Nurture the Motives that Brought you to Medicine

Learning how to communicate effectively with patients is an important part of every physician's training. Physician educators are often challenged to decide how to teach "empathy" and great deal of research and study has gone into helping new physicians learn the proper techniques. After a recent and lengthy discussion thread on this topic on a medical education listserv, Ms. Barbara Packer cut through all the rhetoric to get to the heart of the matter. - Linda Rowe Barbara Packer's message to physicians. July 8, 2014: Before any of you learned or taught “med-speak,” you had another language which hopefully included how to respond to people around you who might have experienced joy or pain. I think if you can impress upon your students the fact that each patient is a unique human being and that they need to meet each one of us with their humanity, this might not be as complicated as it appears. You don’t need to prove you have been in my shoes in order for you to let me know you care that my walk is burdened, and that you want to help me relieve that burden. We patients know when physicians are authentic and when they are not. So a little more nurturing of the motives that brought students to medicine might be in order. Best, Barbara Barbara Packer Senior V.P./COO The Arnold P. Gold Foundation www.humanism-in-medicine.org Working to keep the CARE in healthcare!

HELP DRIVE AWAY CHILD ABUSE

Show your commitment to kids and child abuse victims by purchasing exclusive Stop Child Abuse Special Event License Plates. Display these blue ribbon license plates during March and April, and show your support with the Pediatric Resource Center in the fight against child abuse in Central Illinois. Each year professionals all over central Illinois help over 350 children obtain much needed specialized-medical exams and case-management services through the Pediatric Resource Center. These exams are often vital for the health of the child and to assist with criminal and juvenile court processes. All proceeds from these special plates will benefit the PRC. To purchase these temporary special license plates, simply complete a form http://p1cdn4static.sharpschool.com/UserFiles/Servers/Server_442934/File/Peoria/Departments%20and%20Programs/PRC/BlueRibbonLicensePlate/2014%20PRC%20License%20Plate%20Registration%20Form.pdf and return to PRC one of 3 easy ways: 1. Mail your completed form, a copy of your current vehicle registration and a $40 check to PRC, 530 NE Glen Oak Ave., Peoria, IL 61637 2. Fax your completed form and a copy of your current vehicle registration to 309-624-9694, and we will send you an invoice for the cost or let us know you will drop the check in the mail 3. Send an email to prcinfo@uicomp.uic.edu along with a scanned copy of the completed form and copy of your current vehicle registration, and we will send you an invoice for the cost or let us know you will drop the check in the mail Interested in the special license plates but have a question? Call Amanda Erwin at the PRC, 309-624-9595 or email prcinfo@uicomp.uic.edu The PRC is a program of the University of Illinois College of Medicine at Peoria

Giving Bad News Compassionately

It’s never easy telling someone’s family that their loved one might not make it. The ability to do so might set good physicians apart, but it also a skill that is difficult to teach in medical school. Most would say it falls under the “art” of medicine, and that it is something that one can only master with practice and the right perspective on life and death. I am grateful to have had the opportunity to learn second hand from “Dr. S” during my rotation on the neurology service this year. What I also learned from Dr. S is that giving bad news is even harder to do when that patient and her experiences resemble so much of your own life.

Our patient, “Jennifer”, was transferred to St. Francis Medical Center that day after suddenly becoming unconscious hours after running a marathon. Her loving husband, mother, father, and mother-in-law accompanied her. Her two young children were in the waiting room, not old enough to understand what was wrong. Her diagnosis was a massive stroke to her brainstem.

By the time she arrived, she was non-responsive on a mechanical ventilator and there was little that could be done in terms of immediate treatment. As a medical team, we decided the best thing we could do was to wait and see, day by day, how she would recover. We also set out to understand why such a debilitating injury could happen to a seemingly young, healthy individual who had no previous medical history. As it turned out, Jennifer had the misfortune of having a serious genetic clotting disorder that did not show itself until that one fateful day.

As the days went by, it became increasingly clear that Jennifer’s odds of meaningful recovery were getting slim. She displayed some primitive reflexes, but continued not to be able to breath on her own. It was time to have a more frank talk with the family about Jennifer’s situation.

Dr. S was the leader of the care team, and led the family meetings that ensued. She displayed poise and confidence, empathy and concern like she had so many other times. However, there was something about this particular situation that seemed to be affecting Dr. S more than in the past. It wasn’t until my last day on the neurology service when I learned why.

In a discussion at the bedside with Jennifer’s mother, Dr. S and I answered more questions while we were examining our patient. It was during this conversation that Dr. S started to break from her usual stoic, doctoring persona, and began to discuss with the family how this case had affected her personally. She let them know that Jennifer and her were the exact same age, and that their kids were the same ages as well. Even small details from Jennifer’s life had reminded Dr. S of her own.  That was why it was even more difficult for her to say that to the family that their loved will likely never recover. Her encounter with Jennifer seemed to bring the idea of her own life’s fragility into remarkable clarity. It was then that Jennifer’s mother broke down into tears and Dr. S followed suit. Not a word was said for a period of time, and the visit with Jennifer ended with Dr. S getting a hug from Jennifer’s parent as if it were her own mother. It was a moment of pure empathy. It meant more to the family then I could possibly put into words.

