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A simple hug and a humble heart

Smith, David A. MPAS, PA-C

Journal of the American Academy of PAs: January 2017 - Volume 30 - Issue 1 - p 1–2
doi: 10.1097/01.JAA.0000511036.87563.0b
Mindful Practice

David A. Smith is an assistant professor in the PA program at Salus University in Elkins Park, Pa. He works in the surgical ICU at the VA hospital in Philadelphia, Pa., and in the ED at Suburban Community Hospital in Norristown, Pa. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

Forty-three minutes till my shift is over. I log my charts for the day and begin signing them off. It has been a long ED shift; 33 patients and counting. I glance at the main screen and see a 53-year-old woman with a chief complaint of “not feeling well.” My attending's patient list is long with five in the hole, and he just came on shift; I might as well see one more to help out the night float. I assume “not feeling well” will be a quick discharge. It will probably be viral syndrome, and then I can finally get some rest after working four shifts in a row.

As I approach the room, I see the curtain half closed and the patient trying to tie the back of her gown. I'm tempted to tell her she can get dressed and I'll do a quick physical examination and save her time. But this time is different. I make eye contact and see a patient who looks like she needs help, not just clinically but emotionally.

I introduce myself and begin taking a history. My patient tells me she just doesn't feel well and would like a checkup. During the physical examination, I notice she is in incredible health. She is not obese, her examination reveals no abnormalities, she is well groomed and well nourished, and she clearly takes care of herself. She denies fever, chills, nausea, vomiting, diarrhea, and pain, and the examination findings are normal.

Now I'm perplexed. She is not a drug-seeker. She is not requesting antibiotics for some phantom illness. Usually I will tell a patient like this that she's fine and can go home, and even congratulate her on having such a quick ED visit. But this time, something inside tells me to dig deeper.

“Ms. Jones,” I say, “why are you really here?” Her answer is unexpected.

An emotional Ms. Jones begins to tell me how 2 years ago she stopped taking her HIV medication because she didn't see the point in living a long life. About 5 years earlier, she had been raped, and the rapist had given her the virus. She has no immediate family, though she has a good support network of friends from church. Along the way, though, she has become depressed and feels she has nowhere to turn.

I pull a stool over and sit down, and she sees I'm ready to listen. Her story is one of shame, confusion, and loneliness. She fears she is different and has no purpose. I tell her there is no reason to feel ashamed for what happened to her. There is nothing she could have ever done to be the victim of such a heinous act. She should be proud of herself for what she has overcome and endured.

She smiles, agrees, and seems somewhat comforted in her moment of despair. She begins to tell me she has not told anyone she has HIV until now. I'm shocked she has kept this hidden for so long; I can only imagine how difficult it is to hold something like that inside. We continue to talk about her ups and downs and the importance of getting into a support group. As we talk and even laugh, I glance at the clock and I see I'm 45 minutes past my shift. Ms. Jones looks better and happier since that hour started.

Not forgetting that this is still an ED visit, I counsel my patient that she needs to see an infectious-disease specialist to be reevaluated and to start her HIV regimen. She is now beginning to realize she has a long and fruitful life ahead of her. I tell her what a pleasure it was speaking with her and that she has no reason to live in fear anymore. She cries one last time and I give her a hug—not a hug of pity but one of love and compassion, a hug that tells my patient I understand and care.

I hustle back to my computer and complete a fast-track discharge. I am technically overtime at this point, but I don't log it as I feel it would cheat the human interaction I just had. For once, no massive workup, no pain medication, no antibiotic, no late night consult—and yet my patient feels better. And so do I.

On the drive home, I contemplate the interaction I just had and think about the role of providers in healthcare.

At times I rush the human component of healthcare. Sometimes I forget the esteem that our patients have for us. Sometimes I forget that some patients are looking not just for a clinical answer but for a human connection, and maybe life lessons as well. Sometimes I forget that simply talking to a patient with a humble heart is practicing the best medicine.

Reflecting on our bedside manner is critical in providing the best patient care. Yes, it gets busy and there is virtually no time for conversation, but when you have a patient encounter that tugs at your emotions, take the time to explore it. These reflections provide the reminder we all need of why we went into medicine in the first place.

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