Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Discomfort as Your Internal Compass


There are situations that can make us feel uncomfortable when caring for patients. Acknowledging these feelings may result in deeper and more meaningful relationships with patients.

One afternoon during third year of medical school, I hesitated outside of a patient’s room. So many people had been inside that room today. How did I have the right to enter this room and enter this person’s life? Under whose authority could I examine her body and implore her to answer my questions?


“Come in,” she said in response to my knock, as I walked through the door.


I sat on the edge of an uncomfortable hospital armchair that was too wide, too deep, and too square. I perched precariously on the armrest, wondering if my discomfort was visible to the patient who looked up at me from the bed. My eyes drifted towards her pulse-ox readings, which were in the low 90’s, but occasionally dipped into the low 80’s. According to her care team, her imaging and oxygen requirement labeled her as someone who would die within the year. She wearily followed my gaze.


Adjusting her nasal cannula, she asked, “how can I help you?”


I was silent for a moment, thinking about how she was the same age as my father.


“I just came by to see how you were doing,” I said.


Her face softened, but didn’t fully relax.


“Oh, that’s nice. I’m okay. It’s been hard today,” she said.


“I noticed that you seemed a bit overwhelmed during rounds today,” I said.


I, too, had felt overwhelmed, standing around her bed in a group of nine people, absorbing the scary information that she would soon die.


We talked about how the medical terms blurred together—I confessed that I got confused too. She told me how some doctors use language she understands and some sound like they’ve forgotten how to speak English. I agreed. She spoke candidly about her experience as a Black female patient. One conversation turned into two weeks of afternoon chats about her family, dogs, favorite Subway sandwiches, and fear of dying. With time, she shared difficult, personal, and medically relevant history. We waded through her advance directive together. After I came off the rotation, she was discharged into hospice.


There will always be moments in medicine that feel uncomfortable during the rush of the day—interactions that grate, looks that tug, and questions that haunt. They happen so quickly that we wonder if we’ve imagined them when we hand off our patient, or we sometimes try to dismiss them. However, it’s in those uncomfortable moments that we’re actually closest to our patients, when their feelings and our understanding of those feelings truly align. Acknowledging and embracing our feelings of discomfort may guide us toward a more meaningful relationship with our patients.