One bright, spring Saturday morning in clinic, I met a pleasant middle-aged woman with a cold. She was new to me, but I recognized her right away—educated professional, mother of two, loving wife, keeper of all schedules and task lists—the command center of her complex world. Her symptoms had followed the typical arc of a viral upper respiratory infection—fatigue, sore throat, nasal congestion, headache, fever, cough—and it was the green snot that brought her in on day 5. My physical exam revealed no signs of strep throat or pneumonia…
The relaxed calm I had felt heretofore began to unravel as I contemplated telling this woman, suffering at the peak of acute illness, that I would not prescribe an antibiotic. In an instant I heard familiar scripts in my head: She did not have time to be sick; she needed something to kill this infection right away. She was about to travel and did not want to feel this badly on the plane. Her regular doctor always gave her an antibiotic for this before. The snot is green, that means it’s bacterial (it doesn’t)! My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive. My inner conflict escalated quickly: Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?
Maybe it was the sunny weather that day, or the initial connection I had felt when we talked. Amid the flurry of mounting anxiety, I had a flash of clarity: What if I just asked her what she needed?
“What are you looking for from me today?” I queried.
“I just want to make sure I don’t need antibiotics.”
Imagine the absolute and complete relief of realizing that my swelling dread was, in fact, unfounded and unnecessary. She needed reassurance, and probably formal permission to leave the air traffic control tower and go take a nap. I cheerily listed all of my self-care recommendations, including a firm admonishment that she take care of herself ahead of all others for at least the next 24 hours, doctor’s orders! The visit ended happily for us both.
“What are you looking for?” Such a simple question, and key to understanding one another, as well as ourselves. I was looking for connection, authority, relationship, and affirmation. I wanted her to like me, and to trust that I knew my stuff. And more than once before, I had given my best advice in this situation, only to be rejected as a power-tripping antibiotic extremist. I had one eye out for an ambush.
What if we ask ourselves more often, both as patients and physicians, “What am I looking for?” Could we identify biases and fears more readily, and then challenge them? Would it make asking for and getting what we need a little easier? What do you think?