I am always looking to teach people ways that they can change the way they think about challenging patients. (#nodifficultpatients audiobook run time is under four hours) When patients or families behave in a way that prompts us to label them as difficult, I suggest that we find something else that is true about them. Is the crabby lady someone’s grandmother or the young, intoxicated man someone’s son? What if that person were your grandmother or son? How would you want them to be treated and could you generate more kindness and curiosity about why they might be behaving in that unfavorable way?
This is not really a novel or new approach. Doctors and nurses get so bogged down in our plan and our tasks that we become intolerant of any time diversion or opposition to our way. The talk amongst us during sign-outs and coffee breaks takes on a derisive and mocking tone towards our patients. Some of us blame the patients or their families for our unhappiness or our feelings of hopelessness. We become the injured victims.
Sometimes, someone comes along to remind us of where we can do it better. Physician scientists Stephen Trzeciak and Anthony Mazzarelli presented the scientific evidence that caring makes a difference in their 2019 book Compassionomics. The authors lay out a plethora of scientific evidence and anecdotes to present their thesis that the art and science of medicine can converge to provide better care. The Compassionomics audiobook runs nearly ten hours. May I offer another compelling and brief reminder about practicing medicine with compassion.
The students graduating this year from the University of Florida College of Medicine were very wise to invite Dr. Kimberly Manning (@gradydoctor) to be their commencement speaker. Dr. Manning is a general internist/hospitalist who serves as Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine. She promotes narrative medicine to bring students, residents, and her colleagues closer to their patients as fellow vulnerable human beings.
The university has posted the commencement ceremony video which I am linking here. Dr. Manning begins speaking at 19:15 and ends at 34:00. 2023 Spring UF College of Medicine Commencement (ufl.edu) Her words of advice and encouragement are not the typical trite or boring commencement address. Of course, she tells her audience a story.
She explains EBM as evidence-based medicine where treatment recommendations are based on the results obtained when the number of patients (the N)10000. But Dr. Manning skillfully introduces the concept of a unique and targeted therapy for the N=1. Her EBM stands for empathy-based medicine. I will not ruin her speech for you by trying to summarize. Just listen: 2023 Spring UF College of Medicine Commencement (ufl.edu)
We have a shortage of time and a lot of screens to click through on our computerized charts. When we find some of our interactions with patients or their families going badly, our defenses go up and our patience dissolves. Our empathy muscle atrophies. Our thoughts do not reflect those wonderful attributes of mercy, kindness, and compassion that we wrote about in the personal statements on our med school or residency applications. Our actions are terse, impersonal, and punitive. We are only human and sometimes our thoughts or our actions are not the best.
If we could only imagine that patient as our brother or my daughter, how would you want them to be treated? You would want that extra benefit of the doubt and that special dollop of generosity. It cannot be measured or quantified by RVU’s. It cannot be provided by the cleverest AI generated treatment algorithm. It is a warm blanket or the comforting presence at the bedside. It is asking one or two more questions to really find out why that person is behaving in that unexpected or unwanted way.
We must be reminded from time to time how to get in there and do it a little better. Of course, it helps when our own tummies are full, our shoulders are warm, and we are entirely convinced of our worthiness and value as healers. Take care of yourself and then go take care of others. If you need a warm hug of a short pep talk, check out that link to Dr. Manning for a timely refresh.
Dr. Joan Naidorf is an emergency physician, author and speaker located in Alexandria, VA.
Her book, “Changing How we Think About Difficult Patients: a Guide for Physicians and Healthcare Professionals,” is published by the American Association for Physician Leadership.