Sunday, August 12, 2012

Lessons in empathy

I follow a number of breast cancer survivors and patient advocates on Twitter (see the #bcsm hashtag), which leads me to some interesting blogs that I probably would not have otherwise discovered. One is written by Chemobabe who per her biography is a social scientist and survivor of Stage III, HER2 positive breast cancer. Her most recent post Schooling the Resident is about her experiences at a 3-year follow up visit. Thankfully, she's NED, but she recounts her impatience with the resident who was interviewing her before her regular oncologist entered the room. What was particularly annoying for her was the fact that the resident starting fiddling with his iPhone while the attending was talking to her, which led her to wonder if he was texting his friends or even taking pictures of her. She used the experience to remind her regular oncologist to mentor this resident and try to remind him to be more empathetic. In one of the comments, one person went so far as to say that the resident should be formally reprimanded with a letter in his file.

I had several reactions to the post. I went into Defensive Doctor mode first, thinking of ways to defend the hapless resident.

C'mon, it's hard to imagine he was using the phone to take pictures of you he was tweeting somewhere.

Be realistic. I can't imagine he was texting his friends. Maybe he had to answer a page, or look something up to help another patient.

Or maybe he was using his phone to research something about YOUR condition.

It's 2012 for God's sake, we all have pay way too much attention to our digital devices when we shouldn't be. It's not a cause for reprimand.

And don't be so hard on the guy when he was talking about how your arm pain might have been caused by neuropathy or lymphedema. Yes, that's obvious to you and your regular oncologist, but the resident has never met you before, and maybe he is just trying to be certain you do have an understanding of your diagnosis. It's very hard to assess a patient's understanding by reading another physician's documentation in the chart.

But on further reflection, this is wrong, wrong, wrong. I think Chemobabe really nails it here. The visit IS about her, and even if at the point the regular oncologist was taking charge of the interview from the resident, the guy should not be focusing on his phone, at least not longer than a second or two to see if it's a page that requires immediate attention (and by saying "excuse me" or something). It's just rude, and it misses the point of why he is in the room in the first place. And maybe he could have saved himself some grief by spending the first minute or two trying to develop rapport with the patient and asking her what she knows about her symptoms, and more importantly, what he can do to help her that day.

I haven't at all forgotten what it's like to be a trainee, even though it's been 20 years for me. It is intimidating when you are in a patient encounter where your fund of knowledge is minimal, your experience is nil, and everyone knows that. But the biggest regret of my days of residency and fellowship is not that I didn't know the answer to the attending's question or I made a mistake that someone else had to fix. It's that I missed too many opportunities to be empathetic and listen, right at the moment that the patient across from me needed it the most.

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