It was a typical Friday night: The trauma bay was full, patients were lined up in hallway beds 1 through 6, and we were 50 deep in the waiting room. Within an hour of starting my shift, I had a chest pain in Room 4, a pregnant vaginal bleeder in Room 6, an old lady with belly pain in the neighboring room, and a colostomy malfunction in Room 13. These descriptions were exactly how I attempted to remember them. I had systematically hit all the right questions for each patient and put in the necessary orders, imaging was obtained, charts were being typed up, and the attending physician had been notified and had agreed with all my plans. Feeling like I had things under control, I called over to the nurse, “Hey, can you please check on the vaginal bleeder to see how she’s doing?” The nurse stared at me blankly and responded, “You know she has a name, right?”
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ACEP Now: Vol 36 – No 02 – February 2017I was immediately taken aback. To me, she was “Room 6,” 35-year-old female G3 P 0111, newly pregnant with a few days of spotting, mild abdominal cramping, no rebound or guarding, rule out ectopic, and confirm a live intrauterine pregnancy. My face immediately became flushed and warm, and my voice stuttered. I was unsure how to respond. I had been so consumed with everything else, I honestly hadn’t even glanced at her name. Like a good resident, I had checked on her a couple of times to ensure her abdominal cramping had resolved. I gave her ice water and updated her on the wait time for her ultrasound. Once those items were marked off my checklist, I went on my way. The nurse proceeded to ask me, “Did you know she and her husband have been trying for a year? That she’s had a prior miscarriage and is worried it might happen again?” My face was now beet red and my heart thumping out of my chest from my embarrassment from the unintentional reprimand.
I walked back in, this time more aware, noticing more than just the vital signs. In front of me was a woman not much older than me, clearly worried. Her lips were pressed together nervously, hands clutched tightly, and eyes wide in anticipation of bad news. This was someone seeking reassurance, not just lab values and test results. She was more than just “vaginal bleeder in Room 6.”
As busy physicians, we get so caught up with our endless tasks and algorithms that we often fall prey to practicing cookbook medicine. We mechanically run codes, fly through procedures effortlessly, and transition from room to room, chugging through the never-ending emergency department tracking list. With the practice of medicine becoming so methodical, we forget that, on a daily basis, we meet patients who are having the worst day of their life. They divulge to us private details not even their best friends and families are aware of. We forget that we are the privileged few who patients trust with their secrets and stories—what a humbling honor.
“To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.” —Anatole Broyard, from “Doctor Talk to Me,” The New York Times, Aug. 26, 1990
This challenges those of us in the medical field to remember what it feels like to be on the other end of the stethoscope—to remember that there is a person and not just a pathogen infecting a host. Let us remember the importance of rekindling and keeping alive the desire of service to humankind with which many of us had gone into the medical profession. Caring doctors are better doctors. They practice safer medicine, earn more trust from patients, and get them engaged in their health care, leading to better outcomes. In changing our practice of medicine, it could change our own perspective, too. Perhaps this is a step toward figuring out the antidote to physician burnout.
“Not every patient can be saved, but his illness may be eased by the way the doctor responds to him—and in responding … the doctor may save himself. … It may be necessary to give up some of his authority in exchange for his humanity, but this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and everything to gain by letting the sick man into his heart.” —Anatole Broyard, from “Doctor Talk to Me,” The New York Times, Aug. 26, 1990
Thank you to my Room 6, future mom of two, fellow foodie, and wife of her high school sweetheart. Thank you for reminding me that when I chose to go into medicine, I made the commitment to connect with all patients, to be their advocate, to bring compassion to those who are vulnerable and scared in their most vulnerable moments. Thank you for reminding me that the woman in Room 6 has a name.
Dr. Hsiao is a PGY-2 emergency medicine resident at Einstein Medical Center in Philadelphia.
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One Response to “Opinion: Connecting with Patients Can Help You Become a Better Doctor”
March 5, 2017
Gregory BowermanDr. Hsiao,
Your nurse’s put down was not unintentional, but the information that followed was, of course, very valuable to you and her. We made a conscious effort to call patients by their names about 20 years ago, until HIPAA and now we’re back to the handy way we used before and you were using now. If you just say “the patient in room 6”, their identity may have changed once or twice since you last saw them. Metrics are presently a god to administration, making it more difficult to get to know your patients. It’s great to be reminded of it’s importance often. But if you feel bad after an encounter with a nurse, that’s because s/he was hoping you would feel that way. Address him or her by their name, thank them for the information they conveyed, confirm that you knew and were concerned or didn’t and are glad they brought it up. Remind them in this way that you too are human, as are they. Good luck