A year later, a patient returned with an unlikely outcome and positive feedback. But, let us not be so naive to think the impact of clinician is always positive. Sampling bias is not always bad I guess, I’m lucky she walked into the medical ICU that day. Hopefully, the impact of her visit will last past tomorrow. Clinicians, after all, are human as well.
I wondered to myself about how easy it was to treat, interact, and generally be pleasant to this patient and her husband. Not that her case was simple, or her progress quick, but the interactions with family, the social aspect was nearly effortless. And, she was full of gratitude and positive energy. Every clinician, at some point, experiences cultivating a strong therapeutic alliance and connection with a patient. Why? It’s likely a complex interplay between personalities, the situation, the patient’s psychological state, and the clinicians current demeanor. The perfect storm. Naturally, variance occurs in our own attitudes, performance, and interactions. Despite her struggles, her long journey, her complications, a surprising lack of complaints, in fact none, were aired. It was the patient room you never dreaded entering. Is it possible I benefited more from the therapeutic interaction than the patient and family?
I also wonder about the patients, the people who are challenging to engage. Those without social support and coping mechanisms. High symptom burden and remarkable distress. Pain. Lack of understanding. Unmet desires or requests. No resources. Learned helplessness. The patient room everyone dreads entering. Difficult, non-compliant, lost causes…or so some would say. How does the previous story end if they return for a hospital visit? I shudder at the potential. Post traumatic stress. Resentment. Acquisations. Confusion. Anger. Sadness. Loss. Depressive symptoms. What happens to those patients? Likely we see them again. By we, I mean the healthcare system. I’d postulate those are patients with a higher degree of medically unexplained symptoms, poor functional status, readmissions, poorly managed chronic conditions, and other complications. I’m sure they never volitionally come back to “visit” and tell their story, unless it’s during another hospitalization. Although, I wish they would, because it’s a narrative all healthcare professions should attend to. It’s easy, and I sense commonplace, to blame the patient in those exceedingly difficult circumstances. We’ve seen other patients do better. We’ve seen other patients understand. We’re trying our best with the knowledge and skills we possess. Why isn’t this person improving? Unfortunately, in such situations, neither the patient nor the providers are likely well equipped to deal with, rectify, or even improve the situation. What can be done to modify our education and approach to such difficult patient scenarios?
Despite the satisfying and motivating effect of this specific patient visit, I’m not sure my personal day to day practice will evolve much from the experience. Hopefully, it remains a reminder on the potential, and long lasting impact of our interactions. Hopefully, it doesn’t lead to arrogance. Hopefully, I can muster the focus and resolve to remember not everyone returns with a happy ending. And, those patients, the difficult ones, need our help too…arguably even more so. I hope I don’t forget the instances, well actually the people, that the system and myself failed…not by direct fault or intent, but because of the convoluted, complicated, regulated, inexact, and at times rushed human enterprise we practice within. Healthcare. Humans trying to take care of other humans.
3 Replies to “A Year and a Day Later”
A nice reflection on the therapist-patient encounter, Kyle.
The stoics are influential on my thinking in the professional setting in that they remind us that we only have control of a small aspect of the clinical encounter, and that control is most greatly influenced by our own character. This line of thinking was concisely expressed by Dr Jason Silvernail, PT, DSc when he once wrote, “When I freed myself from the responsibility for the *outcome* of the clinical encounter, something interesting happened. I freed my patients from blame also.”
The best thing about our jobs, should we choose to look at this way, is that we always get an opportunity to right our wrongs and help those who (we?) have failed – as you point out, those are the patients we are treating today. All we can do is enter each of the rooms/residences as courteous, respectful, quiet (when appropriate), reflective and poised professionals – then we let the pieces fall where they may, and try again tomorrow.
Respect goes a long way.
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