Transference

While I was reading another blogger's discussion about malpractice, I realized that there are certain things that are true about a lot of situations where people threaten litigation.

In my experience thus far in residency, the most common occurrence where litigation is threatened is the angry family, where no malpractice has been done. It's just an irate family, entirely unsatisfied with perhaps even the best of care.

I've had families where we diagnosed small cell lung cancer, and simply that piece of knowledge prompted the family to yell at me for 40 minutes, threaten to sue me personally, my residency, the hospital, and the nursing staff.

And this is just my observation, and probably not that generalizable, but the worst of them seem to be families with guilty consciences. Maybe they didn't love their father like they should've. Maybe they should've visited mom at the home more often. Maybe they shouldn't have yelled at their sister and called her a whore before she went into a coma.

And transference is a bitch, because it's so easy to shift all that guilt and self-loathing to the doctor. He's the lightning rod, and it's easy to dump on him. He should've done a better job, worked harder, developed godlike powers to miracle heal. And you know, sometimes, I don't mind.

So, I try to work with families and get them to understand things, because it's important for families to see, especially in terminal situations, that I am also in up to my armpits. Families need to see that someone else cares. Because for all of medical technology, we have little power over disease, and even less over life. I had one patient who just wanted to die at home, and I could not even give her that.

Most families are fine, despite the worst outcomes. I've had grim discussions with families who shed their tears and thanked me for telling them it was okay to pull the plug. And it's touching to see a patient's family who loves him enough to let him die.

But to those families who feel the relentless need to find fault with everyone involved, and blame doctors or nurses or the whole profession (excepting those where we have earned such blame), please realize this: what we can do with medicine, what we can offer is not playing catch in the backyard or teaching to ride a bike. We can't offer family vacations or Thanksgiving gatherings. We can't save everyone. We can't turn back time. We can't forgive you.

Feel free to yell at me all you wish, but please remember that all the yelling in the world won't make you feel whole inside. I know that for sure.