A Frustrated Patient

Perched on a stool off to the side of a small exam room, I opened the chart of our patient, “Dave”, and glanced at the notes: anxiety, depression, and migraines. He’d already had a few visits with a behavioral mental health counselor, but he was a new patient for Dr. P.

As a volunteer scribe, my responsibilities lay in documentation. As he entered the room, I clicked around in his electronic record, inputting initial information and getting ready to take down the “History of Present Illness”. I looked at the score on his depression screening for the day – it was a very high score, but he’d marked a zero for suicidal ideation. I let out an inaudible breath of relief.

He dropped heavily into the chair across from Dr. P, foregoing the one closer to her, and then burst out “Where are you guys on the medication approval for my migraines? I have been waiting for weeks to hear back.”

The tense visit unfolded in my notes in the condensed, direct language of medicine:

Patient was recently laid-off from work and had to change insurance plans. In clinic today to establish care and get migraine medication.

Did it capture the trauma of his lost job and the uncertainties he faced in this change of medical coverage? Was I conveying his fear, as he counted down the pills he had left and the hours until he faced pain again? His hands ran forcefully through his hair, and he rubbed his temples as if the migraines were haunting him there in the exam room.

All Dave wanted from the visit was a prescription for the migraine medicine that was effective for him, but his new insurance company was requiring proof he’d tried all other alternatives; they’d rejected his medication coverage request. Getting the records from his previous providers was going slowly. As Dr. P explained all this – calmly and directly – I sat quietly and clicked haplessly between screens in his chart. There was nothing I could do.

Frustrated, Dave shouted and swore loudly. He was gripping his knees, nearly shaking in his chair with anguish.

“Nothing gets done in here unless I YELL about it!”

Dr. P kept her calm, trying to explain. “There are few things I can do right now,” she said, but Dave was shaking his head and furious.

“I’m just another patient, just a number – you don’t feel my pain! You don’t care!!” he shouted.

Now it was Dr. P who shook her head, “We do care about you. We are doing our best. I am doing my best, okay? But I am not in charge of this. I am going to work on it and see what I can do.” Dave was quiet, but distraught. When it seemed there was nothing more to say, Dr. P got up, opened the door, and went to arrange for next steps with the clinic staff.  I was still perched uncertainly on my stool; I had stopped taking any useful notes a while ago.

Dave got up, but half-way to the door he turned back to me and in a plea for understanding said, “You get it, right? I can’t get any help! I just need someone to fight for me and to make this right. You understand, right?”

As a scribe, I was mostly quiet during appointments. My goal was to be helpful and unobtrusive. But very clearly in that moment, I was also part of the team. Though “only” a scribe, a volunteer, a pre-med, I was part of his care.

I looked at Dave directly and told him that I did understand. “We’re on your team, and we’re going to do everything we can. Us, your counselor, we’re all in this together, okay?” I hoped I was conveying my compassion and the empathy I felt imagining him running low on medication, facing the possibility of incapacitating pain. I hoped he could see that I believed him.

Like the crest of a wave, his anger broke and tears rolled down his cheeks. He sat back down in his chair, deflated. The tension dissipated with each small sob and shuddering breath. Just then, Dr. P came back, with forms and information from the front desk in hand.

“Ohh,” she uttered gently, moving to his side and taking his hand. “It’s going to be okay. Just breathe.”

I slipped out quietly to grab him a glass of water, and returned to find them speaking kindly to one another.

“Thanks,” Dave said to me, taking the cup. He sniffed and wiped his nose with a Kleenex. Giving Dr. P a conciliatory look, he said “I’m sorry. I just need to get results and I didn’t know what to do.”

Dr. P was gracious, “I understand. I’m sorry I was blunt. We are going to work this out, okay?”

As a pre-med, it’s easy to feel like the true beginning of everything will be the admission to medical school. But, in truth, we have already begun. We are already learning the art of medicine. If we watch, we can learn how to listen and communicate with patients. As we crossover into the medical world, the best we can hope is that we don’t forget this time before we were doctors – when all we could offer was our presence and compassion. And sometimes a glass of water.