When the doctor is the patient, humanism and competency matter

Over the past few weeks I’ve had ample opportunity to be on the other side. Not like some parents with chronically ill children or those with children who have suffered tragic illness. No, not like that; I am fortunate that hospitals aren’t a part of my family’s everyday (except for work). My children have had amazing fortune and I remain in awe of good health. Lately though, we’ve had some stumbles. Literally.

O broke his leg a week ago after falling from some play equipment while we were on a trip to California. Six days before that, he turned blue in his lips and mouth and we ended up in the ER for a 6 hour investigation. My mom finished a week of chemo this past weekend and we’ve got follow-up visits for nearly everyone. Two today, in fact. I’m still living a part of the generational sandwich. And we go to see doctors. Allowing ample opportunity for being on the other side.

When I tell others about my experiences in the ER with little O or with my mom at the cancer center, or going to the doctor for my own health care, people often point out how good it is for me. Enter broccoli with a side of brussel sprouts. People want doctors to go to the doctor. I get it.

 

It’s a little like how, on some level, it would feel much better if BP’s Tony Hayward lived on the gulf coast, wore boots that were drenched in washed-up oil, and had to make a living in a small fishing town in Louisiana for 5 months. Maybe then he’d feel the impact of the oil spill that we expect. We just want people in charge to understand and feeeeeel.

We consumers of health want our doctors to connect, to understand, to care. We anticipate, discuss, and await the visit; often it’s the crescendo in our day. We want the doctor to sit down. We want them to listen so we don’t have to repeat ourselves. We want them to know it’s a scared space–that airspace between doctor and patient. I mean, it’s a formal endeavor for many of us; my mom puts on make-up, I comb my hair. We want it valued. Really, we want to share our shoes. Swap them, of course, with those who help us so they walk like we do and understand. We want to have those who are in charge of big decisions in our lives (read: doctors) really embrace the decisions like we do.

Lots of providers, lots of the time, really do feel this. They really do connect. Ask them to if they don’t. Say something like, “Did you hear what I said about her not being able to sleep?” if your doctor is distracted. It’s always okay to clarify. And it’s always okay to ask.

When O broke his leg, we were in northern California visiting the husband’s parents. We were far from Seattle Children’s and from the resources and colleagues with which we are familiar. When we arrived in the ER, I was unsteady. Hoping for good care but expecting the worst. Trying to find balance in being primarily a mom, but having the pediatrician inside me, too.

Crazy thing was all I found was compassion. It changed everything. From the nurse (who told me about his children) to the ER doc (who enlisted my opinion) to the orthopedist (who told me of his 20 month old while holding tyrannical O down for the casting), the entire team took the time to care about O and his entourage. They took time to connect. It was this humanism that changed everything. They call this place, “The Queen.” Maybe this is why.

Humanism, care, and competency are exactly what you want when you’re stuck on the other side. I’m okay with all this time on the other side. I’m learning a lot. And with a leg that is healing, I know the little bits of my mommy-broken-heart will, too.

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

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  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Some medical schools in my day, required students to become patients for a weekend. They would enjoy the pleasure of frequent blood draws, NG tubes,and perhaps an enema or two. I imagine that such an experience would be unforgettable, and might provide the physician with some perspective. Perhaps, this approach could be incorporated into our board recertification process, which would be more valuable than the current system.

  • Medlibrarian

    While I sympathize with Dr. Swanson’s post, I wonder if the words “I’m a doctor” passed her lips at any time during her ER visit with her child or while caring for her mom. Those three words can open doors that would otherwise remain closed to the average healthcare consumer. How much of the compassion shown to her was the result of her being a healthcare “insider?” I would like to think otherwise, but my personal experience has included being condescended to or ignored until or unless I play a similar card, using a staccato communication style and correct medical terminology. That is, I reveal my level of knowledge of medicine, which often results in better treatment. I pity those who are not “insiders.” They’re sicker as a result.

  • J’accuse!

    I had the unfortunate occasion to use the word “hematospermia” recently in a urologists office on behalf of a sick person in tow.

    I got accused of “reading the internet” instead of insider status. I also got a neat little drawing of anatomy made for me to explain where everything goes (eyeroll).

