It was a busy night (as usual) in the emergency department. I was in the final hours of my shift when I knocked on the door to see my next patient. She was a young woman in her 30s on opiates to treat chronic pain. She presented with a chief complaint of abdominal pain and constipation. Depending on your perspective, this chief complaint can conjure up different thoughts and emotions about this patient's presentation. We may prejudge this patient based on our past experiences: “Chronic pain, really, in a 30-year-old? Possible fecal disimpaction at the end of my shift? Drug seeking?”
It can be so easy to get sucked into a vortex of preconceptions about a person we have never met before, and these presumptions can affect our attitudes, words, body language, and even the energy we project. Admittedly, many times our assumptions will be correct. But not always. So what do we do? How should we address this person? Is she truly suffering, or does she have ulterior motives that have compelled her to feign illness? Sometimes it is obvious, but other times it is difficult to differentiate between the two.
How should we treat this patient? I believe the answer to this question may be found in the reason that we decided to become health care providers in the first place. Do you remember back when you filled out your medical/PA/nursing school application? What was the principal reason you wanted to get into the medical field? For all of us (hopefully), it was because we wanted to help people. We wanted to do something good in the service of others.
I believe that the absolute most effective way to accomplish this is through kindness. Of course, having a solid and ever-growing fund of medical knowledge as well as excellent technical skills are mandatory. Kindness, however, is the icing on the cake. The doctor-patient relationship, the interaction between two human beings, is such an important aspect of healing. Being kind to others creates a bond of warmth and openness that will reassure them. It can help our patients better comprehend and accept the treatments we offer. Our kindness will make it more likely that our patients will ask questions to clarify things that they do not understand. Our compassion will help our patients feel a bit better.
I work in a busy ED, and I understand all too well the time constraints that are imposed upon us. We need to see our patients quickly so that we can move on to the next thing. Thinking about it, being kind doesn't take much more time than being curt. We can be kind even when we are in a hurry (which is most of the time). In a few extra seconds, we can provide a smile, an expression of caring, or a gentle touch on our patient's shoulder. Sometimes we can choose to take an extra moment that we don't have to be sincere and give a little more of ourselves to the person lying on the stretcher in front of us. Isn't this the reason we come to work every day?
Occasionally, we are given the luxury of a few extra minutes. This can be a wonderful healing experience for the patient and the provider. Not only does our patient feel that we care, but our genuine kindness has emotional benefits for us as well. Even during encounters with those individuals who we know have hidden motives, we can still be kind. We should always exercise sound medical judgment, but that does not necessarily preclude acting in a compassionate manner.
Returning to my patient, I entered the room and saw the young lady standing hunched over the bedside table. I did not know what her motives were. I chose to act the way I normally would, in a considerate manner. I introduced myself, and she told me what was bothering her. I thought that her chronic opiate use was likely a contributing factor. Following this line of thought, I began to ask more questions. I formulated a plan, and she agreed. A few minutes later, she came up to the nurse's station and wanted to leave AMA. I went back into the room with her to understand why she had a change of heart. Apparently, she had been seen for this same recurring problem a few times, and all her treating providers had questioned her opiate use. She felt that I was blaming her. It was busy, and I still had many things to wrap up, but I sat down and explained that my motivation for inquiring about the opiates was driven by a desire to figure out how to best address her problem. She understood and agreed to stay.
I could have just as easily let her leave AMA, but that would not have been the right thing to do. I genuinely cared about her, and wanted to do what was in my power to help her. We ended up speaking for a short time, and I learned a bit about her. She was a pleasant young lady who had unfortunately been experiencing some tough times. She appreciated the fact that I listened to her. I felt content, knowing that I was able to improve her life in a small way. Oh, and she declined any offer of pain medicine.
There is an abundance of diagnostic and therapeutic tests, procedures, and pharmaceuticals in modern medicine that have helped heal countless people. These are the tangibles. But we must never forget the equally important intangibles — the kindness, empathy, caring, and sincerity that play such a vital role in healing the body, mind, and spirit.