Sometimes empathy and the right bedside manner are the best medicine.
My aunt was 49-years-old when she was diagnosed with cancer. Over the course of 6 months, she was in and out of doctors’ offices, seeking any way to control what was slowly consuming her body. She lost weight rapidly. I had read about the behavior of cancer in books, seen cancer patients through shadowing, seen gross specimens of tumors surgically removed from the body, yet nothing prepared me for the emotional rollercoaster my family would go through, desperately hoping for my aunt to get better.
Books told me that cancer was relentless, merciless, aggressive. Doctors told me my aunt had less than a 50% chance of survival in the next year. My emotions told me my aunt was a fighter; she was too young to die, she could beat the odds.
Over the course of her treatment, as she continued to get worse, our family became very angry. Angry this happened to her, angry we couldn’t get answers from doctors. All the anger came entirely from our frustration over things NO one could control. Everyone was doing their best, but the hardest part was accepting the reality that there were so many unanswered questions, so much uncertainty, and that the odds were in fact very much against her.
Three months after her diagnosis, my aunt stayed over our place while seeking a second opinion. Before my eyes, she developed skin nodules first on her shoulder, then all over her body–signs the cancer was spreading. I knew then that she didn’t have long to live, but I didn’t have the heart to tell our family. Denial is a powerful poison, but even more painful is seeing the suffering of someone we loved so much. As the cancer stole away my aunt, it also took from us a mother, sister, daughter, caretaker, and philosopher. It was my first taste of the reality of our medical (and human) limits.
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Fast forward 3 years, and I start off my intern year in the medical intensive care unit, a place where patients are struggling on the brink of life and death; supported by ventilators and chemicals that keep their organs perfused and their body hanging on. Medical care updates, end of life discussions, and family meetings happen on a regular basis.
A week into my rotation, a patient with metastatic lung cancer was transferred to our unit for airway stabilization. We needed to protect her airway if the oncologists were to even consider palliative chemotherapy, which would give her perhaps a couple more months at best, hopefully easing some of the discomfort from the masses compressing her lung.
However, the family was angry when we told them their mother would only be a candidate for palliative options. “We came here so that you guys could cure her, not let her die!!” were their sharp accusations. They thought her doctors were giving up on her, when in reality, we just wanted to protect her from more unnecessary suffering.
Her cancer, like my aunts’, was at a point where we simply could not stop its course. The image of my aunt in the palliative care unit of the hospital and my family distraught about her, displacing their frustration onto the doctors, flashed before my eyes. I understood exactly why they felt the way they did. I was there once too.
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When I started my clinical rotations, I quickly learned that just as important as textbook knowledge is the ability to adequately gauge a patient’s medical understanding and emotional burden. With such a diverse patient population encountered daily, from the rich to the poor, the stable to the very sick, the temporary to the terminal, how do we, in our limited experiences, connect with so many different situations?
My aunt’s story made me realize the powerful effect of keeping patients informed. Frustration is a natural outlet of suffering, uncertainty, and accepting the limits of medicine, but people have a right to be adequately informed of these limits –this gives them the dignity to know their choices in their suffering.
In connecting with patients, we have to first, realize is how frightening and frustrating uncertainty can be, and second, make sure the patients are educated about their medical condition, to at least level the field of uncertainty. I tell my patients I understand and accept their exasperation. Informing patients of the most recent updates, allowing them to express themselves–this shows them that you care.
Exposing yourself to as many experiences as possible allows you to at least somewhat relate to a greater variety of situations. This ensures connections between physicians and patients can be that much stronger. I guarantee your patients will appreciate it.
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