“Be here now.” – Ram Dass
Being a physician is an important role. It’s easy to forget sometime the impact that you have on a patient just by being at their bedside.
It’s huge.
Have you ever been a patient? It’s an incredibly vulnerable experience.
You’re not really sure what’s happening and what is going to happen next.
People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease the mind and body of someone in that vulnerable state. Sacred, really. Don’t take it for granted.
If you understand that power, or that responsibility, then you can use that to improve your experience together. By understanding the importance of your presence, you can help people out in ways you might never fully appreciate.
It really boils down to understanding this:
What does a patient really want to hear you say?
There’s only a few really important messages you need to convey.
You don’t have to say these things directly, but you should be letting a patient know that you’re there… for them. By how you enter the room, how you greet them, how you look them in the eyes and how you listen to them.
Patients in that heightened emotional state really are sensitive to the verbal and non-verbal cues that you’re putting out there. A simple thing like a little eye roll can entirely ruin the experience.
It matters.
We know from a few studies that “good-doctor patient interactions effect patient satisfaction and good outcomes”.
This is HUGE. It means that your attention and communication with others really impacts the care that they receive. The nicer you are, the better your patients will do.
We too often think of a patient’s disease as simply as physical ailment. We forget all of the thoughts, worries, and rumination that impacts those symptoms.
What is our role in the treatment of the mental side of physical disease?
What are the messages that a patient should be receiving from you? For me, I try and run through a little mental checklist. You can try instituting this, as an experiment, and see if your interactions with people change for the better.
So, now, when I’m able to remind myself, I work to try and convey the following messages.
1 “I hear you”
Patients need to feel like you’re actually listening to what they’re saying.
It’s not just the sensation of hearing their words. You need to give them the impression that you’re REALLY listening to what they have to say.
In the ER where I work, patients are often waiting several hours for a few minutes with a doctor. They’ve been rehearsing and re-rehearsing what they’re going to say. Give them a chance to say it, and let me know you’ve heard it. How does it feel when someone cuts you off after fifteen seconds of talking?
Look them in the eye. Put down the chart for just a second. Listen, really listen, to what they’re saying. It the ER it usually comes down to one of “I’m scared”, “I’m sad”, or “I feel pain.”
2. “I feel you”
It must be hard to feel whatever it is you’re feeling. I get it. It’s tough. It hurts. I can see that you are grieving and I know that you’re in pain.
Let patients know that you really understand why they’re seeing you today. This builds trust and confidence in your ability to actually care. When someone trusts you they are more likely to actually follow your advice.
3. “I want to help you”
I really care that you’re experiencing the distress that you are. It’s hard and I know you want relief. You’re not just another burden. A whiner. Or some paycheck. You’re a person and you’re not feeling well. I’m on your side here.
4. “I’m going to try my best”
I’ll do what I can, within my limitations, to help you.
I’ll try and order the right tests and investigate your problems to the best of my ability. It doesn’t mean I’m ordering 2 am MRI’s for benign headache symptoms. It means that I’m going to let people know that I’m trying to figure out their concerns.
I often can’t. I mean, I work in an ER after all. But if you let patients know that you tried, they are often still satisfied with their visit and respect the limitations of what you can provide them.
5. “I will make you better”
This one is perhaps a bit controversial. I mean, you can’t really make everyone better, and some things just aren’t going to get better. But what does it mean to be better? If a person with low risk chest pain is told that they aren’t having a heart attack, but still feel the same symptoms, aren’t they in some ways still better?
They’re much less worried. You’ve eased a suffering. If a person with end-stage disease gets some words of comfort or short-term pain-relief, for that moment at least, are they not better? Do they not still feel some relief?
In certain cases, let’s say a patient is diaphoretic and screaming from the pain of acute renal colic, I often use this statement – “I know it’s bad now but you’re going to feel a lot better by the next time I see you.” It doesn’t always happen, but that degree of confidence can already cause a fair bit of relief.
“Suffering = Pain x Resistance” – Shinzen Young
We know that pain isn’t just a physical process. It’s a combination of physical sensations and a thought. “I don’t like this”. “This isn’t supposed to be this way.” “I want this to go away.” “This is not fair”. “Why won’t this stop?”
When you’re able to assure the right patients that they will in fact, feel better, there is a letting go of some of the clinging that amplifes their pain. It’s using the placebo effect to the fullest. It’s a real thing, remember. When someone believes that their pain is going to get better, they are much more likely to do so.
This is a reminder to take full opportunity of the brief time you spend with patients. Remember the importance of your presence.
We don’t just make people better by giving them drugs and removing their organs. We help sometimes just by listening. By understanding. By caring. And by reassuring them, that in fact, this will be better soon.