Why a Patient-centric Approach Is Best: Stories from a Physician

Patient-centricA number of years ago our family was engaged in a happy frenzy of activity preparing for my middle daughter’s marriage. While there had been some joking about what might happen because this upcoming marriage was taking place on Friday the 13th, so far things had been progressing smoothly. However, the day before her wedding, I returned from my workout to find my daughter having difficulties swallowing. We knew that she was allergic to something in some milk products, and that she was fine as long as she stayed away from those products from cows given rBGH, which she always made a conscious effort to do. However, despite all her precautions, something slipped through the cracks that day, and she became panicky as she noticed her tongue swelling up. She was able to get down some Benadryl right before I drove her and my wife to the hospital, where we arrived in record time. After a nurse initially told her to “calm down”–which understandably my daughter didn’t appreciate–the physician there quickly intervened, and gave her a shot of epinephrine. Although to my daughter, it still felt like hours before she was treated. It goes without saying that there was an enhanced feeling of gratitude in our hearts the following day as she and her fiancé exchanged vows.

Training Physicians to Be Patient-centric

I have reflected on this and similar experiences over the years, and have realized that, among other things, most of us take for granted the healthcare system we rely on for our medical needs. Even as a physician–or perhaps even more so because I am a physician–I find myself counting on having access to that support structure whenever it is needed. I tend to assume that the healthcare providers involved in the diagnosis and treatment always will do the right thing for their patients from the very beginning. I know that this expectation was ingrained in me by some excellent mentors during my medical training. And, I was fortunate in the consistent quality of my mentors. Not all are so lucky as Dr. John Haughom has explained: “In the healthcare industry, we still have a craftsmanship mentality to process management. Even the way physicians are trained reflects more of a craftsmanship approach because it relies heavily on whom they shadow during their residency, resulting in inconsistency in expertise among doctors.”

Using Humor and Expertise with Patients

One rotation that stands out because of the personality and vast medical knowledge of my supervisor took place in Marion County, Ohio during my family practice internship in pediatrics. Dr. Albert May mixed humor and medical expertise in his interactions with children and their families in a very memorable way. For example, after confirming his suspicions that a boy’s asthmatic condition was aggravated by a cat in the household, he would launch into a sermon with the mother about the downside of keeping the cat, and explain that she basically had to choose between the child and the cat. After seeing this scenario repeated several times, I quickly came to anticipate the next part of the conversation (and had to force myself to keep a serious face, despite knowing what was to follow). Generally, the mother would push back some, explaining that the cat was a beloved family pet… and, how could they possibly replace a pet like that? Dr. May was always quick to respond that there were other pets that were even more “cuddly” than cats, and, when expectedly questioned what those would be, he would reply “snakes!” … much to the delight of the little boy patients, who then would beg their mother for a snake. As you might imagine, there never was an answer in the affirmative. While Dr. May’s humor at times would catch one off guard, there was a central theme in everything that he did that reinforced what I had learned from other great mentors – he was “patient-centric,” and always would bring the focus back to the kids he saw.

Connect with People First

Physicians also need to take the time to connect with patients, not just their diagnoses. Interestingly enough, I actually had the more general principle of “putting people first” driven home to me in a non-clinical environment. I was working at an AT&T manufacturing plant in Guadalajara, Mexico (an interesting story in itself) and had a question arise regarding a software engineering project on which I was the lead. I grabbed the paper with the related details and rushed over to the purchasing department and into a cubicle to see the person who I knew would have the answer. I began blurting out my project question, only to become aware that all the attention was being focused on someone else who had walked into the cubicle right behind me. As I assessed why priority was being given to that person, and not to me, even though I had arrived first, I realized that my colleague behind me took the time to greet everyone before anything else. I was humbled by this realization that I had not put people first, and recommitted myself to be people-centric, and, as a physician, specifically to be patient-centric.

Patient-centered Teams

Patient-related successes are the result of a team effort, and not of any particular individual alone. One such experience came during a series of medical student clerkships at Grant Medical Center in Columbus, Ohio. As I was carrying out an H&P (history and physical) on a patient in the hospital, I could feel as I lightly palpated his abdomen an unusually wide aorta. I made sure that this was highlighted in the patient’s chart, which I knew would be reviewed later that day by several other healthcare professionals. I learned a short time later that one of the vascular surgeons mentoring our team picked up right away on this note in the chart, confirmed the diagnosis of aortic aneurysm, and scheduled the patient for surgery. While different factors affect the probability of rupture in patients with an abdominal aortic aneurysm, the decision of this experienced vascular surgeon to operate was a good indication of a significant possibility that this discovery and subsequent procedure saved the patient’s life. Had we been distracted, and not had our primary focus on the patient, we might have missed this rewarding and potentially life-saving opportunity with this patient. I was grateful to have had the knowledge of the best practices that I needed to pick up on this vascular anomaly in a timely manner, and then involve the necessary healthcare professionals in addressing and resolving it. It always is rewarding to do the right thing for a patient the first time and every time.

I continue to be grateful for our healthcare system, and to know that it is not quixotic to believe that we can work together altruistically to improve the lives of millions of patients and their families. We can put people before projects. And, we can be patient-centric.

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