I still wonder if before that day Dr. S ever thought about how her family would deal with things if she were to one day unexpectedly go into a coma. Even if she had, I wonder if it could have captured the true gravity of the situation. Hearing our patient’s story would be difficult for anyone, but it is probably even harder when that story hits so close to home. I think this is what makes Dr. S’s actions even more impressive, and why she is a wonderful testament to compassionate, humanistic care in Peoria.


Brian Andonian
UICOMP Class of 2014

Time is Precious

Fictional anthropologist Dr. Temperance Brennan, a normally stoic woman who prizes logic over emotion and science over passion, is mystified when she cannot stop herself from worrying about her baby daughter after dropping her off for her first day of daycare.  She is faced with the fact that it is human to be unable to control certain feelings even where knowledge and trust abound.  Though Dr. Brennan is not real, the dilemma she faces is one that is very applicable to one that many patients face.  Whether the patient and their family has to see a physician for a benign problem or learns that there is a very serious issue, there is the potential for anxiety.

Recently,  during my time in clinic I met a patient whose condition required her to have a tracheostomy tube.  As the visit progressed she became increasingly distressed.  Though calm in the beginning of the appointment, her composure was lost as she described the problems she had with her tube.  Her fear of future pain and of the still unknown condition which had led to the multiple hospitalizations and procedures she'd endured was palpable.  Understanding that her trach tube was likely keeping her alive did not stop the worries she had.  However,  what also became clear during the course of the visit was that she did not necessarily want more information, but that she wanted to feel that the medical professionals entrusted with her care actually cared.  She said, more than once, "You [doctors] don't know,  you never have had one these [trach tubes]."  My attending's empathetic demeanor helped her to feel comfortable enough to share her concerns.  He acknowledge her feelings and made her feel validated,  even though his deeper understanding of her medical situation could have led him to devalue her worries in the face of the necessity for the tube.  At the same time he calmly advised the patient to take the logical steps to improve her situation.

Patients need conscientious care that is explained to them in a way they can understand.  However, what many want is to know that someone, in this case someone with a particular skill set they do not possess,  is in their corner.  For television's Dr. Brennan, it is a husband who encourages her to accept her feelings and a on-site daycare provider at work.   For patients like the one I described,  is someone with and empathetic ear who is willing to use their powers on his or her behalf.  

By taking a little extra time with her,  my attending showed her that he cared.  And that made all the difference for our patient.  Knowledge is necessary,  but time,  especially in the medical field,  is precious.  Giving time and attention to our patients is a way in which we can care for them.
--
Abimbola Olayinka
UICOMP, Class of 2014

Start with the Patient's History

When you ask people why they went into medicine, quite often the answer is “because I wanted to help people.”  Sadly, sometimes this noble intent gets lost in the rigors of medical school and the demands of the profession.  And yet, I think it finds itself best in the little actions of compassion that happen every day.  Good medical care requires a solid foundation of medical knowledge coupled with the ability to communicate that information to others.  Much of the compassionate medical care I’ve witnessed is not about grand gestures—although those are nice—it is about the details:  taking a moment to ask about someone’s family, putting your hand on a patient’s shoulder, sitting down with a patient when you ask them if they have any questions.  I’ve seen all of these at work every day, and I’ve seen how they make a difference.  Physicians I respect and admire do these things with each and every interaction.  In this way, they establish relationships with patients and really can change lives.

I worked with an attending who wanted every presentation to start with something about the patient’s history.  Not their medical issues as is standard, but something about them personally.  I think that was his way of humanizing patient care and trying to teach compassion—not an easy task.  Throughout the tenure of my training I have had the privilege of working with physicians who go the extra mile for students.  These are the physicians that are always available for questions and guidance, and who themselves provide exemplary patient care—modeling the kind of physician I someday hope to be.  These physicians are also changing lives—they are changing the lives of people who will help other people.  I am grateful to have had so many of these role models throughout my education.

Lisa Fosnot,
UICOMP, Class of 2014

The Power of Truly Listening

Too often in the hospital we refer to people as their disease or their symptom: the heart failure patient in room 10, or the shortness of breath patient who was just admitted.  I am guilty of this every day, though I try to remind myself to focus my attention on the person instead of the illness.  My constant lack of really understanding my patients is displayed in my own little case histories that I write or present every day. Most of them begin something like this: “A 55 year old male with a history of such and such disease presents with the following symptoms for this length of time.” The only mention I make of the patient, the person whose suffering is in question, is that he is 55 years old and male, before proceeding to delve into symptoms, the illness or disease, and its characteristics.  The’ what’ part of my case histories are very detailed while the ‘who’ portion is surmised in “A 55 year old male.”  It is too rare an occasion when in the flurry that is the inpatient hospital experience or a 15 minute office visit that I ask patients how they are dealing with their circumstances.  I often forget to ask what aspects of my patients’ lives help or hinder their struggle with a particular illness.  I am, however, trying to spend more time thinking about the narrative of each person because while understanding the ‘what’ is important, ignoring the ‘who’ does not do our patients justice. 

