A few years ago I wrote an article titled, “It Must Be the Patient’s Fault”. Several issues were bugging me at the time predominately being that we frequently blame our patients for problems they might be having. We quickly would ask if the ‘problem patient’ was taking their vitamins and minerals, were they exercising and eating right, were they coming to support group meetings, having regular check ups, in essence where they following our rules. If we could find the patient not being compliant then obviously whatever was going wrong was the patient’s fault.
What was and is still obvious to me is that we don’t want to be blamed for any problems no matter what they are regarding our patients. After all aren’t we supposed to be the miracle workers? Those who heal and do no harm?
Patient problems continue to bug me and so does our role regarding their problems. In the article I asked the question, “Did we?”
Educate the patient well enough regarding the ability for them to understand the use of the surgical tool before surgery as well as after?
Stress the necessity of clinical monitoring and follow-up?
Reinforce the fact that vitamins and minerals are a life-long requirement?
Make it clear and reinforce to the patient the necessity of attending support group meetings?
See that support group meetings are well run, educational, and would be supportive?
Make sure that each individual could be involved in therapy, either by a psychologist, therapist, or psychiatrist? Did we forget the psychological component?
Not stress and continually encourage the necessity of exercise?
Ever lead the patient to believe that having a bariatric procedure was all that was necessary for long-term weight loss?
Ever lead the patient to believe that losing weight would make them happy?
Today I could ask a few other questions:
Let the patients know what long term nutritional deficiencies may occur with any weight loss procedure?
Do our best to stay in contact with those patients who seemed to disappear from our radar?
Even after all we know about the psychological issues that could plague our patient population, make sure we are working with qualified mental health professionals who specialize in eating disorders?
Do our best to rule out any physical conditions that may be the cause of health issues the patient may be having?
I know there are a number of other questions we should be asking ourselves but these are at the top of my major list of concerns. Even though we try and do the best we can for our patients I believe we should always wonder if it is enough. We know all of the great things weight loss can do to help diminish the devastating effects of the disease but we must always be aware of the fact that even though obesity can cause serious health issues so to can obesity surgery.
When I set down and talk to new patients I often wonder if they are even hearing what I am telling them. In most cases the individual is desperate to have surgery and would agree with whatever I tell them. Many times I have heard, “I will take supplements faithfully in replacement of the pills I have to take now.” I would like to believe they will remember telling me that. I know we cannot always expect our patients to be perfect but I believe we can say that about ourselves as well. When I was at a recent ASMBS conference I witnessed a number of overweight surgeons, nurses, and other staff members. Are we not to lead by example?
“Maybe the most any of us can expect of ourselves isn’t perfection but progress.” (Michelle Buford, O Magazine 2003) This is a quote that I still recite to our patients even to this day. I let them know we don’t expect them to be perfect but do expect to see them show progress when it is pertinent to their health and welfare. For those of us who work in this field of bariatric surgery we could very well say the same thing applies to us. We can not expect to be perfect but through our constant pursuit of knowledge regarding the disease of obesity we can surely make a lot of progress to improve the outcomes and health of those in our care.
In the future I would like to see more information regarding the long term nutrient deficiencies our patients may encounter and how we might enhance our patient’s education that would help them understand how they can be prevented. I would like to see the percentage of follow-up for all patients much higher then what it is currently. If patients are lost to follow-up it is obvious we may never know the magnitude of long-term deficiencies.
So when there are patient problems we need to ask ourselves, ‘Did we do the best we could do?” We need to be nonjudgmental and stay focused on ruling out what likely could be legitimate problems whether psychological or physiological. We will never be perfect but hopefully our continuing education and caring will show that we are making progress.