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)
