My puppy looked sick. Not just any sick but “get an attending, two large bore IVs, start fluids, get her on a monitor, move her to the resuscitation bay” sick. And I was scared. “You have to take her to the vet!” I pleaded with my husband as I sprinted down the street to get home to get the keys to the car.
As I sat at home waiting for updates on our puppy, it made me think of all the patients I had seen earlier in the day. As a second-year emergency medicine resident, I have seen hundreds of patients come through the department with chief complaints that ranged from “suture removal” to “cardiac arrest.” I try to approach each patient with respect, patience, and care, then explain the plan of action and final disposition.
While we practice delivering bad news to families and patients, it is hard every time I must tell a patient that their diagnosis or prognosis is difficult. However, I don’t think I ever understood the terrifying combination of immediate decision making, lack of understanding and desperation these conversations demand.
I have had my own personal experiences of family members in the hospital before. But with a background of medical literacy, the conversation was not esoteric. I understood the words, the nuances, the meaning behind the lab results. I was aware of the differential diagnoses, the possible outcomes.
But with my puppy — I was completely lost. I had to Google “puppy emergencies” to come up with a working differential. I became my patients with technology at my fingertips, but limited knowledge or understanding to bolster my search and stunted ability to use that technology coherently.
As medical providers, it is easy for words like diabetes, heart attack, stroke, hypertension, ischemia, and respiratory distress to become mundane. The jargon is a part of our everyday parlance. The words have medical meaning but no emotional trigger. They suggest treatments, medications, risk factors, lifestyle choices, and probable outcomes. To be compassionate providers, we sometimes must remind ourselves that these words can elicit fear, frustration, confusion or a host of other emotions. Our patients deserve it.
It is known that limited literacy skills can predict poor health outcomes. If a patient is unable to read the prescription instructions, it is understandable that compliance will be compromised. If they are too scared or embarrassed to ask for clarification, we as providers must ensure that they understand the discussion at hand, the instruction for follow up, and the implications of the treatment plan.
My puppy was fine. A toddler-associated chocolate-induced food poisoning; but this three-hour experience had a larger impact. I hope these lessons stick with me throughout my training and practice as I continue to engage with different patients on what is for many, the worst days of their lives.
Elizabeth Rubin Ribak is an emergency medicine resident.
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