Listening to Every Patient

About two years ago, I was on inpatient service as a palliative medicine attending working with a second year medical student who was also a Black woman. She was participating in a pre-clerkship mentorship program at her university called EXPLORE Rush that paired students with gender and racially concordant attendings practicing in their specialty of interest. We’d been paired together because she requested to work with a Black woman board certified in hospice and palliative medicine and I was her only option. That isn’t surprising considering that only five percent of American physicians are Black and that about five percent of American hospice and palliative medicine (HPM) fellows during the 2015-2016 academic year were Black.

On this particular day, we were asked to consult on a young Black woman admitted for acute pain secondary to a sickle cell crisis. We’d worked together for several months by this time in the outpatient palliative care clinic and inpatient hospice unit. This was our first day fielding inpatient palliative medicine consults. During our time working together, we’d independently noticed and then later debriefed about how consistently Black patients were initially surprised and then delighted that we were doctors and a part of their treatment team.

I was acutely aware of the national data on Black doctors but thought that practicing in Chicago where 30% of the population is Black and in the Illinois medical district where almost half of the patient population is Black, our presence as Black doctors would be less surprising. I wasn’t prepared for the shock and disbelief consistently displayed on the faces and in the body language of our Black patients. We observed a clear pattern of reactions from Black patients—shock, followed by excitement, and culminating in relief. We watched this pattern unfold patient after patient. At first, it was just really nice to be welcomed and feel like we were providing a needed service to support Black patients. But as time went on the recognition that our Black patients didn’t always feel heard and/or safe was disturbing. The weight of this realization was hard to cope with, for me affirming that I have value in this space, and for my student a motivator to finish training and become a practicing physician.

The young woman in sickle cell crisis was sleeping in her bed when we walked into her room. As she awoke we noticed her smile and she positioned herself in the bed to see us and more fully engage. I asked her how she was feeling, whether her pain was under control, and where she felt she was with respect to her sickle cell crisis resolving. She looked at me in disbelief as she answered my questions. I then asked her what she needed for optimal pain control and she said, “you know the other doctors ask me a lot of questions, but I feel like they don’t listen to my answers. I tell them how I’m feeling and suggest what works best for my pain but they just do whatever they want.”

I immediately thought about shared decision making and wondered if she’d been white if there would have been more effort made to engage in shared decision making, more willingness to offer analgesic adjustments that aligned with her needs. It broke my heart to think that she and so many other Black patients are marginalized and undertreated for acute pain. Patients are the principal stakeholders in their care and often know what’s best for their bodies to heal.

Listen to your patients. All of them. Here are 3 questions to ask yourself when having a conversation with a patient:  

1. Did I listen to what my patient told me?

2. Did I incorporate what my patient told me into the treatment plan?

3. Am I being present for my patient without bias and prejudice?

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