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2012-2013 AAEM/RSA President
Originally Published: Common Sense March/April 2013
We EPs know that life in the ED is fast-faced, extremely busy, and ever-challenging. When things get crazy, it becomes habit to see our patients as “the chest pain in room 6” or “the lac in the hallway.” We turn people with their amazing lives and fascinating stories into chief complaints and tiles on our electronic tracking board.
It’s a practice that’s easy to justify. After all, taking a long time with one patient can delay care for all the other people who are waiting to see us. However, the patient's story and the context of his illness are important to him — and critical to the care we render.
Learning our patients’ stories also makes our professional lives more fulfilling. Last month I was supervising one of our excellent junior residents, who saw a patient she was confident she knew how to treat and disposition correctly. “Room 8 is an old guy from a nursing home with dementia, who was recently here for aspiration pneumonia. He comes in with altered mental status and a cough. He is A&OX1, febrile to 101. His lungs sound junky, otherwise neuro intact and vitals are fine. I’m going to get a chest x-ray and do an infectious workup. He probably has pneumonia, and will need to be admitted.”
That sounded like a straightforward plan to me. It was a busy day, and the attending and I went into see this “old guy” who probably had pneumonia. We introduced ourselves to a woman in his room, his daughter, who was holding a book. It was on love: the metaphysical interpretation of love.
She saw me looking (frankly, I’d never thought about this topic). “Have you ever read it?”
I shook my head. “Well, it’s my father’s book,” she said. “It’s been printed in 100 countries.”
Indeed, this “old guy from a nursing home” was one of the foremost experts on the philosophy of love. He had had a phenomenal career, filled with interesting adventures. The daughter was one of many people who made up his loving family — they were more than happy to tell me about him. In a few minutes, I had learned so much more about him as a person and as a patient.
How often do we find out, really find out, about our patients? Here’s how not to find out: ask, “Do you have chest pain? Shortness of breath? Abdominal pain?” These yes/no questions may seem important to us as we check off a list on their review of systems, but they don’t tell us anything about who the person in front of us is. We need to remember that every single one of our patients has stories. Everyone is someone’s child, someone’s spouse, someone’s friend. They had careers they devoted effort to, accomplishments they are proud of, and goals they strove for.
As I near the end of four years of residency, I think back to the most memorable moments of my training. What stands out aren’t the crazy traumas or the critical procedures, or the lectures or journal clubs. What I remember are the people I met, the patients I have been privileged to take care of, and their stories.
I remember Sharon, a lady who was dying of cancer. Her husband showed me a picture of the two of them when they were both three — they had met in a sandbox 80 years ago, and had been inseparable since then. I remember Fan, a middle-aged man who was so serene after a serious car accident that resulted in tetraplegia. I later found out that he was a Buddhist monk, one of the most revered in Asia. I remember Sydney, a drug addict I saw as an intern who returned two years later saying he was now totally clean and running a recovery program for teens. These are the stories I take away from my residency.
We EPs are in a humbling profession, an incredibly rewarding one, and we are honored to meet people from all walks of life. Instead of shying away from this task and turning people into chief complaints, I urge you to embrace the gift that our patients are giving us. Ask your patients about themselves. Not just what pain they have, or do they have this or that symptom — ask them who they are, what they do, what drives them, what makes them happy. Not only will it add depth to your diagnosis and treatment, knowing your patients will make you a happier doctor, one more attuned to the humanity of your patients — and to your own.
I explore issues in this column in my new book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. I welcome your comments. Please email me, firstname.lastname@example.org and follow me on Twitter, @DrLeanaWen, and my blog, http://whendoctorsdontlisten.blogspot.com.