Health Topics

A Transplant Surgeon’s Philosophy in Patient Care

Table of Contents

Andrew Schorr:

Dr. Mike Mulligan come on over. So Dr. Mulligan, you see people who are really sick; and I think in Annette’s case, Annette, you probably wouldn’t have been long for this world without a transplant; and other people with a variety of conditions. So when families are faced with that, some tips on how they can work with you, a director of a service, to really get better care?

Dr. Mulligan:

We’ve heard a lot of different perspectives today about advice that one can take away to better advocate for yourself, and truthfully the advice that one gets from one specialty doesn’t necessarily apply to another, but there may be some concepts that you can take away, and in order to understand my philosophy I think one needs to first and foremost understand how much medicine has changed. We’ve become hyper-specialized.

When I went to medical school back in Connecticut I aspired to have a family practice in a bed-and-breakfast in Vermont where I could ski during the day, see a few patients, and then join them at the bar at 8 o’clock and have a pint.

Well I went to medical school for about six months, and I was pulled out of anatomy class, told I was going to be a surgeon. The next year I was pulled out of a respiratory physiology class and told I was going to be a thoracic surgeon. I was pulled out of internship and told I was going to do immunology research and then ended up to being in transplant, and the next thing you know there’s only about six places in the country where I could find a job.

So I am very far away from Vermont. I’m very far away from being a primary care provider, but I have ultimate respect for them, and I think rather than give you advice about how to manage your interactions with all your providers perhaps I can espouse my philosophy of patient care, and you can then understand the different roles that we all have to play.

First and foremost I would characterize it (my philosophy of patient care) as collaborative patient care meaning that your surgeon is going to provide a service for you that is a profound, intimate, at times overwhelming interaction that you’re going to have with them, but it’s only one part of your recovery process.

You are responsible for the majority of your healing. You, or the god that you pray to, are responsible for the majority of your healing. The doctor I see more than any other doctor in the world right now is Jens Chapman as I have a variety of spinal ailments, and he keeps me going, and it is because Jens gives me my homework, and I do it dutifully, and I do it passionately, and I keep myself going. So you must do that.

Also there’s an element of trust that’s implied in that collaborative arrangement, and that may not sound fair because you’re going to walk into a doctor’s office and decide if you trust them enough to open your chest and remove a portion of your lung or trade your lung for another. It’s tough to make that assessment in a one-hour interaction, but we trust that the butcher at QFC is not going to give us tainted meat. We trust that the man at the gas station is not going to put water in the tank. So there are certain things that are implied, and there are certain things that are earned. So let’s start with that implication, but they must earn the rest of it, and I think you can sound their commitment, you can sound their ethic, and perhaps this is a way of rephrasing what Ben alluded to in terms of their affability. How available are they to you in the moment? Are they completely dedicated to you? Now I realize that availability means different things because later on if you have one person who’s at the pointy end of a pyramidal team that provides care to an entire region, you’re not going to be able to have a lot of social interaction with that fellow, and particularly in the days of electronic communication realize that he’s not avoiding you; there’re just so many hour in the day, and that leads to the final point in that collaborative arrangement is that you need to advocate for yourself, but you don’t want to agitate.

There are times when patients will square off with providers or will square off with nurses, and we lose sight of the fact that we’re really trying to do this together. It’s not that someone is trying to do you wrong, and if you begin to agitate the quality of that care, the quality of that interaction can deteriorate, and I realize that this sounds a little unsettling to have a doctor stand up and say this to you, but realize that those of us that have an undying commitment 24/7 to be available to our patients whenever they need us, we’re human too, and we’re trying our best. So don’t be afraid to ask questions.

By all means get second opinions. I do about 500 oncology cases a year and almost 60% of those come off of self-referred patients who didn’t like what they heard in somebody else’s office, so you can and should advocate for yourself, and find out what your doctor knows. Make sure they’re current. If you can stump your doctor with something that you’ve heard about in many different circles about your particular problem, then maybe he’s too comfortable in his own little parochial approach to those problems. I’ve yet to be able to stump Jens on the most esoteric or hair-brained ideas about spinal therapy. He’s aware of everything, and that’s why he’s got my complete trust and always will. So I hope I’ve given you a feel for who’s behind the coat and what’s behind the notion of collaborative care, and don’t be afraid to ask questions; just make sure that your doctor is fully committed to you and your best interests.

Andrew Schorr:

Great tips. Annette is there anything you want to add from a lung patient’s perspective?

Anette Lusher:

Yes I would. I wanted to say, and that is probably said before, but as a patient you take control of yourself. As a lung transplant patient we had to have a caregiver live with us for three months, but the minute I could walk I walked. I administered myself for three months. I had a port in my arm, and so every evening for one-and-a-half hours I had to administer intravenously some medication, and I would do it because it’s my life, it’s my responsibility, and if push comes to shove and the caregiver may not be there, I’m there.

I want to live. So I would always tell the patients when I go and visit with post- and pretransplant patients I say, you take your own life as soon as you can in your own hands.

That’s so important, and that’s exactly what Dr. Mulligan just said. You empower yourself, and I think that’s important.

The other thing is, there is no dumb question. I always tell the patients ask, or you can ask me too, and trust with your surgeon and with your team. I know this from a patient’s standpoint. We all feel they are sometimes private and intimate questions. You have to be able, you have to trust your doctor that you can ask any question, and you should, and you are allowed to. Thank you.

Andrew Schorr:

Amen. Thank you.

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