Providers as Patients
Mar 29, 2016 08:00AM
By MED Magazine
By Faith A. Coleman
“If you understand any one’s ailments so well as to sit down and tell him exactly how he feels, better than he can tell you; he will be apt to believe all you afterward say and do.”
The Physician Himself from Graduation to Old Age by DW Cathell, MD, 1922
It’s analogous to becoming a parent. Among people who have children, virtually everyone, even before conception, thinks, “I got this.”
After the birth, shock sets in along with the thought “What was I thinking?!” The parent realizes that no one can know what it’s really like to be a parent, until they’re a parent. No returns, even with a receipt.
Likewise, most healthcare providers think they “get it”. They believe that they truly understand the thoughts, feelings and experiences of their patients (or want them to think they do.) Then the provider becomes a patient, and realizes just how much they didn’t really “get”.
That can be especially true in cases of life-altering medical conditions. Providers who experience these, like their patients, cannot help but be changed by them. If they are humble and courageous enough to examine that experience with their minds and hearts, they may be so fortunate as to become uncommonly great healers.
Been There, Done That
Orthopedic surgeon Steven Meyer, MD, with the CNOS Clinic in Dakota Dunes, South Dakota, admits that he kept his pain and loss of function a secret until it could no longer be hidden.
“I think doctors often try, intentionally or not, to hide any weaknesses we might have,” says Dr. Meyer. “We want to present this kind of ‘got it all together’ thing, you know? If you went to most doctors and asked them if they had a colonoscopy at age 50, or get their executive physicals every year or two, you’ll find out that doctors are often the worst patients. We don’t follow our own advice. We don’t eat right or sleep right or live right. We think the rules don’t apply to us.”
As a case in point, Meyer had lived with pain in his shoulders for more than 10 years. He attributed it to wear and tear during his college football days. “I was on the hamburger squad – I took a lot of hits,” he says. Eventually, the pain and disability progressed to the point where he couldn’t reach for instruments in the operating room. The day he could no longer do a push-up, he knew things had to change.
Over the last three years, he had both shoulder joints replaced. “It’s just been a remarkable experience,” says Meyer. “The greatest thing about it is that I’m re-enthused about what I do for a living, because it was absolutely life-changing. There’s nothing worse than chronic pain with everything. It makes me feel incredibly blessed to be able to be an orthopedic surgeon – I know the impact I have on people’s lives.”
And Dr. Meyer says his experience has been as good for his patients as it has been for himself. “You always tell patients ‘your pain is going to be like this or that’ and they say ‘you’ve never had it.’ Now, I can look at people and say I know exactly what that’s like. I know the anxiety that you have ahead of time, the concern about risks and benefits. My shoulders were affecting everything in my life. I wish I had done mine sooner. That’s why I advise you to get it done.”
“It’s given me a greater sense of empathy, and enhanced my understanding. It helps me relate to patients, and helps my patients relate to me,” says Meyer.
“The faculty of keeping hopefulness, contentment, and confidence, alive in a patient is a great one; and the look with which you meet them has much to do with this. A bright, fresh, thoughtful countenance, and an easy, soothing professional air and manners are powers that will impart tranquility and repose to their minds, and carry many a patient with you toward recovery.” - DWC, 1922
Stephanie Broderson, MD, a family doctor with Sanford Family Medicine in Sioux Falls, was 28 weeks pregnant when she learned that her kidneys were failing. When things didn’t return to normal after delivery, a kidney biopsy revealed that she had lupus. So two months after the birth of her son, Broderson began a two-year course of chemotherapy for class IV lupus nephritis.
“Around 2000, Dr. Burris [Larry Burris, DO], who is now my transplant nephrologist, told me that I could expect worsening kidney failure for about a decade and that I would eventually need a transplant,” says Dr. Broderson.
That transplant happened on June 27, 2011, when Broderson received a kidney from her 24-year-old stepdaughter, Andrea.
“Before the transplant, I was tired all the time and I was chronically anemic. But I was the main breadwinner for our family, so I had to work. I just made modifications. I tried to get more sleep, etc. I just had to do things a little differently.”
Five weeks after the transplant operation, Broderson returned to work at Sanford. She says the experience definitely had an impact on her practice.
“I feel like I can relate on both ends of the spectrum [as a physician and as a patient],” Broderson says. “I had to do a lot of yucky stuff. I had to do chemo. I had to do a kidney biopsy and a bone marrow biopsy. I was chronically ill and had to take medication. And I underwent a major surgery. So I understand how tough it can be.”
