic? But rather, what makes a family physician special?
When we ask the second question, the answer can be unexpected. We begin to see that family medicine is defined not by the presence of an ambulatory clinic, but by the ethos of providing comprehensive and continuing care to the individual patient.
The vignette above describes how care continues in the face of despair. The team involved was a family medicine team working in an acute hospital, providing care and advocacy in the hospital and on discharge.
Dr Ng Lee Beng
Ng Lee Beng finds her energies and passions shared between patient care, training the next generation of family physicians, advocating advance care planning, grand parenting, and community gardening.
The vignette and commentary were reproduced with permission from the book, ‘Being Human, Stories from Family Medicine’ edited by Cheong Pak Yean & Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
