How I developed the essential medical skill of remaining unfazed no matter what a patient says

Dr Pam Rachootin.

The art of remaining nonchalant in the face of whatever crazy, cockamamie, confabulated or crude confession a patient may reveal is a valuable skill for which one receives no formal training.

I believe that desensitisation over time helps refine and automate this art of medicine.

In my case though, I learnt the essential skill a decade before I became a doctor.

I was taught it in one go, by none other than my own incomparable mother.

It was on the day of my wedding, and now I like to think of it as the second of two wedding gifts I received from her on that occasion.

The first one was a Hebrew prayer book, with a satin cover sewn by my grandmother, a gift to my mother on her wedding day, 30 years earlier.

My mother wrote an inscription to me: “A gift from the heart. May you remember her goodness.”

The second ‘gift’ she whispered to me at the reception.

Recently divorced from my dad, tanned, and just back from Club Med in Cancún, Mexico, my mother said:  “So many guests have told me how radiant I look. If only they knew that the mother of the bride wore clap.”

It took me a moment to register, as my mood shifted from one of celebration of my wedding to contemplation of my mother’s vaginal discharge.

“So beautiful, rolling together in the surf at sunset,” she giggled.

Could it be the infection or the alternative antibiotics she had been given to treat it (she reminded me she was allergic to penicillin) that seemingly gave her that inner glow?

I did not breathe a word.

Over four decades later, and after my mother’s death, I broke my silence. I told my daughter and immediately her esteem for her Bubbe rose exponentially.

I protested: “But just think of how I felt at the time.”

“Yeah, it may have been a bit hard for you on your wedding day and all, but how cool is that!”

May you remember your grandmother’s joie de vivre and her goodness, I will add to the inscription in that prayer book.

I will do this before I give it to my daughter, with all my love, whether or not she ever actually has a wedding after 19 years of co-habitation and a child.

As much as the episode described above helped me to gain a demeanour of calm acceptance as a doctor, I do not believe this exact wedding-based method of learning nonchalance will become a widely accepted tool of instruction for future generations of doctors.

However, I have been able to keep my cool with patients who believe in conspiracy theories and attribute their own illnesses to the shedding of viral particles from people who have been vaccinated against COVID.

I calmly consult with a patient in a monogamous relationship (at least on their side) who is proven to have contracted a sexually transmitted disease.

I can deal with a mother who wants to have an appointment immediately, on a Saturday night, for her young teenager who, she has just learned, has had sex.

I can listen to the most delusional reasons why a patient can’t accept the bleeding obvious; that, for instance, they actually do have high blood pressure or high cholesterol or diabetes that needs treatment.

Nothing fazes me anymore.

Thanks, Mum!

Dr Pam Rachootin is a GP in Adelaide, SA.

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