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Monday Feb 06, 2017

Patients Have Plenty to Teach a New Attending Physician

With all due respect to my mentors, I've discovered that my greatest teachers are my patients.  

When I was asked to present to my residency program what life was like during my first few years as an attending, I immediately began digging through my list of interesting patients (yes, I keep a list!) for the most bizarre and provocative diagnoses I had encountered.  

In doing so, I realized that each one of those patients had taught me something greater than simply deeper medical knowledge. My patients have taught me to be a better doctor. They've given me lessons on communication, compassion, dedication and more. We've all had these lessons, but perhaps we haven't taken the time to deeply reflect on them. Although the lessons I've received are too numerous to count, here are a handful that may be helpful to all of us.

Keep a Poker Face
I'd like to think I have a pretty good poker face. I'm known in my office for having a serious affect. (I prefer "focused.") When I crack a joke, I keep a straight face, leading my staff to wonder if I was joking or not.

This wasn't the case with a recent patient interaction. I had seen Joe about his weight several times, so I thought we had a good rapport. However, on one visit he casually made reference to his boyfriend, and I turned to him with what must have been a surprised look on my face, said, "Oh, I didn't know you were in a relationship! That's great!" and continued the conversation about his obesity. A few weeks later, my practice manager received a complaint that Joe felt I had judged him for being gay based on that one reply and my nonverbal communication. 

Although my reaction was simply the general surprise of discovering he was in a relationship, the complaint was a reminder for me to keep my facial expressions, posture and tone of voice in check. Patients expect us to be understanding, accepting and nonjudgmental when they share their lives with us. With this small event, I learned that it's our responsibility to make sure our words and expressions help create a welcoming environment that can strengthen our relationship with patients. 

But Don't Be Afraid to Cry
A few weeks later, a young woman presented with a genitourinary problem. She was anxious and trembling. She looked as if she hadn't slept for days, with dark rings around her eyes and a look of desperation. She began to share how depressed she had been feeling during the past month since this problem emerged. Her speech was pressured, and I quickly realized I needed to stop typing, face her directly and look her in the eyes. 

Within a few minutes of her sharing her stresses and struggles, I realized something deeper than the chief complaint was distressing her. I asked her, "What happened?" to which she revealed a sexual assault that happened when she was 11. 

She said she was up all night and couldn't sleep because she was so nervous to tell someone about her trauma for the first time ever. Tears then flowed down both of our faces. It was a moment of sadness but also relief. She had held onto this torturous event for nearly a decade, and now 40 minutes into a 15-minute "acute" visit we were sharing a hug and developing a care plan to address her posttraumatic stress disorder and her (thankfully) unrelated genitourinary problem.

Many times our patients need to see that we are human, too, and we shouldn't be afraid to show those emotions that help strengthen the physician-patient bond. 

Embrace a Sense of Ownership
Our patients entrust their health and their lives to us, which gives us a huge responsibility we must own. This ownership takes different forms, such as reading about diseases we're not familiar with, getting on the phone with specialists to discuss difficult cases and sometimes even trusting our gut instinct to seek out the best care for patients. 

This became most evident with one of my 16-year-old patients who began losing weight. Her workup revealed she had an autoimmune condition, but despite being evaluated by various local specialists, she continued to deteriorate. One day in my office, I watched as she struggled to lift her 85-pound body out of the chair, and her gait made me nervous that she would collapse. It was clear at that moment that we needed to take some drastic measures. 

Her mother and I knew she couldn't continue like this. I immediately got on the phone with a tertiary care children's hospital several hours away, printed out her entire medical record and soon had her on her way to find answers. It was one of the best "ownership" decisions I've made. During her two-week stay in the hospital she not only regained weight but was seen by some of the nation's most renowned pediatric rheumatologists, who have helped slow the progression of her disease. Who knows what would have happened had we not embraced that opportunity for her? Seeing results like this has encouraged me to continue owning a deeper responsibility to all my patients. 

So what have all these lessons added up to? I've learned that my greatest joy in medicine is my relationship with my patients. It's easy to get overwhelmed. I've had my share of moments where I've felt frustrated that my patients' health isn't improving or burdened by the seemingly endless "tasks" that appear in the electronic health record. But relationship is what family medicine is all about.

Family medicine is not just continuity of care, or taking care of patients throughout their life spectrum. True family medicine means genuinely caring for our patients, which can come through when we challenge ourselves to communicate better, when we look a patient in the eyes and ask him or her a question that we know will make us run behind, and when we own our responsibility to patients and stretch ourselves to care for them.

When we strengthen those relationships, we can have better outcomes, happier patients, greater job satisfaction and, ultimately, joy.

These are just a few of the lessons that my patients have taught me. Now I present the question to you: What have your patients taught you? Share in the comments below.

Luis Garcia, M.D., is a family physician in York, Pa., working at Family First Health, a federally qualified health center. He focuses on caring for the Spanish-speaking community and is an avid photographer.

Posted at 03:49PM Feb 06, 2017 by Luis Garcia, M.D.

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