Central venous catheters: optimal patient care or convenience?

Despite its love affair with high technology, modern medicine is still defined by the patient–doctor relationship and its 4C’s: competence (that is sustained by lifelong learning), communication (that is clear and twoway), care (that is caring), and choice (the patient’s freedom to choose). But in the hurly-burly of modern life, the 4C’s are frequently tested. At times, the patient’s choice may seem odd. At other times, professional competence may be wrongly questioned or patients’ expectations become unduly burdensome. William Carlos Williams, the US author and physician, details such an experience in A face of stone, in which he describes how a particular couple provoked his anger. In desperation, Williams had made repeated requests that he not be disturbed every time “the kid gets a belly ache”. “... And sure enough, on a Sunday night, about nine o’clock, with the thermometer at six below and the roads like a skating rink, they would call me. Nothing doing, I said. But Doc, you said you’d come. I’m not going out there tonight, I insisted. I won’t do it. I’ll ask my associate to make the call or some good younger man that lives in that neighborhood but I won’t go over there tonight. But we need you Doc, the baby’s very sick. Can’t help it. I tell you I’m not going. And I slammed up the receiver.” Williams recognised that incessant intrusion into a doctor’s private life sorely tests the patient–doctor relationship. Time away from patients is crucial to the health of that relationship — a need for leisure, simply echoed in the words: “A poor life this if, full of care, We have no time to stand and stare.”*