Getting personal with patients really matters

Ask almost any physician why they chose medicine, and they’ll answer, “I wanted to make a difference in the lives of patients.”

But in today’s high-pressure healthcare environment, it’s easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, “It’s OK, as long as we’re delivering great clinical care, we’re delivering great care. After all, the massive heart attack was averted. The wound was stitched. What more could our patients want?”

We sometimes forget that we’re caring for human beings who are going through the most frightening, painful and significant experiences of their lives.

I can relate. I’m an emergency physician, and my wife Tasha is a hospitalist. We know the pressures providers face every day. But about seven years ago, we went through an experience that changed our perspective forever.

When our son Orion, was 4, he developed a seizure disorder. For a while, it was a seizure here, a seizure there. Then, for about a year, he seized every day — and sometimes up to 20 times a day.

As a parent, it was harrowing to watch. No matter how many specialists we consulted and treatments we tried, his seizures seemed uncontrollable. On bad days, he couldn’t eat because he spent most of his waking time either seizing or postictal.

All kinds of alarming thoughts ran through my head. Would my son ever walk again? How could he possibly start kindergarten next fall? And there were much scarier questions, ones that I couldn’t bring myself to ask out loud.

Orion’s seizures sent us rushing to the ED on a regular basis. In fact, we visited three or four different EDs that year. As I sat with my wife and son waiting for consults and test results, I realized how incredibly different the ED looks from the patient perspective. After all, an emergency physician sees dozens of patient a day, maybe ten seizing kids a month. When it comes to seizures, they’ve got the clinical care down to a routine. But I quickly realized that no ED visit feels routine when it’s your child in the bed.

I also realized that while a single patient encounter may not be all that memorable for a busy physician, it’s a huge deal for the patient and family. I noticed every little thing about Orion’s providers — their expressions, their voices. I remembered their comforting smiles and their condescending stares. I even remember the one that had a serious five o’clock shadow going on. (I figured he must be near the end of a long shift.) For months and years later, their faces were burned on my memory.

We also remembered how each provider made us feel. I recall one in particular who seemed mystified by our concern. “It’s a seizure disorder,” he said. “Of course he’s going to seize.” And on one level, I’ll admit I could relate. I’d had similar thoughts about my own patients. But how was I supposed to stay calm and clinical when my kid hadn’t eaten in days?

Finally, a particularly bad seizure landed us at the pediatric ED at a children’s hospital in Central California. That visit was just as terrifying as the dozens that came before; only this time, the doctor’s response was different. He actually took a few minutes to sit down and talk to us and answer our questions.

And then he said something that changed everything: “Your son’s not going to die.”

I was stunned. It was like he’d looked inside me, seen my deepest, darkest fear, and answered my unaskable question. And thank God, because at that moment, a weight lifted from Tasha and me. I’m not sure why his words mattered so much. We’re doctors, after all. And yet, hearing it from the person caring for our son made all the difference.

Not only was he right, his kindness and reassurance stuck with us — and gave us the strength to endure quite a few more emergency room visits and specialist consults.

After about a year, we finally got Orion’s seizures under control, and our lives changed dramatically. Not only did he start kindergarten the next year, he grew into a healthy, hard-working kid who hasn’t missed a day of school in six years. And not only did he walk again, he now plays basketball on a travel team. Above all, he’s a very caring boy who asks things like, “Dad, what do you need?”

For both Tasha and I, those experiences with our son changed the way we practice medicine. Now when I walk into a patient’s room, I still think about the clinical stuff. But I’m just as focused on the patient and family. Is this single mom worried that a fracture will keep her out of work? Are these parents wondering if their child is actually going to make it? What can I do to make this difficult experience just a little more bearable?

My experience as the parent of a patient has forever changed me as a provider. What’s the difference? I realized that I’m not that important. It doesn’t matter if I’m tired. It doesn’t matter if it’s the end of my shift. It doesn’t matter that I think I’m a “good” doc. Each patient I see will remember every one of my facial expressions and will hang on every word I say. The patient experience is probably the only thing that really matters. Healthcare is changing. Reimbursement is changing. Despite all of these changes, our focus on the patient will always be relevant.

So if you catch yourself wondering whether getting personal with patients is worth the effort, let me assure you it really matters. And in a way, it’s comforting. If we focus on the needs of the patient and family first, we can always rest assured we’ve done the right thing. And when we do, all the rest of the stuff — the outcomes and metrics and patient satisfaction scores — will naturally fall into place.

Imamu Tomlinson is an emergency physician who blogs at Perspectives on the Acute Care Continuum.

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