by Carolyn Thomas ♥ @HeartSisters
Sue Robins of Vancouver has an irresistible writing talent that’s somehow both quietly approachable and yet sneakily explosive. We see this talent in her book A Bird’s Eye View: Stories of a Life Lived in Health Care. We also see it in her compelling blog essay, “We Are All In This Together” as she explores the “basic lack of humanity that ails health care – a lack of humanity for patients, families, staff, clinicians, physicians and administrators.” As Sue says:
“We are all in this mess together. . .
“I know that patients are suffering. I know that those who work in health care are suffering. It strikes me that we are suffering for the same reason. We do not feel seen. We do not feel heard. We feel left out. We don’t have control of our own lives. Over and over, I see a plea from patients asking for respect, dignity and inclusion in issues that matter greatly in their own lives.
“I think health professionals crave the same respect, dignity and inclusion in issues that matter greatly in their lives, too.”
One of the most compelling parts of this essay was a description of Sue’s oncologist. She wrote:
“When I was going through cancer treatment, I wanted to see my oncologist’s heart. She never allowed me a peek in. She had a constructed a tall, seemingly impenetrable wall around her heart and it was protected by the system-built lack of time she spent with me.
“The combination of those two things made me feel invisible and miserable. My oncologist seemed miserable too, trapped inside her well-dressed facade. She never smiled, so neither did I. I walked out of every appointment as demoralized as she seemed to be. I felt her unhappiness. I wanted to tell her we are all in this together, but she never gave me a chance.”
I wondered when I read those words if that oncologist has ever read Sue’s 2019 post, or if she is even remotely aware that her professional demeanor might be making her patients feel “invisible and miserable”. It’s dreadful for everybody all around – including for that doctor, the one who “never smiled”. Imagine being that doctor. Imagine being her patient.
Just last week I received a surprisingly hostile reader comment in response to what I thought was a relatively benign blog article – specifically on doctor-patient communication and the value of listening to one’s patients. What’s not to love, right?
The comment-writer was a physician, using his real name, who wrote:
“Damn right. Wah wah wah. We’re already an hour behind and we have 6 people waiting, 10 FMLA forms to fill out, 62 prescriptions to refill, and more. Get a therapist.”
You know this physician is treading close to his own personal best-before date when he actually signs his own name to a public referral for psychotherapy to somebody he hasn’t even examined.
I looked him up on Twitter. He lives in Texas and loves football. Based on his med school graduation year, he’s likely a bit younger than I am (translation: ready for retirement). When he’s not leaving snarky Twitter comments, he’s probably a nice enough guy.
But it seems that he no longer cares what patients or his colleagues think of his snark – and that is a sad sign. It means he is able to respond in this way to people he doesn’t even know, the ones like me who dare to write about the importance of being a good listener – or anything else he’s sick and tired of hearing about.
It’s important to add here that although it may seem at first blush that his comment was aimed at me personally, I didn’t take it that way.
That’s because what he was railing against were the statements I quoted in that article from several well-respected physicians and researchers who had shared their own opinions on the value of listening to patients – including Dr. Catherine Kreatsoulas (Harvard), Dr. Jerome Groopman (Harvard), Dr. Victor Montori (Mayo Clinic) among others.
So some of that knee jerk snark, unfortunately, landed upon those distinguished heads. I was merely their messenger.
What I’ve learned here at Heart Sisters World Headquarters over the years, however, is that it’s apparently far easier for docs to openly criticize a lowly patient than to aim that same criticism at their peers.
The first response to this physician from my other blog readers was not surprising. For example:
“I’m glad you’re not my doctor. Wow!”
That’s an understandable reaction. But ultimately, I was struck by how deeply unhappy and exhausted this man must be.
Where is the humanity in his own workplace? Why would his employers make it almost impossible for him to take the time to be a good listener? All those people out there in his waiting room, all those forms to fill out, all those prescriptions to refill. All the relentless demands from those damned patients who keep coming in. . .
And only more of the same to look forward to tomorrow, and the next day, and the day after that. I wonder if he asks himself: “Is this why I went to med school all those years ago?”
Luckily for patients, not all doctors are this unhappy at work. I know this, because I’ve been writing about many of them for 11 years. Everybody has moments like this, of course, but generally, many if not most behave and sound as if they truly like their jobs.
Here’s an example: Dr. Alex Nataros is a family physician; like me, he lives on Vancouver Island off the beautiful west coast of Canada. Back in May, I read his letter to the editor of the local newspaper, the Comox Valley Record. This letter was all about kindness during the COVID-19 pandemic, which he summarized like this:
“All that matters is basic human kindness.”
And here’s what young Dr. Nataros wrote on Twitter recently:
“During my ‘Meet & Greet’ new patient appointments, I always try to make a point of asking widows for the name of their late partner and gently how/when they died. So far it seems to be helpful as a therapeutic touchstone during future encounters.”
I’ve decided that whenever I get snarky comments from doctors from now on, I will think of physicians like Dr. Nataros, who’s out there carefully listening to the precious stories of his widowed patients. That’s basic human kindness for you.
I’ve never met Dr. Nataros, but his attitude reminds me of Mayo Clinic’s Dr. Victor Montori. (Alex and Victor: I hope you two can meet one day!)
I was thrilled to spend some time with Dr. Montori in person during my last trip to Mayo Clinic in 2015, but I was already a huge fan long before then. For years, I’d been writing about and quoting him and his groundbreaking work at Mayo on concepts like Minimally Disruptive Medicine or the patient’s burden of treatment among his many other patient-centred passions.
