Humanism in Medicine

When did it become okay to look the other way, cut corners or treat people like a commodity? Never in my opinion, but the pressures of clinical practice sometimes force physicians into feeling that they need to make compromises for the sake of efficiency and flow, due to ever growing emotional, physical, mental, and spiritual demands. Unfortunately, interpersonal relationships between the physician and patient are often the first to be sacrificed. This is problematic because not only does it reduce medicine down to an algorithmic diagnosing machine, but by neglecting to understand the emotional needs of a patient, one completely misses the art of a being a physician.

A few months into my intern year (the first year of training after the end of medical school,) I had the opportunity to put my own flavor on what I think ideal patient-care should be; namely during my rotation in Trauma Surgery. In this specific instance, I was called for a consult to the Emergency Department (ED) to evaluate a patient who was hit by a motor vehicle. When I arrived at the ED, I was met by an elderly woman, with her face and head colored red. The distinct smell of fresh blood, which carries its own aroma, like salted kale –was present. The woman was confused, shrunken in height, underweight, and I likened the age lines on her face to a navigational map of her life. One thing struck me – her piercing blue eyes with a sense of resolve and determination; they told me all I needed to know about this woman, not only in her current state, but also in her earlier years.

After tending to her medical needs and stabilizing her in the emergency room, despite her injuries this patient was adamant about going home. I learned that after she was struck by the vehicle, she lost consciousness, woke up and walked to her apartment while bleeding profusely from her head. She lived alone, completely independent at an age when having assistance in her life would be more typical. Admitting and accepting the need for help and being physically incapable of doing things one once did effortlessly is one of the harder truths to accept; like an athlete past their prime, a career comes to an end.

In the chaos of the emergency room, it is sometimes easy to forget about individual patients and their specific needs. On several instances she wanted to sign out against medical advice (AMA) while still in the ED because she felt neglected. Her comments about care were candid, but on the mark. However, to a tired and overworked ED crew, her concerns may simply have been perceived as being troublesome. It took me 45 minutes to explain to her that given her injuries and current status, it would be ill-advised to sign out AMA. Forty-five minutes is often difficult to spare, especially on a single patient in the ED. Rather than telling her about her limitations and current precarious state, I demonstrated them through her inability to walk or bear weight on her injured leg and hoped that she realized staying in the hospital was the best thing for her. My plan worked and she agreed to stay.

She was only meant to stay until she was medically stable, but on pan-imaging (total body imaging that scans for injuries), we incidentally found a breast mass. This led to a week-long pending matter on a trauma service where her new medical findings really were not trauma related. I learned that she was alone, divorced, estranged from her only child and reliant on friends whom she held in high esteem. She had not been to a physician or filled a prescription in years. I was concerned that if this patient never had her breast mass investigated she would be lost to follow-up. I presented my case to my attendings and they supported me 100%, despite it not being something commonly done on the trauma service. It was problematic to get her mammogram due to policies, and it was equally as troublesome to get a breast biopsy. For the first time, I spoke to other physicians and discussed my concerns with them and hoped that my novice experience did not carry the theme of an over-achieving intern.

To my surprise, my input as a medical professional was valued. There were several counter-arguments made about this woman not having a breast biopsy in the hospital because of the liability of discovering a possible malignancy and then follow-up being required and necessary. To me, that was a non-issue – if this were my mother, I’m sure I’d feel that she deserved to know regardless of the administration policy or receiving payment for our services.

I’m pleased to report my advocacy for this patient, with the support from my attendings, was successful and we got the breast biopsy. During her entire stay in the hospital, her independence and her insistence on exceptional care aggravated many staff and personnel; if she did not like something, she let it be known. Although frail and weak, her piercing eyes showed she meant business.

I routinely spent at least 15-20 minutes of my time after my work was done daily with this woman, talking to her and learning more about her life. Spending time with her made it very clear to me that she was not suffering from dementia or being difficult just to be “difficult.” What I saw was an aging woman, who felt insecure about her well-being because she had lived an independent life for so long and now found herself in an unaccustomed circumstance. She was alone, scared and filled with anxious questions of the unknown; all completely normal.

I held several family conferences with this patient and her estranged child. It is a noteworthy observation that tragedy helped to mend a fractured relationship. As this woman’s stay in the hospital neared its end, my joy was most shared with the social worker, my fellow residents, attendings and nursing staff who worked with me to place this woman in a facility for the short term until her child would be able to take care of her. We worked as a team to not only mend her physical wounds but begin to heal her emotional wounds that were undermining her future care.

During my last visit with her, she cried, and asked me for a hug. How could I say no? She told me through this journey of being hit by a car to possibly having breast cancer, she was just so scared, and I was the one constant in her life that was tangible. It was rewarding to be able to pick up on and care for her emotional needs. Had I not taken the time to develop a relationship with her, I worry that her health outcomes may have been completely different.

The responsibility of being a physician is not just about making accurate clinical decisions, or acting the role, but also about making morally correct decisions that uphold the value of being a physician regardless of monetary incentive. Like this woman with her piercing gaze, determination and resolve, we, too, as physicians should develop the resolve to emphasize patient care as a priority and let everything else become secondary, because like lost time, a lost patient care opportunity may never be regained.