A few months ago, I woke up to a 4 a.m. text message from my 12-year-old sister:
“Everybody is yelling. Granny’s heart stopped and she stopped breathing.”
I called my mother and learned my grandmother had had two cardiac arrests, one at home and again in the emergency room. She was alive, but intubated in the ICU. My husband, brother, and I got in the car and headed home to upstate New York.
Suddenly, I was no longer the doctor in charge, but the anxious relative, waiting on news. The perspective shift jarred me — and prompted me to change how I think about my own practice.
As an intern at Cambridge Hospital, I’m often up to my eyeballs in daily tasks and documentation. Each time my pager beeps, my to-do list grows. I end up having to prioritize based on what’s most pressing for patients, so requests from families seeking updates on their loved ones are the easiest to put on hold.
But now I was the one waiting. It took time to find out that she had suffered a heart attack and had blood clots in both of her lungs. It took time for her labs to reveal that her liver and kidneys were failing. It took time to find out that she had an active gastrointestinal bleed that required blood transfusions.
Sometimes, nurses updated me on her daily labs, but I wasn’t my grandmother’s health care proxy, so when my dad wasn’t there, it was harder to get information. My grandmother was being seen by multiple doctors, but they usually weren’t around when I visited. And because I didn’t have privileges at this hospital, I couldn’t just peek into her chart to see what the doctors were thinking.
I hated being in the dark, but it made me realize how often I left my patients’ families in the dark, too.
When I’m at the hospital, talking to families by phone invariably takes more time than I have. A five-turned-30-minute conversation in the middle of the day sometimes means I don’t have time to consult a specialist, or it means the difference between getting a procedure done today versus tomorrow. I always tell myself, I’ll call the mom or sister later today, and, I confess, I’m sometimes thankful when I can just leave a vague message.
When patients’ families show up to the hospital, however, I know I have to talk to them. Sometimes I stall. It’s not a matter of practicality — I’m afraid. Patients and their families have questions. They rightly deserve accurate, honest, and thoughtful answers. As a new doctor, I feel like I need to double-check everything before I say anything. I constantly fear disappointing the people who depend on me to do my job well.
I once confided these fears to my supervising resident and she reminded me I’m the person who ordered all the labs, the imaging studies, the consults, so I know more than anyone else on the team.
She reminded me that, when I’m talking to families, it’s OK to tell them, “I don’t know,” and to explain what steps we’re taking to find out.
I had to return to Cambridge with my grandmother still in the hospital. But I returned with a better understanding of what patients’ families feel.
While the grind of medicine can make new doctors feel the need to operate like a machine, I’m taking a vow now: I’m promising my future patients that I’ll always try to take a few minutes to make myself as a doctor more visible. I hated being in the dark, so I’m going to try my best to bring the families into the light, making them my first priority and not my last.
After being at IHI in Orlando, I talked to my doctor about this very thing and he said, ” you know that I love to talk to my patients but I am just overwhelmed with seeing patients, there just isn’t time. ) . I never realized that he had to see about 50 patients a day to make ends meet !
It would be good to hear from doctors, even through your own communication, about how you do it. Thanks. I realize that would also take
This is a smart essay about an important lesson in being a healer. Thank you, Doctor O.
Thank you for sharing your experience. As a physician getting ready to start residency soon, this story is very informative to me and I plan to implement it into my clinical practice.
Thank you for sharing your story. I’m sure it was difficult — you’ll be a much better doctor for the experience.
P.S. Be careful, just peeking into someone’s medical record without justification could be a HIPAA violation.
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