I used to practice hospital-based Internal Medicine in Chicago. I took care of people who were sick enough to be admitted to the hospital with diseases like pneumonia, kidney failure, HIV-related complications, and liver disease. About a year before I stopped practicing medicine, I took care of a young man in his 30’s who was often hospitalized for his worsening kidney failure and his very poorly controlled high blood pressure. The two often go hand-in-hand, and they were made worse by the fact that he rarely took his medications, and likely also by the fact that he had some mild developmental delay. At this current hospital admission, his kidneys had gotten so bad that we anticipated he would need dialysis within weeks to months. What did we do? We wanted to help him plan! We wanted to fix him!
We offered him a surgery that is commonly performed on dialysis patients, which would enable him to get hooked up to the dialysis machine in a safer way, with a much lower risk of infections and other complications. This surgery takes 3 months to heal properly; we wanted to get the process started for him, so that he’d be prepared when the time came to start dialysis. We sincerely believed this was the best option for him, and it’s the standard of care, so we pushed it. My team pushed it, the kidney doctors pushed it, and the surgeons pushed it. He resisted. He’d agree, then on the day of surgery he’d refuse. Which would postpone his hospital stay for another 2-3 days while they rescheduled. Then he’d agree, and then refuse again on the day of surgery. We got frustrated. It’s never a good idea for any patient, much less a chronically ill patient, to stay in the hospital longer than they need to. But, also, why wasn’t he listening to us? Why did he keep changing his mind?
Enter Dr. Wener. ‘I got this,’ I told my students. ‘Let me talk to him. Has anyone really listened to him? Most times, when we actually listen to our patients, we can address their fears/issues, and they will agree to have the procedure.’ So, my ego and I went walking into the patient’s room (I knocked first). He was sitting in the reclining chair next to his bed, so I pulled over a fold-up chair and sat down next to him so we could be sitting at eye level. I asked him to tell me his concerns. I listened. I tried to address his concerns… with the goal of convincing him to have the surgery. I used all my best communication skills with him, and still, he wouldn’t agree to do it. So finally, in desperation, I laid my best move on him. “Mr J, what would you say to you, if you were in my position?” His reply, after a few seconds’ thought: “Take your time.”
Take your time. Man, he was good. There I was, a highly educated doctor, a meditator, someone who teaches my trainees to understand other peoples’ perspectives and struggles, and this man, in 3 words, unflinchingly got to the heart of it all. What was I trying so hard to attain? To get him to have a surgery that would likely help him, but certainly wasn’t urgent or emergent? Why did I think I knew what was best for him? He just wanted to stop being pressured. He wanted time to think before he had a surgery that would mildly disfigure his arm, even though it might save him a lot of complications in the long run. I was listening, but not for his sake. I was listening so I could be ‘right’.
Doctors know a lot of stuff. We train for a really long time, we study hard, we do endless clinical rotations to ensure we take the best care of our patients. We diligently work on our patient communication skills, so that our patients, who are often far less educated than we are, understand their diseases and their treatment options.
Here’s the thing: we often fail. We sometimes just can’t recognize what it’s like to be in their shoes, even though we want to, and we try to. Our best clinical judgment is just that- our best. But it’s not always the only answer, and it’s not always right. It’s just ours. So we sometimes cling to it. Sometimes we forget that we, as health professionals, can and need to learn from our patients. For their sake, not for ours.
We, as humans (and as humans who happen to be doctors), must surrender our preference for control. Yet we (as humans) aren’t taught how to surrender, or the value of true surrender. Not in high school, not in medical training, not in the job market, not in relationships. We need a culture shift. We need a culture that instills in us, from the outset, that we should truly listen to people, not for our sake, or for the sake of tolerance, but for the sake of giving someone the gift of truly being heard. Mr J. taught me how to truly hear him. It’s a gift I will never forget.
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