Takeaway
Soliciting diverse perspectives and considering unexpected etiologies can improve diagnostic accuracy. Answers to clinical puzzles may be rooted in cultural and geographic specificities.
Connecting with Patients | August 7, 2024 | 2 min read
By Rajat Soni, MBBS, Kasturba Medical College, Mangalore, India & Amy Yu MD, MS, Johns Hopkins Medicine
When I was observing the Johns Hopkins Bayview Medical Center hospitalist service I witnessed a significant patient interaction. Ms. P was lying on her left side with her head buried in the corner of the bed. She had agreed to transfer to hospice care and fear seemed to grip her heart.
The stillness was broken as Dr. Y came in. “Good morning, Ms. P, how are you doing today? Do you remember that we talked about the hospice liaison coming to see you today? Do you have any questions about this?”
Ms. P shook her head.
A couple of hours later, Dr. Y was paged and learned Ms. P didn’t want to sign the hospice papers. Dr. Y went to talk to her. There were two nurses, the hospice liaison, and the social worker standing at her bedside. Here’s what I learned from Dr. Y as this conversation unfolded:
1. Be transparent.
When Ms. P decided not to sign the document, Dr. Y reviewed the entire document, line by line, to ensure she fully understood it. This transparent approach helped to build trust and clarity. By going through the document in detail, he made sure that she was aware of every aspect of her care plan and the implication of each section of document, ensuring there was no confusion or misunderstanding.
2. Explore patient concerns and fears.
Dr. Y learned that Ms. P was afraid she would be kept sedated all day at hospice. With this knowledge, he was then able to address her fears directly. By asking open-ended questions and listening to concerns, Dr. Y was able to identify the root of her anxiety and provide information that directly alleviated her fears about hospice care. Dr. Y also reassured Ms. P that signing the hospice paperwork was not a final decision and she could always change her mind. This assurance helped reduce anxiety and gave her a sense of control. By clarifying that her decision was reversible, he empowered Ms. P and gave her the confidence to make choices about her care without feeling trapped or pressured.
3. Support the patient’s decisions.
Remember the importance of respecting patient autonomy and providing emotional support. Honor their wishes and maintain patient dignity during their most vulnerable times in life.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.