There are opt in moments in medicine, where physicians choose to do more than what is expected of them, and to embrace the fact that when a patient and doctor remove their ID badges and identification bracelets, they are two people sitting in a room, trying to make things better.
After rounds one morning, I listened to one of my co-residents in our workroom recount her frustration with a mother who had yelled at her on rounds. It didn’t make sense — the resident was carefully managing her son’s care and preparing to send him home, and the mother had lashed out. “She said we were going to let her son die!” To the medical team, the patient had seemed healthy and ready to go home, his asthma was now back under control. My co-resident took a deep breath and began to attend to her tasks when, suddenly, she pushed back her chair and left the work room. When she returned she looked mildly bewildered. She told us that in the patient’s room, the mother had cried and apologized. It seemed that what this mother was really feeling was fear, not anger — instinctive maternal fear that asthma could take her child’s life, and that she wasn’t prepared to manage his condition on her own.
These moments of intensity and friction when dealing with sick kids — when we brave discomfort and the constraints on our time for the sake of actually hearing our patients’ stories, teach us invaluable lessons that can help us to connect our patients. These connections can reveal actionable opportunities, helping us connect patient’s to resources, and making a profound difference in their lives.
Residency can feel like an athletics competition in which we work hard for long stretches of hours, try to see as many patients as we can before shift change, and then go home to refuel and get back into the game the next day. While we want to do our best, competitiveness in an of itself is not at the root of why most of us chose medicine. I, like many, committed years of my life to working in a profession where I could help people live healthier, better lives. And yet I find myself, in our current health care climate, feeling like our work environments will prevent us from succeeding in that ambition.
There are things we cannot learn about our patients in 15 minutes. While our health care system is starting to evolve towards outcomes-based care, the most easily measurable outcomes may sideline the importance of the doctor-patient relationship, at great cost to physicians and patients alike. The day-to-day systemic demands reward us for our speed and endurance. We are impressed by our co-resident colleagues who can do the “fastest admission,” finish notes before noon, and awed by our attendings who time-manage 15-minute patient blocks without getting behind. Many of us have developed an internal buzzer that goes off when we are spending too much time in a patient’s room — there are others waiting, charts to complete!
There is clear evidence on the power of taking the time to connect. In one study, patients with HIV who have strong relationships with their physicians were more adherent to retroviral medication regimens and had better outcomes. Yet as physicians we are rarely rewarded for building these connections and delving into the circumstances of our patients’ lives to determine what is contributing to making them sick. The medications I prescribe may be the standard of care, but they are not sufficient to help my patients live healthier lives.
Practicing the most humanistic side of medicine has other functions in fostering well-being—it can make patients feel better, as demonstrated by a study wherein physician assurance was shown to reduce a patient’s symptoms. In a related study, placebo treatment was more effective when administered by a warm and competent doctor as opposed to a doctor who was merely competent but cold in her demeanor.
To look at it from a wellness perspective: helping people is also a big part of what creates job satisfaction in physicians, what protects us against the epidemic of burnout that is plaguing the field of medicine. I believe that physicians are still trying to have meaningful interactions with their patients despite constraints, and if we succeed it is to our benefit; evidence shows that these relationships positively affect both the health of our patients and ourselves. Advancing a health care system that acknowledges this, however, is not simple — it requires a great deal of front-end investment in increasing the efficiency of our resources, in order to free up time, and there is no single initiative we can implement to make this change. Nevertheless, if we take an economist’s perspective: allowing the doctor-patient relationship to be steadily undervalued as the currency of medicine will continue to sink both the ROI on physicians who leave the field, and lead to a decline in the quality of care we administer. In a system that has adopted the nomenclature of “customers” to describe patients, shouldn’t the quality of our product be of great importance?
If physicians can be afforded the time to bring humanism back into medicine, we can, then, at the very least, address one small portion of the burnout upsurge, as well as the costly and poor patient outcomes that our country is facing. Doing so will require a dramatic shift towards patient-centric care, a multi-disciplinary approach to responding to the information that patients share with us, and a commitment to re-adjusting our health care culture.
Cecile Yama is a pediatrician in the Bronx. She is interested in how to make medicine more equitable, interdisciplinary and humanistic.
Illustration by Jennifer Bogartz
