Treat the whole patient and do the right thing


Sometimes what makes truly great catchphrases, mission statements, and movie titles so powerful is that they are true, always necessary, and sometimes sufficient.  I was reminded of this a few months back when a patient called into our telephonic urgent care triage line worried about a drug overdose.  I was in my office typing or talking away, as I am prone to do, when the registered nurse who took the call dropped in.  “He thinks he overdosed on Percocet,” she said, “and wonders if he should go to the hospital.”  Luckily every word in that sentence turned out to be false.

First, we assessed the danger: The patient had advanced cancer and had taken two or three pain pills that morning.  But he takes five-times that amount every day for chronic pain, so no risk of an overdose there.  Tell me about the patient, I asked.  Does he live alone?  Is he well supported?  What else is going on?  Our nurse had the detail: the patient had been ill and anxious for 2 to 3 days, he barely slept two hours last night, he is exhausted.  He wants to take a nap but is worried about the ‘overdose.’

Where is this patient, I wondered, so we can meet him there?  “It sounds like he is fearful,” I said, “Let’s focus on that.”  Perhaps “overdose” was a proxy for “dying?”  Is he afraid to die alone?  Isn’t everyone?  Is there a relative or friend who might come over and keep an eye on him while he naps?  All good questions, she would call him back and learn more.

I went back to my work, and eventually, the day ended, but I hadn’t heard any update on our patient.  I found his nurse at her desk on my way out.  “So,” I asked, “Any news?”

She smiled and sighed.  He liked the idea of calling a friend.  And yes, he was afraid to die alone.  But what he really wanted, more than anything else, to put his heart and mind at ease and get him through one more day, was a prayer.

“He wanted me to pray with him for a few minutes,” she told me.

And there he was, the whole patient, revealed.

“And …,” I asked, leaning in, though I knew the answer already.  Nurses who spend all day talking with severely ill, sometimes dying patients are a special breed, patient, comforting, dedicated to a fault.

“We prayed together,” she said, and we both smiled.

Patients will always need medications, diagnostic tests, surgeries, and therapies.  Practitioners like us are obligated to provide them.  But sometimes patients need our personal time and attention too, precious moments like this one as they bravely navigate the rough waters of chronic disease, pain, suffering, or even death.  Compassionate moments that our practice doesn’t bill for, can’t plan for, and won’t ever capture on a spreadsheet, a dashboard, or a slide deck.  I suspect our teams provide these moments hundreds of times each day.  Doing the right thing time and time again.

In health care, we will always strive for efficiency, for effectiveness, for quality.  Our challenge is to ensure that these pursuits neither drown out our compassion, nor the time that compassion requires.

And our patient?  He calls now and again.  Each time one of our nurses says a short prayer with him, for him, helps get him though another day.  And sometimes that is just enough.

Marc Rothman is a geriatrician and deputy CMO, Aspire Healthcare. He blogs at The Geriatrician Next Door

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