To be a doctor means you have to touch the patient -- no matter what. That’s what we do. Even if what we are looking at is dirty, ugly, gory or just plain benign looking, it is what we do...or are supposed to do. We forget this sometimes, but the patients don’t. And even if they don't consciously notice, somewhere deep inside, where their fears and vulnerabilities about being ill or injured lurk, they know.
At the beginning of our encounter with the patient, we talk to them or rather ask and listen (another thing we sometimes hurry through), because we have to find out why they are here. Before we jump into action, we really need to listen and show an interest. No matter how trivial a problem appears to us, it can be something major in the eyes of the patient.
I learned this lesson early and quickly in my career. It not only cost me a new patient, but it warned me of the price I would pay if patients saw me as a physician who didn't care.
Let me explain...
A patient comes in on crutches with a short leg splint in place following a fall in which she broke her foot. Simple. But clearly the patient is in pain and anxious, as the injury had happened over the weekend It is now days later before she sees me, the orthopaedic surgeon, who will certainly make the pain go away and make it better.
So as my ortho assistant is removing the poorly applied splint and making the patient feel somewhat better, I am on the other side of the room, focused on looking at the x-rays as I should be. Sounds good so far. But then here is where it all went wrong. From across the room I regard the patient as a non-problem, an unchallenging and “run-of-the-mill” diagnosis in a world where I see the challenge of real pathology requiring real intervention. This is a non-displaced fracture of the base of the fifth metatarsal.
So how does this patient regard me? I don't even think about how I appear. So without even touching or examining the patient (why should I, it's only going to hurt more), I stand back in all my wisdom and proceed to pontificate, "This is a fracture of inconvenience, a hassle fracture, a ‘no big deal’ injury. You don't need surgery and you don't need a cast. Just wear a comfortable, non-restrictive type of shoe, walk with crutches or a walker, partial weight-bearing, use ice, elevate it, take these pain pills, and see me in a few weeks. Oh--and have a good day. Can't get any simpler than that.
Looking back on this, I’m sure the patient was thinking, "You'll have a good day, but my day and the next several weeks will suck. What about showering? What about work? What about the questions I didn't get to ask you?”
Fast forward three weeks later. I run into the patient at the hospital (yes, she works in my hospital), she is on crutches with a short leg, pretty pink cast in place and I say, "why didn't you come back to see me?" Duh! This is what she said to me, “You didn't even touch me. You didn't examine me," or in her mind, you didn`t care. “So I went to Dr. Wonderful." He probably figured out the patient really wanted a cast (a pink one). Even though it wasn't medically necessary for healing, he thought, ‘O.K. no harm, I`ll put her in a cast since that is what she wants.’ Because in her mind it was serious—and she got her cast.
Six weeks go by and I run into her again at the hospital and inquire how she is doing. She is miserable and can't wait to get the cast off and she hopes the fracture is healed.
The point I'm trying to make is this. If I had only walked across the room and laid my hand on her foot, gently touched her leg and let her know I understood just where it hurt, I would have made the connection. It wouldn't have taken any more time. If I had listened with my hands on her, she would have taken my advice, the fracture would have healed fine and in the long run, the patient would have been less uncomfortable.
"Ice, elevate, take these pain meds as needed, wear the most comfortable shoe you can get on for protection, slow down a bit, and everything will be fine.”
I was right from the get go. But at that first encounter, she only thought I didn't care and wasn't interested. If I had touched her and made that connection, she would have trusted me and listened -- and would have been a happy patient.
I blew it...but I learned. Touch does equal Trust!
By Fred Levin, DO