I’m So Glad To See You
Then one day, as I hopelessly glanced out into the waiting room, I saw him. He was sitting in a chair, looking much like I remembered him. I ran over to him with excitement, told him I was so happy to see him, and that I would get him a room right away so we could talk.
Here’s the killer: I had been a disappointment to my patient, my profession, and myself, and do you know what my patient said to me? Thank you! He said thank you for being honest with him and for giving him all the information I had. He told me he had made some major lifestyle changes, and he wanted to seek treatment.
I got him the earliest available appointment for gastroenterology. I then called the clinic and spoke with the physician who was scheduled to see him. I ordered a series of additional tests based on my reading and her recommendations. And, lastly, I updated his number in our system.
Before he left, I gave him a hug and told him he was going to be OK, because even though we didn’t have many answers today and this was a serious condition, we were going to figure this out together. He was not alone.
To me, that day was the day I joined the medical profession.
I called him several times over the following year. He was able to get treatment and, the last time we spoke, he was doing quite well.
Lessons Learned
To this day, that episode is still my greatest failure as a physician. I carry a part of it with me every day, in every patient encounter. I’m grateful for that.
There are three lessons that I’ll never forget in my practice of hospital medicine:
Humility. As a resident on my first day of internship, I felt that I had so much to prove—mainly demonstrating that I could handle a tough situation. Now I realize that while I handled the situation, I failed to take care of my patient.
If I had looked around, I would have realized that I had an entire team of experts—attendings, nurses, case managers, and social workers—willing and able to help my patient. Despite our many years of medical training, it is our responsibility to humbly engage our entire team and ask for help and insights, for the purpose of healing and supporting our patients.
Respect the hierarchy. Hierarchy in medicine is an interesting entity—sometimes visible, but often an invisible veil that governs our behaviors. When my attending asked me casually if I was OK with communicating critical information with our patient, I felt pressured to be casual about the gravity of the situation. He set the tone for that interaction without realizing it. We do this often as hospitalists. Our tone and body language with our team members or trainees, while respectful, can keep them from feeling comfortable about reaching out to us at critical moments.
Above all, advocate for your patient. Ultimately, my biggest failure was that I did not advocate for my patient. Sadly, this is not a rare occurrence in our profession. With mounting pressures to deliver on many fronts—among them, quality, cost, and experience—advocating and supporting our patients sometimes falls to the side. The increasing numbers of handoffs often lead to a culture of passing on problems. At times, we use labels like “noncompliant” or “not engaged” without deeply understanding the underlying challenges our patients face. Advocating for our patients is one of our core professional values in medicine; it should not be compromised.