The nurse bangs on your clinic’s door, “His blood pressure is 175; I checked it twice!” You go through the patient’s chart quickly. It seems like he was non-compliant before. It seems like he had psychiatric issues and was refusing help. You anticipate how the encounter will be. The patient walks into your office. You greet him with as much warmth as you can offer. And let’s just say — he is not as excited to meet you!
You start asking one question after another:
“So, what medications are you taking, sir?”
“I don’t know.”
“OK. when was the last time you experienced that pain? ”
“I don’t know.”
“OK, no problem. Why didn’t you go to that appointment?”
“I don’t know.”
Most people in other jobs would probably not care to help a person who is indifferent and doesn’t want to help himself. But in medicine, your knowledge and morals make you the desperate person in the encounter.
This person showed up today but might not show up again next time. He might go home, not take any medications and come back with a deadly stroke or heart attack. He might be hiding suicidal thoughts, and the next thing you know is he ended his life.
One form of saving a life we are accustomed to seeing requires physical skills for CPR, intubation, or other emergent procedures or surgeries. The other requires delicate knowledge of medications to start life-saving drugs in a timely manner. But here in the clinic, it’s another form of saving a life and a whole other tactic altogether.
It’s not just the art of medications and scientific challenges this profession teaches us; it’s the art of dealing with human beings as complex and different as each person is.
You have 30 minutes to tackle the many issues this patient walked in with. The number one issue is having this person, who is fed up with the whole health system, trust you and open up, and the countdown begins. You play one card after another. You are kind for a minute, then you are firm, then you are understanding, until a key clicks, and he starts to speak.
Now, he is yelling about how unhappy he is with the care he has been getting. Well, at least you got him to talk!
In other professions, most people would not accept to be yelled at for no reason when trying to help, but you are the primary care provider and different. You put aside your ego, absorb his frustration patiently and continue trying other ways. You talk scientifically. Then you talk from the heart. Then you don’t talk at all and let silence prevail, trying to read through his unspoken words … until he finally chooses to break the silence:
“So, where are you from?”
“Would you like to guess?” (I enjoy playing that game.)
“Wow! No one ever gets it from the first shot! How did you know?!”
“I had a Palestinian friend once. You reminded me of him.”
And the rapport is finally established!
Success is when the patient walks out of your clinic, agreeing to take his medications, acknowledging that you are there for him if he ever needed it, and willing to come back to see you again in a few months. You drink a sip of water, take a deep breath and take your seat again to scroll in the chart of your next patient, who will walk into your clinic in a few minutes with their own very different set of challenges.
Dana Hassneiah is an internal medicine resident.
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