Feel my pain…be the patient!

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excerpt from The Rules of Medicine by Sonya Sloan, M.D. (coming soon)

RULE #14     BE THE PATIENT | EMPATHY

em·pa·thy

ˈempəTHē/

noun

    1 the ability to understand and share the feelings of another.

Empathy… “The act of correctly acknowledging the emotional state of another without experiencing that state oneself.” It is one thing to take care of a patient, to diagnosis, prescribe medications and operate on them, but being the patient is a whole other animal. During my residency I discovered that it was going to be very difficult to have children due to an unforeseen medical condition that I had recently been diagnosed with. I guess if I am truly honest with myself, the immense stress that I was under did not help one bit either.  But in the face of possibly not being able to have children, I did what a lot of people thought was crazy and tried to get pregnant intentionally. As a hopeful soon to be mother, I was willing to undergo the scrutiny of colleagues, professors and staff. I courageously took on the systemic taboo of a female surgical resident having a child while in training. This was a huge unstated no-no!  It just did not happen in a surgical residency program. When I finally did get pregnant, my joy and emotions were preemptively masked with caution. I chose not to tell anyone for the fear of the criticism. I physically protected myself wearing double lead aprons (an extra 10-15 pounds of weight) during surgical procedures with intra-operative x-ray and or fluoroscopy. Both of which are used a lot in Orthopedics. The radiation produced is monitored, but the quantity and its affects are unknown or poorly documented as it pertains to a pregnant woman in any trimester. Go figure…I guess that was somewhat metaphysical too.

Despite all of my efforts, agony and reputation at risk it just was not meant to be. Sadly, as fate would have it, I had a missed miscarriage at nine weeks and had to undergo surgery. I woke up in familiar surroundings but as the patient and not the doctor. In a post-operative anesthesia dazed state, I was not sure what I was supposed to feel or say.  I was gingerly greeted by a PACU (post anesthesia care unit) nurse who knew me on my best days as a strong and decisive surgery resident. But on that day, I was vulnerable and exposed, with hormonally chaotic emotions that no one could comfort. But somehow she knew exactly what to say. She protected me as a patient and cared for me as a mother-who had just lost my child. She respected me both as a physician and the invisible professional boundaries that existed between us. To this day I still believe she was my angel on earth. But more likely as a nurse and a woman, she was empathetic to what I was going through.  She helped me in so many ways: medically, physically, emotionally, and psychologically. The Versed and Morphine meds began to wear off and I became more aware of my surroundings and pain (physically and emotionally). I stoically tried to put my so called “MD” badge back on, hoping to show that I was not just a patient. She quickly stated, “You know doctors make the worst patients, right?” I achingly laughed thinking of my mother also a nurse and the “worst” patient I know.  I had said these same words to her only a few years before. She said that it was ok to be the patient for a while.  I needed that dispensation to say it was ok… for me hurt, to grieve and for me to heal. And in her own angelic nurse-ly kind of way she made me laugh through the tears and said that I could ask for more drugs if I would sign off on the order.

Medicine in some respects teaches us to emotionally detach ourselves to do our job. “You never really understand another person until you consider things from his point of view – until you climb inside of his skin and walk around in it,” wrote Harper Lee in To Kill A Mockingbird. It is understandable that you may not feel exactly what your patient feels but I would say that you should at least try to be empathetic to them. There are books, blogs and medical research to discuss how you can improve your empathetic touch. The idea is simple, says Roman Krznaric in his timely book Empathy: Why It Matters, and How to Get It. “You are…therefore I am.”

More recently the discussion of Emotional Intelligence may play a more important role in the training of empathy to medical professionals as well as the business world. Emotional intelligence is your ability to recognize and understand in yourself and others, and your ability to use this awareness to manage your behavior and relationships. I now know empirically what my patients feel when they are in clinic hearing a diagnosis and having to share the possible outcomes with their family. I now know what it means to sign a consent form and hear all the scary things that can possibly happen to you while you are unconscious. I understand the feeling of physical post-op pain, forget the damn scale (0-10). I can now fathom the cut of a surgical blade and the sensation of being medically appropriate, but violated. I now have a better sense of being on the other side of the table so to speak. Now more than ever, as a physician, I can truly empathize with my patients. Being the patient meant that I was no longer wearing the white coat, in fact it was the thin blue hospital gown that had a broken string to tie and mooning the whole floor with my ass out. But now I get a patient who is looking at me for answers, hope and reassurance of a prognosis. I can relate to how it feels to be unsure and uneasy, the way so many patients feel. I learned what one perceives, when they are exposed, and at the mercy of everyone in that hospital, from the surgeons to the janitor. I was not “Dr.”  that day to the transport person that I knew so well. On that day he who took me to my car in a wheelchair and helped my husband transfer me and secure me with only a smile of reassurance.  That day, I gained a whole new perspective—not to mention respect–for my fellow medical professionals, and I gained an even greater appreciation for my patients and understood the importance of empathy in practice.

So if I could share some of the most important ways you can empathize with your patient I would suggest  :

  • See the patients viewpoint (their needs, fears, welfare and interest)
  • Validate (share your experience or affirm where they are)
  • Check your attitude and judgement at the door (walk a mile in their shoes)
  • Listen/Connect
  • When in doubt ask what they need or want or don’t need or want

You never know when you will find yourself or a family member on the other side of healthcare. So even in medicine one of the great commandments works here too: “Do unto others as you would have them do unto you.”

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