On Turned Exam Tables

I was asked recently by work to write an article for a newsletter about physicians’ experiences with illness. My response to this request was to say that I have been trying to write this very article for a few months and through my efforts I have experienced a new “illness”. It is apparently, quite a powerful one and has had me in its grip for some months now. Its name is writer’s block.

Tonight though, relief has come – in the nick of time. I was reading a NY Times article about a minimalist sculptor Carl Andre. It was entitled “Less is Less” which set me thinking. I started a blog site to challenge myself to improve my writing, to practice writing and to observe myself in the role of writer. One observation to date has been about how story ideas come to me – usually by an odd trickling of input from multiple sources coalescing together to form a lit-light bulb moment of “Aha!” and then, out it flows. No different today. After weeks of struggling with what message to write about from my way too many experiences on the other side of the examination table, that title “Less is Less” did it.

Less is less? Huh? What? I thought less was more. Exactly! That’s it! Every time I began to write about my experiences with being on the other side of the exam table over the last few years, I had too much to tell. I, doctor come patient, tried telling all the stories and giving all the advice I could. But that was too daunting. Instead I find myself thinking, when telling a story, sometimes less is more and,  in the world of forming a bond with your patients? Less is definitely less.

Five years ago, I ruptured my appendix while on vacation in Hawaii. When I made it back to the mainland I faced surgery and a week-long hospital stay. Being the patient it turns out, really is hell. And the worst? The worst was that easily 75% of the people involved in my care did not introduce themselves, leaving me to feel lonely and objectified. From the phlebotomists and radiology technicians who worked without verbal identification, to some nurse and doctors. Yes, doctors. After the initial ED doctor took his history, the nurse gave me some blessed pain relief and the CT was done I waited. And, waited. Then, suddenly into my room burst a young resident who abruptly leaned his forearms on my the rails of my gurney (ouch) and said “So! You have an appy!”. I was tired and in pain so forgive me when I tell you that I looked at him and said in my best attending voice, “I am Dr. Land. And, who the heck are you?”.

This spring I managed to tear all of the hamstring tendons off my pelvis. The repair for that gave me the chance for another stay in the hospital. What a difference five years have made in the quality of care! Every single person introduced themselves and explained why they were with me. They spoke in terms anyone would understand. From the nurses and technicians to the people cleaning my room and the doctors. Yes, the doctors.

This is where more was so clearly more. At my first meeting with my surgeon he entered the room with hand held out, eyes on mine and a calm smile. He sat.  He began by asking about me, about my family, about my job. He cared! He went through my chart in careful detail – family history, medical history, medication list cleanup…. all for my hamstring tendons. I was left feeling that if he cared to take the time to hear about my children and my job, if he cared that my mother and father both had lymphoma, that I no longer take Prilosec then – Wow! He must care about me and he must be a very detailed and thorough surgeon. At my first post-op appointment he asked first how I felt. How was I handling the long weeks of braces and crutches and being non-weight bearing? Then he asked how my daughter was recovering from her  appendectomy (that last bit falls under the category of “when it rains it pours”). Only then after these kind moments, did he dive into what he was there to accomplish.

I learned much from these two times on the patient side of the exam table. Overtly stated, when we as physicians begin properly the rest falls into place. Start with a slow, calm, eye-held introduction. Get to know the person you are with. Then, proceed forward in your work as their doctor. From this beginning success will follow.

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