Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Listening to Your Patients

At one point or another, we are required to interact and communicate with our patients. In general, when a patient presents to our care, we obtain a history although in today’s world of physician pressure to see as many patients as possible during a patient encounter, the check form history has become commonplace. Often, we scan that check form, history form before we are face to face with the patient. It has become my experience to scan that form but pay closest attention to the reason the patient has sought my care, i.e. the chief complaint.

Often the chief complaint may not be readily evident from that check list form but becomes more evident as you communicate directly with your patient or observe your patient when you enter the room or see them on the stretcher in the emergency department. This first impression, is quite useful in addition to listening to your patient’s voice, observing their demeanor, posture or simply observing their state of dress, interactions with others, such as family members who may be present. I try to use every second of my interaction in order to gain the most accurate assessment of their reason for being in my care.

Listening with your ears while observing with your eyes can be an important skill to hone as you see patients. When what you are hearing matches what you are observing, you naturally feel more confident in your ability to get to the root of the patient’s problem but don’t forget to challenge yourself to look at the encounter from as many directions as you can. Having a strong sense and comfort level with consideration of alternatives is a skill to hone.

As I have challenged myself to spend time with my colleagues in theater arts and acting, I have acquired some skills in patient observation. Additional, my theater colleagues and self-imposed exposure to stage and film productions has enabled me to appreciate good dialogue and words. Sure, my actor/director friends make fun of my fledgling efforts to understand their crafts, far more complicated that I imagined before watching them but my best friend, a professor of theater arts has increased my knowledge of how to observe human beings, most important, how to listen to my patients. I would encourage those who are undergraduates or applying to medical school, to take theater arts coursework as it will be very beneficial in your future patient encounters.

As physicians, we should return to our history-taking skills course and directions even if our medical school experience is quite remote. If we revisit our Physical Diagnosis course notes and directions from time to time, coupled with our experience with every patient encounter over the years, we get better in our listening skills. In short, anything that we practice, we tend to hone.

It’s no accident that patients tend to prefer older and more experienced physicians, often feeling apprehensive in the presence of younger physicians.  This apprehension can be addressed by the younger appearing physician/medical student by conveying a sense of interest in what the patient is saying. Listen to every word, reflect out loud on what your patient is saying and repeat your patient’s words to make sure that your are fully understanding what they are communicating.

Full understanding, good eye contact and conveyance of a sense of relaxed interest by you, the physician can greatly increase getting good information from your patient. By making sure you clarify anything on that history check form with what you observe and hear within the context of exploration of the chief complaint/reason for the encounter is also necessary.

It’s no accident that patients tend to associate better care with better communication and with physicians who have good listening skills. In today’s world of shorter patient encounters, it becomes our tasks as physicians to become something of actors in making sure that our patients feel comfortable enough to give us the information that we need to solve their problems.

We also have to develop our observational skills, visual and aural, that will allow us to make sure that we are as accurate as possible in treating our patients. For me, even as I have become one of those old gray-haired surgeons, to consistently and constantly improve my connection/communication skills. The more impaired or confusing patients in my care, the greater my satisfaction in getting their problems solved.

Yes, listening with my ears, observing with my eyes and in many cases, noting smells have all contributed to my connections and communications with my patients. For me, this is some of the most satisfying aspects of medicine. My warning is to not let being rushed to get through your patient volume, interfere with your ability to connect and communicate one by one. In the long run, you don’t save anytime if you are not getting the patient’s problems solved one on one.

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13 July, 2017 Posted by | life in medicine, medical school, practice of medicine | | 1 Comment

Time keeps moving and it’s is a blessing that it does keep moving.

In most places, we await the end of 2016 and the beginning of 2017. The passing of one year and the advent of another full of hope and promise for most of us. Still, nothing is new because time always keeps moving and everything changes often from one instant to the next. I have allowed this movement, this continuum to spur me to renew and reinvent myself without question.

This past year to my surprise, I embraced long distance running. My stress level dropped to nothing; my self-empowerment went to high levels. As I race along streets at 3AM, the only time I can get 1.5 hours of pure running into my crammed schedule, I do this movement for me and my sanity. I work on problems, I accept my world with joy and gratitude. This turns out to be a great way to get every day started and every challenge faced head on.

I will often mull some paper or new information as I tread along my winding path in my neighborhood near one the the Great Lakes in midwest United States. I can always hear the ebb and flow of the waves of the lake as I run along the beach; even if it’s too dark for me to see them. On a bright moonlit early morning, now long before sunrise on these shorter winter days, I love seeing my breath just in front of me.

Since I live in a suburban area, I seldom meet any automobiles in the early morning. If I meet anything, it’s a heard of deer grazing or a racoon crossing the empty street heading for the deep woods next to the lake. The deer ignore me but after spotting a coyote or two, I run with mace but still I run with emphasis and determination.

The thing about running, or even a brisk walk to begin your day, is that you can’t do these tasks for others. As a physician, my life and my practice has centered around being present to help my patients and students with solving their problems even if I ignore my concerns. With running, I do this for me and me alone; heady for non-self sacrifice. I think about me and how my middle-aged body runs faster and faster in the cold early morning darkness.

Daily running has a way of adding discipline into every aspect of one’s life. I eat healthy and clean because I know that high fat, high simple sugar foods will zap this burst of energy that running gives. I also forgive my occasional indulgence of beer on a non-practice evening because I have already run and exercised for the day. I also know that I am at my thinnest and lightest weight in my adult life; enjoying how well my clothes fit and how comfortable I am parking far from my destinations and hiking the extra distance.

