Tuesday, December 15, 2009

Rembering Mrs. Kahn

The first Head Nurse I remember, one that molded my thinking for a lifetime, was Mrs. Kahn. I never knew if she had a first name. She wore the starched white nurses "dress" with the super starched nurses cap, with a deep blue band and a small medallion from whatever school she attended. She struck fear in the hearts of all who came near her for the first time, medical students notwithstanding. It was always "Yes, Mrs. Kahn" or "No, Mrs. Kahn". That was the way everyone spoke to her, even the Chiefs.

She knew Medicine better than any seasoned physician and her role was to protect the patient, from students, and even from physicians from time to time. Mrs. Kahn was God's personal agent on earth ensuring that health care was provided properly.

That is why today in reading the NY Times article by Dr. Valinoti I was somewhat pleased to see that there is a vestige of concern for the patient. In some offices from time to time the assistant comes out and screams "Terrence". Now for those of you of a certain ethnic background, the calling of you by your first formal name, "Terrence", "Richard", "Jonathan", and the like is generally done by one's mother, and when one's mother was seeking to invoke some form of guilt therapy for failure on the part of the son in complying with some unspoken but to be understood rule of behavior. Otherwise it would have been "Terry", "Dick", "Jon" and the like. Safe and secure names showing acceptance and not pending doom. Thus when the appellation from some office assistant is in the tone of a maternal reprobation one responds poorly.

Now back to the good Dr. Valinoti. She states:

"This got me thinking of how, in my own career, I have always been addressed as “Dr. Valinoti.” Freshly minted M.D.’s, some as young as 25, get a title of respect while seasoned nurses in the hospital are Betty, Kaye or Nancy.

I remembered the absurdity of this situation when, as an intern, I was addressing critical care nurses with decades of experience by their first names while they deferentially called me “Doctor.” These were women who had started their careers when I was still playing with Barbie dolls, yet where were their professional titles? Like most things in medical training, I got used to it, and it became second nature"

Well Mrs. Kahn would have never allowed that. It was not that Mrs. Kahn ever said a thing. Her presence, her aura, demanded it. She stood bolt upright, shaming any Marine in her stature, and her visage as well as dress just exuded authority. In those days even the physicians white coats were starched. No one would ever think of wearing scrubs and looking as if they had just jumped out of bed. In addition the attire was proper and the contact with the patient was correct. I remember in an old copy of Harrison's 5th Edition a whole section on how to properly address the patient, as Mr., Mrs, or Dr. or Rev. Now many office personnel speak as if they were still in high school. Thus one can see the change even in Dr. Vallinoti.

Valinoti continues:

"Regardless of whether I am “Anne Marie” or “Dr. Valinoti” to a patient, I rarely call a patient by his or her first name. As a rule, patients who are my senior are always “Mr./Ms./Dr.” Patients I meet for the first time are always addressed by their title, even teenagers (it seems silly, I know). Although many patients introduce themselves by their first name, I would never presume to address them as such without their specific permission. And even then, frankly, I find it hard to call a man old enough to be my father “Frank” or “Jim.” It is akin to my habit of still addressing old friends of my parents by their formal titles....But doctors do this at their own peril. A physician friend of mine experienced this firsthand when he made the mistake of calling a woman of a certain age by her first name during a visit. “That’s Mrs. White, thank you,” she told him, icily."

Yes, good for Mrs. White. If one is paying for a service then one deserves respect. This is not an oil change. In many cases it is one's very life. Perhaps the Senators should put a section in the new Bill to deal respectfully with patients, like customers! We should call it "Mrs. Kahn's Law: The Patient's Respect Act of 2010"!