Takeaway
I recently cared for a patient labeled as “difficult” and struggled. Learning more about his life story would have allowed me to serve him more effectively.
Connecting with Patients | April 24, 2025 | 5 min read
By Eric Last, DO, Northwell Health
Seated at the desk I’ve occupied for over 35 years, the piercing tone of my intercom heralded yet another interruption. I’ve practiced primary care internal medicine from this base, in this community, since I left training. My practice has been built on a foundation of relationships that I hope benefit my patients, and that I know are the rechargeable battery of my professional soul. My desk has changed (once adorned with beloved fountain pens, now crowned by a reviled computer screen); I hope I have not.
I was hoping for a moment to catch my breath, to keep my promise of staying hydrated. Once again, the artificial time constraints of my schedule were unable to accommodate the numerous and complex needs of my patients. The morning’s challenges were compounded by IT and staffing issues, all too common in our workdays.
The front desk staff let me know that “Tom Watson’s son is on the phone. Mr. Watson passed away a few days ago. He’d like to speak to you.”
For a brief moment, I hesitated to take the call, knowing it would further delay my day. I also knew that would be wrong.
Mr. Watson’s son told me his father had died three days prior, in a skilled nursing facility that he’d been transferred to after a recent hospitalization. While recovering from surgery to repair a hip fracture, he contracted pneumonia. He was transferred back to the hospital and eventually succumbed to infection. I listened patiently while the son recounted, in painstaking detail, the events of his father’s final few days.
At the conclusion of our conversation, I told the son, with truth and sincerity, that my staff and I were always impressed by the level of caring he and his three brothers demonstrated. I told him that the gift of love and devotion until the end was irreplaceable. It was a conversation I’d had with other families, and I knew the power of those words.
What I didn’t share with the son was the truth about the reaction Mr. Watson’s visits sometimes engendered in me. At a different time, the father would have been described as a “difficult” patient. Seeing his name on my schedule, I always knew that the remainder of my day would be delayed. Mr. Watson was strong-willed, opinionated, and irascible. No matter the treatment I advised, nor the diagnostic test that was indicated, he’d find fault. No specialist was smart enough, no physical therapist strong enough, no test accurate enough. Despite detailed and understandable explanations of my advice, Mr. Watson would resist.
The patient was always accompanied by one of his sons. Their adoration for their dad and their patience with him were on display at each visit. But, to the detriment of my schedule and all the patients whose visits were scheduled afterward, they seemed to believe that their love could be measured by the number of pages of legal pad notes brought to each visit. The notes, and their line-by-line recitation, seemed to be a proportional expression of the family’s level of caring.
Through the years, I’ve come to recognize the telltale signs I feel when seeing patients like Mr. Watson. And I’ve learned to subsume those feelings, to go the extra step to communicate my concern, empathy, and true desire to help. Yet, after each such encounter, I’m then apologizing for my tardiness for the rest of the day to the remainder of my patients. And I often find myself ordering one extra test, checking the medications and their dosages one more time, to be sure my judgment hadn’t been clouded.
Several days after speaking with his son, I stumbled upon Mr. Watson’s obituary in the local newspaper. As if transported by a time machine, I was introduced to a man I’d never really known. Written by his sons, I learned from the obituary details the patient had never shared, and in reality, about which I’d never asked. I learned that Mr. Watson and his wife had grown up and married in midwestern America, then relocated to the “big city.” They eventually moved from the Bronx and settled down in my community on Long Island. The patient was a blue-collar laborer, rarely missing a day of work. He and his wife were people of simple means, who lived frugally, saving for a home and for their children’s educations. They were deeply religious, committed to their community, church, and family. The obituary enumerated his children and grandchildren and alluded to the special, sweet kindnesses he’d shown to each.
We practice at a time when medicine has become a commodified resource. The care we provide is measured in predefined “units” meant to give financial value to our time, knowledge, and expertise. “Quality” is defined by metrics that measure outcomes that may be dubious, and that ignore patient complexity at the expense of relationships, only to benefit expedient data extraction. We invent billing codes designed to account for the special demands of “longitudinal care,” only to see those allowances challenged by, and ultimately co-opted by, subspecialties. We click boxes, check lists, and stare at computer screens. And we can overlook subtle details of a person’s life not because of disinterest, but because the crushing pressure of time pushes us relentlessly to the next visit and task.
Yet, our patients have stories that are not just “medical histories” but are rather the sum of a life’s experiences that brought them to the point when we meet. Their triumphs, travails, loves, losses, and interests all combine to manifest in a patient with whom we may connect, or from whom we may recoil just a bit when they appear on our schedules.
Maybe, just maybe, it would have been better to read Mr. Watson’s obituary when first I’d met him, years before he passed away.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.