Memorial Day weekend was tough. As the holiday weekend approached, I was faced with the difficulty many hospitals face during times when the majority of the country gets off work, but “essential personnel” must still work. With a shortened staff and several in house departments closed for “emergencies only” visits, several patients could not get procedures done until the hospital was back in full operation on Tuesday. Add to that the fact that a number of outside facilities like nursing homes and rehab facilities were not transporting patients over the weekend, there was no way the census was going to stay at a “reasonable” number. There were also severe people who had to stay because the medical supply facilities were closed, so and their home oxygen and other items could not be delivered. As the census continued to grow, I was faced with the dilemma many inpatient physicians face; too many patients and only one me.
To compensate, I found myself shortening the times I spent per patient encounter and rushing to discharge those stable enough to go home. This was all in an attempt to make room for the new admissions steadily coming in (and no, there is no census cap). I also found myself quickly writing notes with only the most pertinent information in an effort to be done at a reasonable time (averaging about 13 hours per day).
Again, Memorial Day weekend was rough.
By the middle of the holiday weekend, I was realizing that detachment was starting to set in and I was not connecting with patients the way I normally do. Disconnecting from patients is a feeling I am sure no physician likes to experience however it happens more times than we care to admit. There are certain instances where despite having the desire to care, we cannot provide “connected care” in a way in which patients will feel linked to us. Unbalanced patient: physician ratios (like what I experienced during Memorial Day weekend) can cause you to dissociate as you make “getting through the list” a priority. Increasing administrative and non-clinical duties also put a strain on the doctor-patient relationship. However, numerous studies indicate that a good patient-physician relationship leads to improved outcomes for patients and improved patient satisfaction. Despite what may be going on we must try our best to not allow outside forces to cause us disengagement between ourselves and those we are called to serve.
In my opinion, every physician must find his own way to stay connected to the human side of medicine. Here are a few ways I believe we can engage more with patients.
Attack Your Day
Consider seeing your most complex cases or patients who you need to spend more time speaking with at the beginning of your day. Usually, you will be less fatigued earlier in the shift, allowing you to connect more compared to seeing them later in the afternoon when your tank may be near empty.
Regroup Before Each Patient
Often times we walk into a room carrying thoughts about our previous patient encounters or with a nurse, case manager, etc. on our heels with questions about a different patient. Prior to entering the room, try to re orient yourself to that specific patient so you can give their case your undivided attention.
Remember to Watch Your Stance
The eyes are the window to soul and making good eye contact with a patient makes them know you are not only listening but also hearing what they are saying. Standing at a respectable distance without hovering over them (except maybe during physical exams) allows patients to know that the conversation you are having with them is very important.
Find a Common Ground
Building rapport with a patient during their hospital stay may lead to increased emotional engagement during the patient encounter. Commenting on a picture of their pet on the wall or briefly discussing sports teams can allow you to engage on both a professional and (respectfully) personal level.
Busy wards can sometimes cause us to lose focus on the reason (the majority) of us went into medicine; to connect and help others. Staying connected should be just as important as thoroughly reviewing a patient’s allergy list and other things that have been deemed necessary to provide quality care. Making a conscious effort to not disengage despite several constraints can enhance a patient’s inpatient experience and improve quality of care.
What are some ways in which you ensure you are connecting with patients?
Akua Ampadu, MD is a hospitalist physician who is passionate about quality inpatient and outpatient adult care. As a survivor of work- and life-related burnout, she aims to provide tools necessary to live a life focused on self-care and self-advocacy. She recognizes the importance of reading to one’s health and launched the Healing Words Foundation, a literacy-based charity focused on providing books to pediatric wards and outpatient clinics. She is active on social media.
Dr. Ampadu is a 2018–2019 Doximity Author.