  • http://nostrums.blogspot.com Doc D

    I find not telling anyone I’m a doctor lets me see how people perform (occasionally, that’s not possible, because they know me). My spouse doesn’t agree; she wants them to know I’m a doctor and I’ll be scrutinizing everything they do (especially if she’s the patient).

    But when I’m the patient, I don’t look for compassion, or sympathy. I look for hand-washing, sanitation, patient safety procedures, clinical competence, and meticulous attention to what they’re doing.

    When I don’t see those things, I intervene…either at the moment or later with the person in charge. This doesn’t happen often.

    Competence and attention to detail mean more to me–and to my thereapeutic outcome–than attitude (as long as it’s not abusive or disrespectful).

    I’ve been told I don’t value the “caring attitude” so much because I don’t have the same fear and uncertainty most patients experience: I generally know what’s going on and why, and what the plan’s going to be.

    They’re right…that makes a difference.

    So, when I was in ER practice, it was critically important to make sure my patient knew what was happening and why: fear and pain can cause patients to mis-interpret your actions. Making sure they were “with me,” and giving me feedback on how we were doing, worked better to create trust and reassurance than expressions of sympathy.

  • http://www.twitter.com/alicearobertson Alice

    I am reading a book by Dr. Gawande and he would back up the premise that doctors and their families get better treatment (residents know who they are treating and they give special treatment to doctor’s and their families). He has the book out about checklists to prevent mistakes in hospitals (scary stuff when he discusses surgery…….definitely not for a mom on the eve of something similar). My daughter will soon be in the hospital for her neck dissection. I am considering impostering a doctor………..:) at the very least adding “MD” after my name when I sign the paperwork……..ack! A girl can dream ya’ know!

    Actually, if you treat the nurses with the respect they deserve, and engage them in conversation, and gratitude, etc. they often give you exceptional care. I think they are used to backing up the errors of others. They are the core of your care while in hospital because you only see the doctor or residents for what seems like moments.

    • twicker

      While I sympathize with your desire to enlist the extra benefit you can get by being “one of the profession,” I’ll warn you that you’d better know your stuff: the surest way to go from being “VIP” to being sub-standard is to be discovered as trying to pretend you’re someone you’re not.

      More importantly from the research, make sure your doctors know your perspective. To back up Doc D’s point above, we don’t have any evidence that suggests that doctors perform any better if they empathize with you; you may feel better if they feel your pain (most humans would), but you won’t receive better care. If, however, they better understand your perspective, and your daughter’s perspective, then they’re likely to give you better care.

      One of my favorite techniques is to ask them, “If you were in my position or my mom’s position [usually, I'm at the hospital with my mom], what else would you want to know, what questions haven’t we asked that you would want asked, and what else would you consider?” That simple technique gets people to try to see things from your perspective — not feel, but see. In the world of the doctor, where s/he is having to deal with a multitude of patients with a multitude of problems, possibly on very little sleep, helping them re-connect with you and your daughter as individuals, as people, will help them help you.

      And that’s all to the good.

  • http://seattlemamadoc.seattlechildrens.org Wendy Sue Swanson, MD

    @Medlibrarian, I absolutely did tell the ER doc/RN and others that I was a pediatrician. And that my husband was a pediatric radiologist. We felt it was important for them to understand our perspective and how we wanted to be involved in decisions at an advanced level. We were there for help; we wanted their opinion and care but we also wanted to see the x-rays as we knew a pediatric radiologist was not going to be reading the films. Seems like a lack of transparency, if we don’t tell them who we are…

    I will say this, though–I wrote another post on my blog about how I wanted others not to know that I was an MD while helping care for my mom at the cancer center after a number of errors were made. I felt nurses and caregivers were not acting in a standard way and it was throwing them off their protocols.
    There is data that “VIP” care is WORSE than that of a “standard” patient so I would caution anyone thinking that health care providers always get “better” care.

  • http://www.twitter.com/alicearobertson Alice

    There is data that “VIP” care is WORSE than that of a “standard” patient so I would caution anyone thinking that health care providers always get “better” care. [end quote]

    I kinda think that’s probably one of the most problematic aspects of the internet and medicine. There is data for just about anything these days, but this is a hot topic among nurses (who overall don’t like doctors, so I can imagine there is eye rolling when you announce you are a doctor……..and that could very well be your colleagues that caused that stereotype). The interpretation of data and it’s sources keeps me from certain places on the internet at times like this (once my daughter posted on her Facebook, “Don’t ever look up your disease online,” are rarely comforting to me. The stories about her cancer were downright hair-raising).