The discipline that I have achieved with running, eating healthy and lifting a few weights has allowed me to keep a ready smile on my face and a song in my heart. I find that I simply enjoy interacting with my patients; joyful that I can help them feel better and meet the challenges of their worlds. This is some of the true magic of medicine that we keep learning, practicing and enjoying our art no matter where one is in the process. For many, just navigating the health care process is a source of added frustration and fear. Let your patients know that you are always the final common path for them as they place their health and trust in you; have their best interests in mind always.

As this year draws to a close, remind yourself of why you entered this profession and how fortunate you are to be able to help your fellow humans in any way small or large. Remind yourself that while this is a job for you, it’s often a change of life for your patients. Remind yourself that there is magic in empowering your patients; appreciating their fellowship and challenging yourself to be the best that you can be especially being authentic.

31 December, 2016 Posted by | life in medicine, medical school | | 1 Comment

Achieving a balance

Introduction

As I write this, my career has been shifted into a higher level of comfort. I have spent the years since graduation from medical school and residency honing my surgical skills and the craft of taking care of patients. If anything has suffered in the task to become the best physician that I can possibly be, it has been my personal life. In short, it became easy to head off to the hospital or university rather than deal with things in my life that just were not working. Well, working in medicine has a way of making one reflect on what is truly important and making one move past things that are not a good fit for life.  I had decided after ending a relationship that had somewhat sustained me through medical school and residency, that I would throw myself into my work with vigor and a quest for self-discovery.

Make a definition of your “complete” life

I always knew that I was a person who saw the miraculous in all of medicine and humankind. I am just an instrument for our creator does the actual healing. You can call the creator anything that you like, God, Mohammed, the Great Spirit but positivity and balance have a way of forcing one to move along on a plane that is stable. One gets used to “death” as part of “life” and one can sometimes feel how to be aligned with the universe in one aspect of life but “going through the motions” in another aspect of life. So it was with me and I attempted to fill in my “gaps” and “blanks” with interests, flying, sailing and so forth. Being above the earth or on the ocean/lake can allow one to exhale and just marvel at how wonderful the world is at times. I also knew that I wanted to share the miracles of my life with another soul; as a human we all reach out for intimacy in some form. We can have a close friend or we can have a significant relationship (marriage) that allows us to find that person who can help us complete our mission in life. At times, I believed that I needed to work on myself and put all parts of my life in compartments so that I could achieve a close bond with another human that doesn’t mind that I sleep on my abdomen hugging a pillow and look like a “street urchin” in the morning after my nightly pillow fight; that my phone frequently rings all night if I am on home call; or that I might be away for 30 hours straight taking in house call. These are the realities of being in a relationship with most physicians and certainly with a surgeon. I can also add the time that I must spend in reading and study to keep up with my craft. In short, any person who is involved with a physician needs to see that they won’t have 100% of our attention all the time but when we are “with” you, we are 100% committed and need you like we need oxygen, food and water to live. My definition of my complete life was to meet and find a person who could be my friend first and perhaps more later. The inhumanity that is sometimes represented in my trauma bay can color how I look at relationships between humans. Domestic violence is very difficult to deal with but deal with it, I must and I must have a place in my mind that allows me to give my best treatment to the victims and sometimes to the perpetrator too. I am not the judge but only an instrument to an end point – getting that person back to health and solving health problems. My complete life has to allow me to find that person who can allow me to complete my “mission” on Earth and I complete them.

What I tell myself…

I had told myself that my life could be complete and satisfying with a job well-done. I would enjoy “discovering new truths” in my research and writings. I would enjoy hearing the successes of my students and colleagues. I would have a rich and satisfying career giving back with my skills and teaching. Yes, my life was indeed full but not complete. I didn’t have that intimate relationship that adds the depth and richness that just needs to be there. And so I was going through my career, happily enjoying my friends, colleagues and adventures in surgery, medicine, flying and sailing.

No, one can’t plan everything…

I was happily moving along with the things that occupy my time. I decided to do some exploration in trying to reach out and expand my circle of friends. It’s good to be a trailblazer in some aspects of one’s life. I have always challenged myself to take some risk with something at various times. I took a risk and was happily enjoying the experience when a man reached out to me in a most unexpected manner. There was something in the things that he shared so readily with me. He knew that I was a physician/surgeon yet he said that he saw something that drew him to me. At first, my scientific training kicked in and I attempted to define what was going on here; I ran in the opposite direction. Well, there is no definition but only that one has to have the courage and sometimes the faith to know that your instincts are correct (much the same as how I treat a critical patient). In short, life does not always come with clear directions. I have been in uncharted “exploration” the past few weeks and it’s been both exhilarating and unnerving at the same time.  Here I am in a relationship that I can’t plan or define and suddenly my life that I thought was so full, seems empty before I was able to get to this point.

Why this is so vitally important…

In order to give our best to our patients and colleagues, we have to give our best to ourselves. My best now includes a very brilliant environmental engineer (he can’t stand the sight of blood) who inspires me to reach higher and further in all aspects of life. Suddenly the things that gave me immense satisfaction go beyond that and give me immense joy at the same time. I smile and laugh with my patients, my students and my colleagues. In short, he has made me a better and more fulfilled person. The only downside has been that my favorite OR music has moved from my signature “thrash metal” to a bit more “smooth jazz”. For those who work with me, that’s a huge change but they secretly like the music change. I am not playing as much Pantera or Goatwhore in the background. As you move through your university work and your preparation for medical practice, one has to have the best of humanity brought out from within themselves. To be able to give my heart, a myocyte at a time to this environmental engineer who can’t even see my lectures without getting sick, has made me a better surgeon, physician and human being. One simply has to find balance in all things in life and not shut off any part of life to focus on other parts of life.

10 October, 2014 Posted by | organization, relaxation, stress reduction | , , | 5 Comments