Think about how you might feel if you were asked to be recognized as a survivor. I was asked to be recognized as a survivor for breast cancer awareness month last year and I felt an overwhelming sense of disappointment and dismay. My first gut response was: I am not a “survivor.” In fact, I never considered myself a survivor — and I had to do a lot of soul-searching as to why the descriptor did not sit well with me.
I was very lucky to survive breast cancer treatment and the many serious complications that ensued. Up until my diagnosis, I was perfectly healthy. I’d had two negative breast biopsies in previous years, and a negative mammogram the month before I diagnosed myself with breast cancer (by requesting that a lymph node be biopsied). I was able to keep my solo practice open while undergoing treatment for metastatic breast cancer and multiple hospitalizations. I had a massive blood clot with SVC syndrome, congestive heart failure, sepsis, and multiple surgical complications, but I worked as an ob/gyn when I was not hospitalized myself. As I thought about the “survivor” title, I realized that it didn’t sit well because I considered myself more than a survivor.
As a physician, I understand that diagnoses get missed and we all make mistakes. Mistakes made on my behalf were life-threatening, but I still have great and unwavering respect for my physicians. Through my experience, I gained better insight into what makes a great physician versus a marginal physician. Everyone needs a “warrior” to act on their behalf at some point in their life. My goal is to turn my experiences into an educational crusade; from my unique position, I hope to make some warriors.
What makes a great warrior? What I learned is that throughout this process, regardless of the outcome, the best physician in the patient’s mind is the one that listens and validates concerns. They don’t discount complaints. The physicians that run in and out of the exam room without thoroughly looking at the chart have no hope of figuring out what is wrong. Being present and being a partner in solving problems is so important. Discounting concerns is a potential disaster. If you miss something and discredit the patient, not only you have lost the patient’s confidence, but you look incompetent as well.
My advice? First: Try to act as if the patient is the only person in the office or hospital that you are interested in. Listen without interrupting. Constant interrupting can be distracting to the patient, causing them to lose their train of thought, especially if they are very ill or stressed. Occasionally, you might need to redirect the discussion, but you should not dominate during the patient’s recounting of their symptoms or story.
In my case, when I was very ill, I did not always convey all of my concerns to my doctors. I felt silly when test after test was negative. This happened over and over again. I had an extensive clot and SVC syndrome that was missed for approximately five weeks (after spending two weeks in two different hospitals). It is hard for a physician-patient to continue to complain when all the results are negative (because you are sure that they think you have some secondary gain in this). I needed and wanted to get back to work, so I had no interest in being sick, yet at one point I was unable to walk without a diagnosis.
Second: Never blame the patient for a health problem. Doing so serves no purpose except to alienate the patient. Focus instead on what your patient can do to get better and how you can help them. Neither you nor the patient can correct the past, but you can direct them moving forward. I was blamed for a surgical complication because I went back to work too soon. In reality, there was a much more serious reason for the complication, but I never forgot the health care provider’s inclination to blame me.
Third: Apologize when an apology is needed — it’s OK to be wrong. The mistake shows you are human, the apology shows you are honest and caring. People, in general, don’t like excuses. If you are dishonest, you will lose the patient’s respect. Give a simple and straight-forward explanation. Don’t try to place the blame elsewhere as that only makes you look worse. The patient should be able to palpably feel your disappointment regarding their care/problem. Make sure you have a plan of action for correction following the apology, if possible. Be sincere and empathetic, but don’t change your treatment of the patient based on a complication; move forward as you would with any other patient. Finally, a follow-up call is a great idea, in cases where follow-up is appropriate.
Fourth: Do not let emotion guide you. Warriors are strong and empathetic but do not alter their management of the patient even if the patient is also a doctor. If you alter your management based on nonmedical circumstances, you may regret it later, especially if the patient has a complication. Emotion should be present but don’t let it guide your management.
Fifth, and finally: Show some respect for fellow colleagues and staff. In return, they’ll respect you. Similarly, disrespect to your colleagues or staff earns you the same. Be mindful of how you speak to your coworkers both in the exam room and outside it. Try to offer as much continuity of care as possible because in complicated cases, important pieces of information often get lost when multiple physicians are involved.
I know many have suffered far worse than I, and many have not been as lucky. I was lucky when a stent that was supposed to go in my innominate vein went in my heart and my cardiovascular surgeon was able to retrieve it. I loved this surgeon because he held my hand in recovery and explained to me what had occurred when I felt that severe chest pain. He was my hero. Keep in mind, I was seconds away from open-heart surgery, and I still loved this guy. It is all in how you present yourself. If you act like you don’t care about the outcome, the patient will not respond positively.
Navigating my own health care while seriously ill was difficult — and I am a physician. I was not only dealing with the fact that I had cancer and was on chemotherapy; I had a practice to run, plus a family that was distraught. On top of all that, I felt bad. I learned that, as a patient, you have to trust and question at the same time. You must be persistent, but not annoying. A warrior has perseverance, strength, and courage to proceed despite the bombardment of negativity.
When I was asked to be a survivor, I felt guilty. My best friend, who is dying from metastatic breast cancer was appalled at my declination to own the term. She said she wished she could be a survivor and was tired of being a warrior. But in our practice of medicine, I don’t think we just survive. There will be times when we are just getting through the day because we are sick or having problems at home — I’m not saying we can be warriors every moment of every day. However, as a physician, to just survive day-in and day-out is insufficient. You do not want that for yourself (or your loved ones when they are in need of care). You want a warrior — in your physicians, in your family, in your friends, and in yourself.
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