    I have had some good discussions with doctors, and one in particular claims the rich can often get worse care because doctors find them arrogant. And it would seem there is truth in that. I guess the moral of the story is to be a good patient, don’t get the doctor upset because I don’t think anyone can argue that if a doctor doesn’t like you..you quite possibly aren’t going to get the best of care. It’s really just human nature at work there……..and I do believe doctors trust other doctors on a level that creates another public stigma that can’t really be dismantled.

    It’s July……the month of terror…….and my daughter is getting surgery……but I do believe patients are safer with residents than they were years ago……well…….here’s hoping…….

  • http://www.twitter.com/alicearobertson Alice

    While I sympathize with your desire to enlist the extra benefit you can get by being “one of the profession,” I’ll warn you that you’d better know your stuff: the surest way to go from being “VIP” to being sub-standard is to be discovered as trying to pretend you’re someone you’re not. [end quote]

    Hi! I am really sorry……..those who know me know I am very facetious (still searching for a rehab to tame the beast). I would not sign as an “MD” and, am very grateful for my doctors (well……most of them. I am pretty upset with the doctor who caused the cancer spread to the lymphs in my daughter……but that’s already been discussed on these boards). I am quite happy to be a literature, lovin’ mom of six, and would never have sought out the medical field as a profession (my daughter is a nurse………I like teaching).

    Your advice is well-taken……..thank you. I live at the hospital for days after surgery, because it’s simply a labor of love and comes with the territory of being a mom. I like the staff and think helping heal people is an honorable, and empathetic profession to be in. In the book I am reading Complications by Dr. Atul Gawande he has spent pages and pages about mistakes by residents, etc.. Here is a portion of a letter I wrote to another doctor summing up what Dr. Gawande’s book covers. I could type some of what he shares and Dr. Groopman about doctors getting special treatment. At the bottom I quote a jaw-dropping statement about residents. Scary stuff when you are on the eve of having your daughter’s cut open.

    Alice wrote:
    *snip*
    I need to share something he wrote that sorta sent shivers down my spine (oh that’s dramatic…..um…maybe not! ), but I realize it’s a necessary practice in medicine. He is discussing residents, and how they mess up…but it’s part of the training for their future. He shares that the learning is often hidden behind drapes and elisions of language. Sharing that doctors protect their own families from residents because of their lack of experience, and then shares about a conversation he had with a health policy expert who felt patients were being lied to. The expert was questioning whether the chances that were taken were worth it for the gain of society. The, obvious, answer was yes, but ironically the scene unfolded with the author observing a bit of hypocrisy on this experts part:
    Pg. 31 It would certainly be a graceful and happy solution…we’d ask patients-honestly, openly-and imagine though, and then they’d say yes. Hard to imagine, though. I noticed on the expert’s desk a picture of his child, born just a few months before, and a completely unfair question popped into my mind. “So did you let the resident deliver?” I asked.
    There was silence for a moment. “No,” he admitted. “We didn’t even allow residents in the room.” [end]

  • Mandy

    I also read the book “Complications”.
    Dr. Gawande admitted that when in training, he frequently used elision (deliberate withholding of the truth or deception) as one of the ways to “steal” his learning from patients in the clinical setting. He also offered the story of his own ill son who came to the hospital for treatment, and how he refused the care from a resident specializing in his son’s medical problem, opting instead for the expertise of the department head. He did admit the double standard, but had no apologies for taking advantage of his position in the hospital to get the “best care” possible for his son.

  • Frances Stewart, M.D.

    Twicker,

    Actually there is evidence that physician empathy improves quality of care and patient outcomes. For example:

    Practitioner empathy and the duration of the common cold. Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M., Fam Med. 2009 Jul-Aug;41(7):494-501.

    Physician communication with families in the ICU: evidence-based strategies for improvement. Schaefer KG, Block SD. Curr Opin Crit Care. 2009 Dec;15(6):569-77. Review.

    The evidence base on the effects of empathy is more extensive in mental health and in nursing. I hope there will be more work on this in other areas of healthcare.

    When I’m the patient, I definitely want the physicians and other health professionals to be competent and paying attention. Fortunately, I don’t think one has to give that up to get some empathy.

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