Full disclosure  

By Conor McDonnell, MD
University of Toronto & The Hospital for Sick Children

Full disclosure 

you keep telling me what this is not.  

I have fevers,  

                     you say it is not infection.  

I am weary, bone-tired,  

                       but this is no deficiency.  

I have pain where there was no injury.  

I spasm but it does not come and go,  

it is with me all the time while,  

nowhere to be seen: no ion-ray  

no sonic beam can blast it into sight.  

I waste away and still it hangs invisible  

in the spaces vacated by my meat.  

I crack a joke  

– what we don’t know can’t kill me –  

but this is no laughing matter now. 

I grew accustomed to this being  

just another part of being me,  

now you say it is something  

I can no longer live with.  

Have you forgotten how you told me  

this wasn’t worth the worry, likely just  

all in my head?  

Now it’s all I think about, 

the only thing we talk about 

As a physician it’s hard to spend enough time talking with patients. As an anesthesiologist, it can be even more difficult. Conversations tend to proceed along an expected trajectory at a certain speed, often minutes before the patient is due to undergo surgery; therefore, establishing trust is vital. Yes, it’s important to extract all the relevant clinical details to troubleshoot, prevent instability, and confer best possible care, but it’s impossible to turn every rock over in what is often a five-minute drive-by consultation. In those moments, it’s equally as important to establish trust as it is to extract information. And isn’t something that happens by accident; the physician must work to establish that trust.  

My poem is an exploration of the breakdown of trust. Both patient and doctor are flailing in the face of a difficult/impossible diagnosis, and an extra layer of complexity/discomfort is added because the patient doesn’t feel listened to early in the process. I’m also commenting on “efficiencies,” how powers that be push us to see more patients, more quickly, and explore the patient’s “most pressing symptom.” Yet, all such efficiencies go out the window when confronted with an error, or anything requiring unexpected disclosure, and we wish perhaps we could have that time back. 

Read more about the author here: https://www.conorgmcdonnell.com/

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.