What I understand humanism in medicine to be is very simple in concept but difficult in practice.  It is the ability to listen and show patients that their stories, their lives, are unique, and just as important as the symptoms of the illnesses they suffer from.  In the end, every patient just wants to tell their story and feel they have been heard.  For every time I have failed to ask and to listen, I think I can best describe humanism in medicine with a story of when I got it right.

His name was “Eric,” and he showed up at the emergency room one evening with vague complaints that made him appear delusional.  When the emergency room doctors determined there was no physical cause for his aliments, he was sent up to the psychotic unit for further evaluation where I found him the next morning.

Eric, like me, looked young for his age, and it was instantly clear that he was a very shy young man.  Initially his case appeared to be straight forward.  His family mentioned some ongoing drug use, and the team and I believed him to be psychotic secondary to whatever illicit substances he had been using.  We placed him on medication and encouraged him to participate in individual and group therapy in the hopes that things would turn around within 48 hours.

Several days later no progress had been made and Eric seemed distrustful of the entire treatment team.   Everyone was frustrated, so one afternoon when I had some free time I decided to spend it with my patient.  I sat down with Eric and didn’t ask him about his illness or his symptoms. I asked him about his family, his brothers and sisters, and his child.  I asked him his aspirations in life, what his neighborhood was like, and what he did for fun.  I quickly learned that Eric’s life was much more complex than I had initially thought.  I found out that he missed his child’s birthday while he was in the hospital, and that he was basically the sole caretaker of his grandma who suffered from complications of diabetes.  He told me about his prowess in sports and how he would have made the local high school team had he not dropped out to take care of his grandmother.  We talked about his neighborhood and how it was a rare week when he didn't hear gunshots.  Eric was clearly worried about his family, and I asked him if anything had ever happened to a loved one.  Reluctantly, and with tears welling up in his eyes, he told me about a brother, who got caught up in gang violence, and was now serving time in a penitentiary for murder.  Eric said he felt personally responsible for not keeping his brother out of gangs, and that his brother was still his closest friend.  I gave Eric a hug, thanked him for sharing this information, and reported what I had learned to the team. 

What the treatment team decided was that Eric may not be psychotic, but instead he was under an inordinate amount of stress and was likely depressed.  His symptoms could stem from this depression, and he needed anti-depressant medication as well as outpatient follow up at a drug rehabilitation center.  With the new plan in action, Eric became well enough to leave with his family about two days later, much to his delight, as well as mine.

I hope those few minutes I spent getting to know and understand my patient helped him, but what I don’t think Eric realized was that our conversation helped me even more.  Through our interactions I came to understand the power of truly listening to a patient, and I came to believe that in our patients’ stories lies humanism in medicine.    

(Anonymous)    

Student Provides Comfort to Pediatric Patient

I was working on a consult service and was asked to see a Pediatrics patient. She was a young girl, just under 7 years old, and had initially presented with fever, rash, and pain. After an extensive work-up, including evaluation for autoimmune diseases, she was diagnosed with pediatric lupus. 

Just as I was about to enter the patient's room to evaluate her, the third year medical student on the Pediatrics team who was caring for this patient, met me outside the room. He shared with me our patient's story and his understanding of her hospital course up until that point. He shared with me many of the details of our patient's history, which could only have been acquired by someone who had spent significant time at the bedside. 

I asked him if he had any concerns about our patient, to which he shared that he was concerned about the patient's emotional well-being. He revealed that the patient's parents were rarely present, and that the patient appeared scared and lonely. I later found out that this medical student had been taking the patient to the playroom, giving her company and ephemeral retreat from the confines of a hospital room. He had gone above and beyond the expectations of a medical student in order  to address the patient's social and emotional needs. 

I was impressed with this student's insight into the global needs of our patients, and humbled that he did not feel it was outside of his scope to care for her in this way. In the end, I am certain that our patient's hospital stay was not defined by the nature of her diagnosis, but rather by the exemplary medical student who went out of his way to make her feel at home. 

Meghna Motiani
UICOMP, Class of 2014

No Task Too Small to Help a Patient

With how busy many physicians and residents are, it seems that even the most simple and important aspects of the physician-patient relationship are overlooked. However, one medical student that I worked with for a month never found any task too small. Even as the attending would breeze in the room, get the information he needed, and quickly walk out with the rest of the team, this student always remained in the room. She would stay there to ask what questions the patient had, what she could do or get for the patient, and if the patient would like the door closed or not after she left. No matter how busy she or the team was, how complicated or simple the patient's problems were, or how friendly the patient was, she always did her part to make the patient feel important. She always made listening to the patient important. Her consistent actions made the patient feel important. And her actions inspired me to do the same.

Charlie Jain
UICOMP Class of 2014