Category Archives: physician

Thank You, My Patients

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November Gratitude Shorts, Day 23 (I think they will all be late now…)

Though my formal medical training ended in 2002, my real education has continued in earnest since then.  I spent 7 years in my first practice, 5 years in the second, and I have been in my current situation about 18 months.  I have known thousands of patients in that time, some very closely, as well as their families.  It is perhaps the greatest privilege I can imagine, to be allowed so intimately into the lives of so many.

The best part comes after I have had enough encounters and important conversations to say that I truly know a patient.  When I can predict their responses to diagnoses or preferences for treatment; when I can tell by just looking how they feel physically, emotionally—that is when I know a true relationship is established.  Sometimes it’s built over many years of regular visits.  For others the interval is short, because they are dealing with some acute, distressing event or circumstance.  Coming through serious illness with a person bonds you like nothing else.  Sometimes it’s subtle, too.  You come in for a cold, but you never get sick, this time it got you and brought you down hard.  That’s a chance for me to ask some important questions.  What’s going on in your life today?  I never know what lies on the other side of that question, and it’s a tremendous opportunity for connection.

Or, our initial encounter (or two, or three) leaves me feeling tense and frustrated.  I start making up stories about you that may or may not be true.  The next time, we get to a point in the conversation where we can open up to each other about the relationship, and talk it out, figure out the best way forward.  Maybe we come to some new mutual understanding and everything changes for the better—these are the patients who teach me the most.  Other times we agree to part ways, and that’s okay too.  Not everybody is meant to be together.

Either way, there is no substitute for time and face to face meetings.  Every relationship is a two-way street, and my patients teach me every day about withholding judgment, staying curious, asking for their story, and telling the story that I make up.  They teach me to monitor my assumptions, ask more questions, and explain my rationale clearly.  They hold me accountable for my words and actions, as I hold them, too.

They make me a better person, every one.

Who’s Your Team?

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November Gratitude Shorts, Day 17

As I lay on the table in physical therapy today I thought, how fortunate I am to have healthcare insurance that allows me to come every week and get help for my pain and dysfunction. I always leave feeling better, and my therapist knows exactly what’s going on and what to do.

I also have an incredible trainer. She has a sixth sense for my mood and readiness for challenge each session. She is also a lifelong learner, and seeks new knowledge from reading and conferences, among other things. When I share assessments between these two dedicated providers, they each integrate the other’s recommendations and the results are synergistic.

My primary care doctor has ‘the three A’s’ that matter most to us patients, in order: Availability, Affability, and Ability. He also cares for my children, and manages their hypervigilant internist mom with kindness and patience.

My therapist is a Godsend. I don’t have depression or anxiety, nor psychosis or a personality disorder, that I know of.  But I have my share of emotional baggage, and having an objective professional to help me sort and process has proven invaluable in all aspects of my life. Long-established thought, feeling, and behavior patterns show up repeatedly, wearing slightly different outfits each visit. Through therapy I have learned to recognize the party crashers more easily, and manage them better over time.  Sometimes they are allowed to stay, and I make sure they know the rules. Other times they get thrown out, again.  Therapy helps me keep my inner house in order, so that I may welcome and integrate new knowledge and wisdom.

But my team includes more than just my healthcare providers. I have a strong cadre of close friends upon whom I can call at any time, and who will answer always with love and understanding. I recently had a sudden personal dilemma that caused me considerable angst. I emailed a few of these friends and each of them responded immediately with exactly the wisdom I needed… Not necessarily what I wanted, but that’s what true friends do–they tell you the truth with kindness, compassion, and unconditional love.

I also count my parents, sisters, husband, children, neighbors, some colleagues, and many others, as team members. The NFL comes to mind… Choose your team–each is comprised of literally hundreds of people, all working for the shared purpose of making the team, as a whole, the best it can be.

I cannot think of how my team could possibly be better.  And it’s not just about me. I am a member of each other person’s team, too. We all hold each other up.

An idea came to me in conversation this past weekend, when I spoke to a fellow internist about physician burnout and patient satisfaction: We cannot separate my well-being from your well-being, if we are in relationship. And we are all in relationship. So let us take care of one another.

Lessons From Middle School Drama

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November Gratitude Shorts, Day 15

Grateful for the arts today, and theater in particular. This is unusual for me, as I am generally not a theater-goer. But the middle school’s first production of the year occurred this weekend. My son served on crew, so I was excited to see the show!

The students positively awed me with their performance. They adapted three books in what I would describe as visual narrative. The players took turns speaking and acting lines from the books, with minimal props and costumes. The depth of expression these preteens acheived far surpassed my expectations. 

They chose Brown Girl Dreaming by Jacqueline Woodson, Between Shades of Gray by Ruta Sepetys, and Boy by Roald Dahl. The first two blew me away. As I watched and listened to the autobiographical narratives of one girl’s coming of age during the civil rights movement, and another’s harrowing trauma of Soviet subjugation, I found myself trying to imagine myself in their shoes. 

It makes me wonder, do I do this enough in my work? When I hear my patients’ stories do I try to take their perspective and understand their decision making? I believe I do, mainly because I take the time to ask about their stories. I know this is the best way to counsel them on health behavior change. We make decisions emotionally, and rationalize afterward. So I need to speak to whatever holds meaning for each individual, which I can only know by listening to each person’s story and taking his/her perspective.

A study of medical students by Blatt  et al in 2010 showed that perspective taking can be taught, and can positively impact patient satisfaction. I would argue that it also improves physician satisfaction, and the benefits ripple out to the whole system. 

Where I need to practice perspective taking more is outside the exam room, when I interact with my support staff.  I need to learn more about their workflow, to understand the impact of my frequent and often impromptu requests of them throughout the day.  I need to verify that the stories I tell myself about their behavior at work are accurate (or, likely not–then I need to get curious). I need to ask for and listen to their stories in order to know best how to integrate the team.  I’m so grateful to the middle school drama club and my blogging challenge for helping me uncover this insight tonight. Now to put it into practice tomorrow morning!