From the Wards
comment 1

Lessons in Medicine: Understanding Patient Suffering

“To most physicians my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.” —Anatole Broyard

When I first encountered Broyard’s quote, it resonated with me on a personal level, as I was reminded of an incident that occurred on my surgical rotation. A woman in her forties was hit by a trailer while riding her bicycle and subsequently taken to the emergency room. Her family had just arrived, understandably shocked and devastated. I remember tears rapidly rolling down her sister’s cheeks. The resident on call beckoned the family over and asked to speak with them down the hall. We walked to a slightly more secluded  location, although still busy with people walking by. I stood there observing the huddled family members, who were visibly numb with disbelief. In stark contrast, the resident stood there disconnected, arms folded, surgical cap on, leaning against the wall almost nonchalantly. I was struck by how casual his voice sounded. The family members cried — he looked uncomfortable and kept the conversation short.

Following the encounter, I reflected on these two contrasting parties. I knew that the resident had been up since 4 a.m. and had been on call twice that week. I knew that his specialty prides itself on toughness and emotional detachment. I knew that over the course of the week, he had already witnessed multiple traumas similar to this case. To him, this woman was just another case, exactly like Broyard describes.

How then, I wondered, can a resident or medical student learn to “perceive the incongruity”? And better yet, how can we forge a stronger bridge between the two mindsets of catastrophe and routine, so that we can meet the patient and family somewhere in the middle, allowing them to feel a greater sense of empathy from us?

One method is through the recollection of our personal experiences with illness. Certain practitioners remember they themselves, or one of their loved ones, feeling sick, helpless, afraid and confused. They can subsequently draw on these memories to find common ground with patients. However, many of us have never had personal experience with severe illness.

What then, can those of us who have never faced major crises do?

I would recommend first facing the discomfort of the situation, that is, to become comfortable with discomfort. Indeed, in the aforementioned anecdote, it was partially the discomfort of the resident that led him to exit the situation as soon as possible. So instead of fleeing, we can endeavor to inhabit this discomfort, to be aware of it and to remember that the patient is 100 times more uncomfortable than we are. Specific behaviors that reflect this commitment to empathize can manifest themselves in ways such as finding a location everyone can sit down, ensuring that the surroundings are quiet, utilizing therapeutic touch and giving space and silence so you can fully listen and be present. By facing these situations and the discomfort that arises within us, we grow stronger as physicians by learning more about ourselves and our patients.

Third, in my own experience, I found that assisting the neediest populations and listening to their stories helped me cultivate this empathetic quality. At our student-run free clinic, I encourage our undergraduate volunteers to take the time to really listen to the patients and hear about all the factors that contributed to their current illnesses. This act of truly listening can help students develop a sense of humility and compassion that will serve them over a lifetime of seeing patients. I urge my fellow peers to take the time to do this now, while we have time because soon our schedules will be so full that we likely won’t have that luxury. By holding these patients’ stories in our minds, we will not only better be able to connect with patients coming from similarly disadvantaged backgrounds who may have life experiences vastly different from that of ours, but we will also be eliciting our practiced compassion during current practice. 

Broyard’s quote eloquently expresses a common sentiment among patients: they often do not feel heard or understood and therefore feel a general disconnect between their grief and a practitioner’s empathy. Finding small ways to address and ameliorate this issue early on will be of huge benefit to physicians and their patients.

Petra Kelsey Petra Kelsey (1 Posts)

Contributing Writer

University of Texas Medical Branch School of Medicine

Petra is a Class of 2016 medical student at the University of Texas Medical Branch School of Medicine.