How One Patient Reminded Me of the Heart of Medicine

Mr. E is an elderly gentleman who is seen in our practice for a hematologic condition which requires frequent monitoring of his blood counts. He was recently presented to the hospital and was found to have worsened anemia and abnormal liver tests. While the medical team was evaluating and managing those abnormal conditions, his main concern was totally different – his chronic back pain.

All he could focus on was his pain. He did not think his labs were as big of an issue as what he was experiencing – “excruciating pain” as he described. He wanted to have back surgery done as soon as possible.

As physicians, we often face situations when a patient’s priority is not in alignment with what we think it is for that patient. When that happens, there is a disconnection of care – while you want to concentrate on finding the causes for his abnormal labs, his concern is pain control.

The last thing you want to do is to convince the patient that his priority “should be” different from what he thinks it is. That implication that the patient is wrong to even think that way is not only off-putting and discouraging, it is also a ticket for disconnection. Medicine is about treating medical conditions and relating to the patient. In this situation, the patient likely will think that you are not listening.

In the midst of seeing multiple patients and doing your best to be efficient, the last thing you want to do is to spend extra time in a patient room. However, this is essential for better communication and connection. First, ask your patient what the main issue or concern is and why. For Mr. E, it is the back pain, which is constant, severe and debilitating. It is difficult to function when you have constant physical pain that is not well controlled.

Second, discuss with the patient what issues there are. Paint the big picture and allow the patient to understand your concerns. Communicate in a way that is easy to understand. Allow time for the patient to ask you questions. Pause from time to time to minimize information overload.

It is important to take your time – meaning, not in a hurry. Yes, you are mindful of the time and not rushing. Those two things can go together. When you think you have to rush, the patient can sense it with your verbal and non-verbal cues. Rushing means to the patient that “you have no time for me”, and that is a major deterrent for developing a trustworthy connection.

Come up with a strategy to align your patient’s priorities with your top concerns. For Mr. E, the immediate issue is pain control. It is important to help Mr. E understand that, in order to get him ready for back surgery, his blood count needs to improve and his liver function needs to be normalized (or at least close to normal). When it is explained this way, Mr. E softened up. He felt that he was heard – as we did not ignore his cry for pain, and we were doing our best to get him to his goal – getting back surgery to rid of his pain.

It is important for the patients to understand that we are here to care and to meet their needs. It is also important to make it clear that we are doing our best to align our goals. Rushing through the discussion likely will not get you very far. Instead, you may be misunderstood or the patient will find someone else who would listen. The extra time you spend in this discussion will be worth it – the patient will feel seen and heard. The patient will feel cared for. The patient will trust you more. Communication that builds connection is the kind of care a patient needs.