"Dr. Pistoria, they need you over in the preop holding area."
There was no urgency in the request, no indication that I was needed immediately. Nonetheless, I went right over. Once there, I was briefed on the situation – a patient, scheduled to go to the OR for joint replacement had coughed up some blood. The surgery was cancelled and now she was angry. I was being asked to see the patient for the possible hemoptysis and determine whether she could be safely sent home or if we should admit her.
The anesthesiologist and the nursing staff concurred: This patient was mad and rude and, everyone’s favorite word, "difficult." I took a deep breath and wandered back into the bay where she lay on the litter. I introduced myself and explained that I was a hospital medicine physician there to help evaluate her. She stared at me with a look that bordered on disdain and launched into her story.
I let her talk, maintaining eye contact the whole time. I nodded and made appropriately empathetic facial expressions as she spoke. She told me how the surgery was initially set up for 2 weeks prior but was cancelled for reasons beyond her control. She explained how much her shoulder was bothering her and limiting her ability to function in the way she once did. She talked about the fact that she had an upper respiratory infection that had left her with a nagging cough. She expressed her anger that her surgery was cancelled again.
When she was done, I told her that I was sorry she had two surgeries cancelled within the span of several weeks. I said I could not imagine how frustrating it must be to have constant pain and limitations in ability, and that I would be angry as well if my surgery – the surgery I was hoping would ease my pain – were cancelled yet again. I also explained that her surgeon felt she was at too much risk to operate safely today given the blood she had coughed up. I said that my role was to determine whether this incident was something we needed to worry about, and I walked her through how I would do that.
I could see the anger slowly dissipate as I spoke. This was an individual who wanted to feel better and wanted someone to acknowledge that the situation stank.
I took a full history and examined her. I reviewed her chest x-ray and went over my findings and thoughts with her. I was not concerned about the blood – it was likely due to irritation to her throat from her persistent and occasionally violent coughing. When she said she could not get a ride home, I put her on my service for observation and to allow her nerve block to wear off. In the end, the angry and suspicious patient who had greeted me was kind and appreciative.
A key part of health care reform is the concept of shared decision making. We need to work with our patients and find mutually agreeable treatment plans, based upon the best available evidence. In order to get there, we need to develop better relationships with our patients. Sometimes patients just need to vent, and they need to have an affirmation that, yes, their situation stinks. Those needs often run counter to our collective need and desire to have things run smoothly and without complication – particularly a complication that will require our time to listen. However, that time and listening can make all the difference in the world for that patient.
A little bit of empathy and a caring ear can show exactly how important that patient is to us. As we move toward a model of shared decision making, listening is a skill we must acquire and hone. A little bit can go a long way.
Michael Pistoria, D.O., is chief of hospital medicine at Coordinated Health in Bethlehem, Pa.