A frustrating experience as a patient taught me how to be a better doctor. Lesson #1: Always take an interest in your patient as a person.
We all go through challenging experiences. But how often do we say “thank you” for these?
In their book, “1,000 Little Things Happy, Successful People Do Differently, How to Be Grateful and Strong When Things Go Wrong,” March and Angel Chernoff suggest that a lack of gratitude can prevent us from experiencing happiness. One of their many tips is: “Be grateful around difficult people,” and offer a suggestion: “You can think of this person as a teacher who is inadvertently helping you to grow stronger as a person. And, at the very least, you can be grateful for them because they serve as a great reminder of how not to be.”
I took the Chernoff’s advice to heart last week, in the aftermath of one of the worst experiences I’ve ever had as a patient. Now you might think—as a physician—I’ve been spared the kind of negative experiences with doctors that are unfortunately quite prevalent. And you’d be right. I’m privileged to have access to some of the world’s best clinicians—not only through my position at Johns Hopkins, but also my involvement with the Miller Coulson Academy of Clinical Excellence. But before I became a doctor, it was a different story. As a student seeking treatment at the college health center, I was sexually harassed (and beyond) by a male gynecologist and castigated for being “drug-seeking” by a female nurse practitioner when I politely requested a prescription for Motrin (yes, I’m dating myself!). But, since then I’ve been relatively spared such demeaning and frustrating experiences. Until last week.
At the time, I thought I was lucky—and perhaps I was—to get have been able to get an appointment with this particular physician who had expertise in my area of concern. However, the practice of medicine is both a science and an art. And as knowledgeable and technically skilled as this doctor is, her human caring skills were greatly lacking. She showed absolutely no curiosity about me as a person; asked me no questions about work, family, community, not even the weather. When I described the results of some recent imaging studies, she was looking at the computer and clearly wasn’t listening to me, as she started to reorder these same studies thinking they were overdue. I told her I’d had trouble getting my medication refilled (which—although she didn’t ask—was due to not being able to see my primary care provider as frequently as I’d wanted to, due to the pandemic). She was either underestimating my knowledge or being sarcastic when she replied, “Well, it’s not going to work if you don’t take it.” When I asked questions about the rationale for a referral she made, she devalued my perspective and concerns. Instead, with a scolding and argumentative tone, she painted a picture of doom if I didn’t follow her advice. “And you’ll kick yourself when that [bad outcome] happens, won’t you?” she asked me. I said, “Maybe.” She said nothing more.
Needless to say, leaving the visit, I felt demoralized and angry, feelings that were further amplified when I read her version of the visit. In the note, she called me “noncompliant,” documented as an “extensive discussion” what I experienced as a (thankfully) brief one-way lecture, and mistakenly described a condition diagnosed by recent imaging as not having responded to “lifestyle changes” despite the diagnosis just being made and no subsequent imaging being available to judge a response.
So, how to make meaning out of this experience? I decided to follow the Chernoffs’ advice and think of this physician as a teacher and to be grateful for them for reminding me of how not to be. With that in mind, here is what this doctor taught me about clinical excellence:
1. Always take an interest in your patient as a person.
It only takes a minute or two to ask a question about her occupation, family, or hobbies. Not only will it make the patient feel more valued, but you may learn something. That thing could be relevant to her care or could just be something learned for its own sake: the secret to making great sourdough bread, for instance.
2. Look at the patient when you’re talking.
I understand the computer beckons, but positioning the computer in a way that enables eye contact is helpful to connect with a patient, especially at the beginning of the visit.
3. Listen to what the patient is saying.
It may be useful to paraphrase what she is saying to ensure you’ve got it right.
4. Minimize multitasking, especially if it’s interfering with truly hearing what the patient is communicating and you’re making mistakes.
5. Avoid the use of sarcasm.
The first visit with a patient is certainly not a place for sarcasm, and for some patients this may never be appropriate.
6. Treat your patient respectfully.
Don’t underestimate a patient’s knowledge base. You can always check in with the patient to see if she’s understood and—if not—you can adjust your level of communication.
7. Value each patient’s perspective and concerns.
If a patient has questions about your care plan, take a curious approach to understanding her perspective.
8. Instill hope.
No need to offer only “worst case scenarios.” Negative consequences are not motivating or persuasive if you want to change an attitude or behavior (see Motivational Interviewing 101).
9. Don’t use the term “noncompliant” to describe a patient.
Every patient has access to her notes, and terms like that can not only be hurtful they can affect others’ views of the patient and adversely impact healthcare outcomes.
10. Document accurately.
Again, incorrect documentation underscores your failure to hear what a patient is communicating, and can affect others’ understanding of the history.
I always learn a lot from my patients, but it’s not every day—at this stage in my career—that I have an opportunity to learn from another physician. I am immensely grateful for having had this difficult encounter. It not only helped me grow stronger as a person, but reminded me of how to be a better doctor.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.