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Perspectives on Building Rapport with Patients


In contempt of a physician

Plaques adorn the walls of this palace
In which the king prepares the script,
The ambrosial answer which remedies
Our pains, bleeds, warts, sleep.

I was accompanied by a fair maiden
Whose song mesmerized my soul’s senses,
For whose fair hand I fought with sword
Against knights, dragons, wizards, elves.

Winning the love of this fair maiden
Became the start of my life fulfilled,
A life blooming, until this cold rain began,
With children, dogs, ponies, snakes.

In slow, warm showers did I feel the tinge
That brushed me as I hung from a mountain,
Aided only by hooks and a trusted partner
With armour, helmet, javelin, shield.

In rapid waves did the lack of feeling creep
Upwards as if coursing within my veins,
Stopping every so often to sample flesh
Rendered useless, frail, gaunt, miserable.

In these duties as a provider I was failing
Bearing my weight upon my fair maiden,
That she may become Atlas within a day
Juggling work, herself, calendars, me.

Oh, the wretched wind that stole my maiden!
In an amicable affair, I was sadly bested
Without the contest I was too weak to attend,
Losing ambition, sleep, appetite, lust.

I am attended in a hut on the forest’s edge
By nymphs and sprites who make me jealous
For the strength by which I moved my maiden,
Carrying truffles, boars, roses, logs.

No one has written in the parchment scrolls
The process of surrendering knighthood
Or the hopes and dreams of a former warrior
Through days, valleys, nights, swamps.

But hush! The king appears in his white robe
And all must shut their mouths for his word.
I must not bother him with my trivial tales
Of conquests, adventures, defeats, play.

In gratitude to a stranger

In this room where the walls have arms,
The doors have eyes, desks have brains,
We approach afraid to even approach
Lest we see that the surgery failed
Lest we see Gramps’ paraded corpse.

Dear God! We imagine the worst as,
With eyes closed and still asleep,
We do not see that his chest is moving
Until he coughs in his baritone voice,
A sound that even doves envy.

Should we touch him? Should we cry?
Should we laugh? Should we leave?
Frozen we stand, as if Medusa’s head
Has magically appeared in this room
To stifle the joy tearing us apart.

Suddenly, someone seems to be talking;
A person dressed head to toe in blue
Who either has allergies or the damn flu
Judging by the mask he has on his neck —
I should tell him to see the doctor.

He tells us about Gramps’ operation
During which there were no complications,
During which the blood in his brain
Was sucked out and whisked away
Where it cannot hurt anyone else.

He says Gramps will be himself again
But that they will monitor him further,
And then proceeds to say the craziest thing,
“Tell me what kind of person he is” —
The wax in my ears may be deceiving me.

Gramps now hobbles to reach the post office
As I keep the car running in this dead winter;
I think kindly about the man in blue that day
Whose letter of gratitude Gramps holds —
I hope he recovers from the flu.

While being inundated with information on most things that are normal and abnormal about the human body, it is important to remember that we learn all this information to treat patients, not to treat diseases. Patients also present with an entire life history filled with hopes and achievements, failures, friends and frustrations. Disease is just one part of a patient’s life. Seasoned physicians will aver that they have blundered by not considering the circumstances of patients beyond their chief complaint or medical care. These same physicians will also attest that the outcome of the care they delivered was enhanced when they considered such circumstances.

I have come to learn that patients do not voluntarily visit a physician because something is wrong; they seek physicians because something has become dysfunctional in their lives, causing distress or an inability to achieve a goal. These could include their ability to play tennis, fear of dying, discomfort from pain or stress at hearing of a friend’s similar condition. It is thus important to elicit from patients how their condition fits into, or interferes with, other parts of their lives. In the spirit of Kleinman, it is worthwhile to ask during the history and physical exam, “How does this affect you?” As a burgeoning physician, always remember to wonder why patients actually come to the hospital as you work through the history and physical.

As the two poems above illustrate, this approach does not just involve patients, but also their loved ones. The stories patients tell are greatly varied and naturally build over the course of a physician-patient relationship. Patients take pleasure in telling them and being listened to. This affinity may make them more likely to become more engaged in whatever you have to say. The poems illustrate that patients can perceive this effort (or lack thereof) by a physician to know them as a person. When absent, they may withhold information, some of which may prove essential to treating them. When present, they will be grateful that you took the time to build rapport with them.

Ogaga Urhie Ogaga Urhie (1 Posts)

Writer-in-Training

West Virginia University School of Medicine


Ogaga is a medical student at West Virginia University and has completed his second year. He intends to pursue a residency in neurosurgery and intends to integrate clinical research into his practice. To this end, he is currently undergoing a Masters in Clinical and Translational Science (clinical research) with most of his research being in neurosurgery. He has been interested in the arts and humanities since high school and came to appreciate the poignant stories various forms of artwork tell during his university career. He enjoys observing all forms of art and actively write poetry (influenced by his love of Victorian literature). He came to realize that patients and clinicians may have their own stories to tell and that the arts and humanities can help all stakeholders better connect with stories of healthcare. In this light, he is currently involved in two projects that are aiming to use narrative medicine to improve patients' quality of life.