As I get ready to head home, my medical assistant calls out, “Ms. A called and wants to speak with you but will not tell me about what.”
Knowing my MA’s ability to succinctly triage calls, I cringe for a moment at this mystery question call. “I’ll call Ms. A on my way home,” I let her know.
A pretty new patient to me, Ms. A decided now to start caring for herself as her years of caring for her ill husband had come to an end. She came in with active rheumatoid arthritis, carrying with her years of joint damage. We discussed different treatment options that visit, concluding with step up therapy and initiation of a tumor necrosis factor inhibitor. I allowed a few minutes for her to gather her thoughts and leave with some brochures and scribbled notes.
When I called Ms. A back from my car, I sat and listened to her patiently, since I had no patient to run off and see, nowhere to go but drive slowly in traffic. “Did I mention how my husband passed away?” Ms. A asks. He was battling lymphoma, merciless at the end. Now, all she sees is that big L word as she reads the risks of using a TNF inhibitor. Yes, she is in pain, but could lymphoma invade and defeat her as well?
We spent the next few minutes discussing data on lymphoma risk with use of TNF inhibitors and acknowledging her uncertainties. Sensing my lack of haste, she proceeded to share few beautiful memories of her husband and her hopes for the future. Top of her wish list now is taking multiple cruises with her ladies once the right treatment kicks in. She thanked me endlessly for caring, and I thanked her back for her stories.
As I sat there, I wondered, why did I cringe at the idea of taking this call?
Over the past few years, I have taken many calls like this. Calls that remind me of my patients’ humanity, vulnerability, and strength. I wonder for few minutes after what I might be missing when my MA summarizes these call requests down to a few sentence message, to which I quickly type a response back for her to relay. However, on most days, as I race against the clock to rooms filled with waiting patients and a growing pile of labs and messages, I wonder a lot less.
For the calls that do slip past my MA, I keep stories like Ms. A’s in mind. I take a second to reflect on my response as I call these patients back.
Am I greeting this patient warmly or portraying this call as an inconvenience? Am I allowing the patient to discuss what may be consuming them without interrupting them mid-sentence to change the topic?
Though this may be Communication 101 and stating the obvious, it can be easily overlooked during an overwhelming day. Taking a second to be mindful of my response as I call patients back has left me with numerous better relationships and a better understanding of my patient. Apart from few outliers, most patients are appreciative of this extra time and ear offered to them.
After our call that day, Ms. A felt reassured enough to move forward with the treatment option we discussed. She continues to inject herself with a TNF inhibitor and has enjoyed many pain-free vacations with her ladies since. Just as we did on the first call, we continue to take a few minutes each office visit to share a new beautiful memory.
Bhavika Amin is a nurse practitioner practicing at Arthritis and Osteoporosis Center of Northern Virginia for over seven years. She enjoys teaching rheumatology to nurse practitioner and physician assistant students. She is a 2017–2018 Doximity fellow.