When I first watched this TEDx talk of Dr. Montori speaking about his vision for a return to medicine that is “careful and kind”, I almost wept with joy and hope. Not only is Dr. Montori one of the most compelling public speakers I’ve ever heard, but his message is profoundly important and uplifting – for both healthcare professionals and patients alike.
And when Dr. Gordon Guyatt, a Distinguished Professor of Medicine at McMaster University, reviewed Dr. Montori’s wonderful little book Why We Revolt: A Patient Revolution for Careful and Kind Care, this is how he wrote about its impact:
“As a physician primarily involved in research, I do four stints of inpatient clinical care each year. I’ve resolved to re-read one of the chapters of Victor’s book before each clinical care rotation to remind myself of the caring doctor – following Victor’s model – I would like to be.”
In his book, Dr. Montori urges his colleagues to fight back against what he calls “industrialized medicine”, the kind of workplace environment that has clobbered job satisfaction for so many health care professionals.
When Drs. Joseph Ross and Akshay Pendyal at Yale University reviewed this book in the British Medical Journal (BMJ), they wrote:
“The physician workforce, largely as a consequence of bureaucratization, is experiencing unprecedented rates of burnout.
“As bad as things are for clinicians, patients are faring even worse. “
Ask patients about their most recent visit to the clinic, or, worse yet, a time they were admitted to the hospital. They’ll likely tell you about a clinician who barely looked up from a screen, or the experience of being awoken several times in the middle of the night to have their temperature taken. Where, in all of this, does the actual ‘healing’ part come in?”
In that same review, Dr. Pendyal described the crazy-making daily frustration that plagues so many physicians, particularly in the U.S. where the practice of medicine is largely under the weighty thumb of the for-profit insurance industry (unlike here in Canada – also known to some Americans as “commie pinko land of socialized medicine”). As Dr. Pendyal writes:
“Today, I spent more than 30 minutes on hold with an insurance company, attempting to obtain prior authorization for a simple stress test; I clicked countless times within my clinic’s electronic health record, all in an effort to find a single scanned copy of an ECG; and, in the spirit of ‘quality improvement,’ I received several alerts reminding me that, well, shouldn’t I be working just a tad harder to lower my patients’ LDL cholesterol?”
Is it any wonder then that so many physicians may feel impatient with those non-physicians who tell them they should become better listeners?
Dr. Dike Drummond’s sole professional focus since 2011 has been addressing what he calls “the modern burnout epidemic” among his colleagues. The author of the book Stop Physician Burnout: What To Do When Working Harder Isn’t Working, he cites three commonly observed early signs of burnout among healthcare professionals:
- Emotional Exhaustion:
- Depersonalization: This shows up as cynicism or a negative, callous, excessively detached response to their job duties. Often, burned-out doctors will begin to blame and complain about their patients and their problems.
- Reduced Accomplishment:
As Boston surgeon Dr. Rena Xu wrote in The Atlantic, the burden of electronic medical records and demanding regulations may also be contributing to a historic doctor shortage:
“In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care.
“They’re also at high risk of attrition: a survey of nearly 7,000 U.S. physicians, published last year in the journal Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years.”
I don’t want physicians to leave their profession. I don’t want them to feel so beaten down by relentless bureaucratic demands that their only relief is to quit. I don’t want doctors like our football-loving Texan to become so mean-spirited that he needs to publicly take out his resentment on patients he doesn’t even know. His comment to me (and essentially, to other patients) was really saying: “If you need to be listened to, go pay for a therapist to listen to you – because I simply don’t have time at work to do that anymore.”
I also don’t want patients to suffer the consequences of missed diagnoses or inappropriate care or ineffective communication because suffering health care professionals see listening as optional.
I want decision-makers (and all healthcare professionals) to read Dr. Victor Montori’s book on “careful and kind” care, and to pay special attention to his book’s suggestions on how to make that happen within the restrictions of modern medicine.
I want patients to acknowledge, as Sue Robins already has, that our health professionals crave the same respect, dignity and inclusion in issues that matter to their lives – just as patients do, too. And I want our healthcare professionals to acknowledge that, as Sue so astutely reminds us, their patients often feel unseen, or unheard, or left out, or without any control of our own lives.
But respect and caring must flow in both directions to heal what ails the medical profession.
Take care, stay safe. . . ♥
Image: Christo Anestev, Pixabay
Q: What’s been your experience with a healthcare professional who seemed truly happy at work?
NOTE FROM CAROLYN: I wrote more about doctor-patient communication in my book A Woman’s Guide to Living with Heart Disease, (Johns Hopkins University Press, 2017). You can save 20% off the book’s cover price if you order it directly from Johns Hopkins University Press (use their code HTWN). Or ask for it at your local library, your favourite independent bookshop, or order it online (paperback, hardcover or e-book) at Amazon.
– Sue Robin’s book A Bird’s Eye View: Stories of a Life Lived in Health Care, and more wonderful essays on her website, SueRobins.com
-Dr. Montori’s book “Why We Revolt: A Patient Revolution for Careful and Kind Care“ and his brilliant TEDx talk video
-Dr. Dike Drummond’s website The Happy MD on preventing and treating physician burnout
-How Minimally Disruptive Medicine is happily disrupting healthcare
-Living with the “burden of treatment”
-Kindness in healthcare: missing in action?
-We know we should do ___ , but instead we do ____
-the Patient Revolution website, and their Patient Tools to help you at your next medical appointment
-the Minimally Disruptive Medicine website