Preserving the Humanity of Patients and Physicians

Everyone knows that life in the E.R. is fast-faced, extremely busy, and ever-challenging. When things get crazy, it becomes habit for busy physicians to see patients as “the chest pain in room 6” or “the broken wrist in the hallway.” We turn people with their amazing lives and fascinating stories into a nameless number and a “chief complaint”.

It’s a practice that’s easy to justify—after all, taking a long time with one patient can delay care for all the other people who are waiting to see us. However, the story of the patient, the story of why he is there, and the context of his illness—these are all critical to us taking care of him.

Learning our patients’ stories also makes our professional life that much more fulfilling. Last moth, I was supervising an intern, who saw a patient that she was confident she knew what to do with. “Room 8 is an old guy from a nursing home with dementia, who was recently here for pneumonia. He comes in with altered mental status and a cough. He is confused, has a fever, his lungs sound junky. I’m going to get a chest x-ray and do an infectious workup. He probably has pneumonia, and will need to be admitted.”

That sounded like a straightforward plan to me. It was a busy day, and I went into see this “old guy” who probably had pneumonia. I introduced ourselves to a woman in his room, his daughter, who was holding a book. It was on love: the metaphysical interpretation of love.

She saw me looking at the book. “Have you ever read it?”

I shook my head. “Well, it’s my father’s book,” she said. “It’s been printed in 100 countries.”

Indeed, this “old guy from a nursing home” was one of the foremost experts on the philosophy of love. He had had a phenomenal career, filled with interesting adventures. The daughter was one of many people who made up his loving family—they were more than happy to tell me about him. In a few minutes, I had learned so much more about him as a person, and as a patient.

How often do doctors find out, really find out, about our patients? Well, here’s how NOT to find out. Ask: “Do you have chest pain? Shortness of breath? Abdominal pain?” These yes/no questions may seem important to us as we check off a list that doctors feel compelled to ask, but they don’t tell us anything about who is the person in front of us. We have no idea of the careers they devoted effort to, accomplishments that they are proud of, and goals that they strove for.

As I think back to the most memorable moments of my medical training, what stands out aren’t the never-ending lectures, or heroic surgeries, or terrible traumas. What I remember are the people I met and their stories.

I remember Sharon, a lady who was dying of cancer. Her husband showed me a picture of the two of them when they were both three—they had met in a sandbox 80 years ago, and had been inseparable since then. I remember Fan, a middle-aged man who was so serene after a serious car accident that resulted in tetraplegia. I later found out that he was a Buddhist monk, one of the most revered in Asia. I remember Sydney, a drug addict I saw as an intern who returned two years later saying that he was now totally clean and running a recovery program for teens. These are the stories I cherish, of the patients I have been privileged to care for.

Physicians, nurses, and our team of health professionals are part of a humbling profession, an incredibly rewarding one, where we are honored to meet people from all walks of life. Instead of shying away from this task and turning people into a compilation of their symptoms, we need to embrace the gift that our patients are giving us. We should ask our patients about themselves. Not just what pain they have, or do they have this symptom or that symptom, but ask them who they are. What they do. What drives them. What makes them happy. Not only will it add so much depth and accuracy to their diagnosis and their care, knowing our patients will make doctors happier people—individuals who are more attuned to the humanity of our patients, and ourselves.

This column is modified from an article published in the American Academy of Emergency Medicine’s magazine, “Common Sense”. I explore these ideas and more in my new book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.