Today, the healthy and pragmatic Iowa native says she has little patience for patients who neglect their health and offers tough love, born of experience, for the rest.
“My motto is ‘No whining’,” she says. “That’s it. You do what you need to do. It is what it is. Deal with it. I did.”
“Keeping up the patient’s courage is a great thing, often a large part of the treatment. A few cheering words sometimes relight the lamp of hope and do the timorous and despondent as much or more good than a prescription.” - DWC, 1922
Prepared for Practice
Sioux Falls native David Meisinger is a first-year medical student at the Sanford School of Medicine. As a 19-year-old college freshman on an athletic scholarship (soccer), he was diagnosed with the rare and obscure neurological disorder, transverse myelitis.
“I had had a pretty hard workout a couple of nights before and I was a little stiff, but that wasn’t too unusual,” says Meisinger. “I was in a research class in the library when my legs began to feel like they were falling asleep and it just kept getting worse. Then, I had a sharp pain in my lower back. I told my teacher that I thought this was something fairly serious.”
Meisinger’s plan, even before college, had been to become a physician. His experience as a patient solidified his decision to go to medical school. He’s leaning toward psychiatry as a specialty, but is also now considering neurology or physiatry.
“I recently had the chance to follow my physical rehab doctor who treated me at Sanford, and it was great to have that connection” says Meisinger. “Once you’ve been a patient, you start to do things differently, even the little things. I appreciate that the way you conduct yourself has a great impact on them [patients], and the way you deal with their families.”
Early in the third and fourth clinical years of medical school, research shows a drastic drop in empathy among many medical students. “Patients expect you to be better than you are,” explains Meisinger. But, thanks to his experience, he is hopeful that he won’t suffer the same fate.
“I hope my experience will increase my empathy. If a patient says something that stings or offends you, a lot of the times it’s because they’re scared, not that they’re angry with you. I think that understanding will be a big benefit to me when I start interacting with patients in a few years.”
“Do not get insulted at the foibles and infirmities and hasty and angry…bear with the rude and discourteous treatment you will occasionally receive from the hysterical and the peevish – with their patience down to zero, and petulance and nervous irritability up to a hundred…; never take anything a sick or silly person says in a paroxysm of nervous effervescence, or a period of despondency, or a spell of bad humor, or in great pain (or for want of sense) as an insult.” - DWC, 1922
Sioux Falls Audiologist Robert Froke, MA, CCC-A, has been around the block - more than once. He has been a school-based audiologist, has taught undergraduates at Northern State and SDSU, and has cared for patients from infants to centenarians in the clinic setting. But even his three decades of experience did not prepare him for what happened after he developed a bout of a flu-like illness.
“I was left with a mild to moderate hearing loss and a horrible ringing in my left ear,” Froke recalls. “It was keeping me awake at night and it started to affect my work performance. Not only was I exhausted because of the constant ringing in my ears, but I was also missing things. A couple of times I gave some pretty off-the-wall answers and people would say ‘That’s not what we were talking about.’ Trying to focus was like carrying a 10-pound weight all day. ”
Like his patients, Froke says he “played the denial game”, telling himself that everyone around him was mumbling. “Then suddenly I caught myself. I thought ‘You hear this all the time from your patients!’ So I decided I had better get real about it.”
Although it can take the typical patient seven years to come to terms with hearing loss, Froke took just three months to grieve before taking action. After an MRI ruled out a tumor, his Midwest Ear Nose and Throat colleague Kelcey Cushman, AuD, prescribed a set of RIC (receiver in canal) digital hearing aids that Froke can adjust with his iPhone.
“It’s an absolute godsend,” he says of the lack of ringing. “I feel like I’m back in the ballgame.” Gaining a better understanding of what his patients are going through, even after years of practice, was an unexpected bonus.
“This has really helped me help my patients,” says Froke. “Now, I can be one step ahead of people in terms of my counseling and tell them, yeah that’s normal. That is to be expected as far as your adjustment to your hearing aids or to hearing the world again.”
“I’m kind of taking this lemon life gave me and turning it into lemonade.” These days, he’s serving it to anyone who’s thirsty.
“There is an art, a perfection, in entering [an encounter] with a thoughtful and dignified, yet gentle, manner that clearly evinces interest and a determination to master the case…with a cheerful, self-satisfied demeanor that puts a patient at his ease and inspires confidence.” - DWC, 1922
Note: Our thanks to LifeSource for putting MED in touch with Dr. Broderson. LifeSource works with hospital, transplant center, and community partners in the Upper Midwest to support donor families, facilitate the donation of organs, eyes, and tissue to transplant recipients, and encourage people to register as donors.