The weight of words, the power of presence 

Drs. Peijin Han, Michigan Medicine & Carolina Musri, Johns Hopkins Medicine

We all know that an essential skill in medicine is delivering compassionate care to patients and their loved ones. I found myself reflecting on this while witnessing the collaboration between the palliative care clinicians and the case managers, as they guided and comforted families facing loved ones’ poor prognoses. As a medical graduate from China, this experience was particularly valuable to me, as palliative care and case management weren’t well established in the healthcare system where I studied nine years ago. 

During my hospital rotation at Johns Hopkins, I helped care for a young patient who was initially admitted to ICU due to cardiac arrest. He’d sustained a brain injury and was ventilator dependent. He could awaken to a voice, but the prognosis was poor. Once stable for discharge, the team arranged the transfer to a facility that could manage his tracheostomy care.  

I participated in the family meeting via telephone with the patient’s wife, who lived out of state and didn’t speak English. We arranged a medical interpreter for the call. The palliative care physician led the conversation and explained that while the patient’s condition was stable, he remained ventilator-dependent, and the medical team had exhausted treatment options. We recommended transferring him to a facility capable of managing his continued care. When the wife said she needed time to process this information, the physician conveyed his empathy, acknowledging the difficulty of their situation. He also offered emotional support and said, “The medical team is always here. If there’s anything we can do for you, please let us know.” Finally, he concluded with reassuring words, “We’ll find a safe and peaceful place for your husband, where he’ll receive excellent care.” 

From the case manager, I learned more about the challenges the patient’s wife faced. She was struggling to maintain her job with limited time off for hospital visits and even had to hide at work for the phone call. I empathized with her situation, which must have felt overwhelming.  

Here are three things I learned that I’ll carry to residency and beyond:  

1. Successful communication involves understanding patients and their families’ backgrounds, socioeconomic status, and overcoming language barriers. Achieving this requires teamwork.  

2. While it’s our responsibility to make medically sound decisions, it’s equally important to communicate in a way that makes patients and their loved ones feel acknowledged and supported. This can be a significant challenge when the health professional and patient don’t speak the same language. Moving forward, I plan to seek out additional language resources and practice culturally sensitive communication to better meet the needs of diverse patient populations.  

3. Involving the palliative care team for terminally ill patients, identifying care goals, and always offering emotional support to patients and their families are essential components of patient-centered and holistic care. 

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.