Tuesday, February 19, 2019

It's Not About The Pus

To Dr. Sandra Lee. Heartfelt thanks for humanizing medicine and for inspiring along the way...

Several years ago, my daughter Emma introduced me to some videos on YouTube of a dermatologist from California who posted her sometimes shocking but always intriguing encounters with patients who suffered from a variety of dermatologic issues. Of all of these videos, it seemed like the ones which made Emma happiest to watch were the videos in which this doctor's treatment resulted in gallons of pus draining from some part of the patient's body.

Well, okay--Emma liked pus and blackheads. Well, pus and blackheads and massive lipomas (fat-based tumors). Well, pus and blackheads and massive lipomas and big hairy moles. Well...

You get the picture.

With some great finesse and skill, and with a good mix of humor and learning, Dr. Sandra Lee, better known as Dr. Pimple Popper, was able to help many embarrassed patients survive their dermatologic issues, all the while captivating my daughter's interest. "Eewww, gross," Emma said. "Let's watch it again!"

Suddenly, my job as an ER physician was boring. Stories of heart attacks, strokes, traumas, broken bones, asthma attacks, allergic reactions, even drunks vomiting on me at 3 am--none of them held any excitement compared to the ten-year old massive cyst that Dr. Lee excised from a women's scalp or the golf ball-sized lipoma she removed from the upper back of a man who hid it by wearing a draped shirt. Yes, it was intriguing even for me to watch. How was I going to compete with Dr. Lee popping juice out of everything she touched?

I lost my daughter to the wonders of Dr. Lee. "Dr. Pimple Popper is so great, Dad!"

Not only Emma, but soon my friends and family were asking if I did "the stuff that Dr. Pimple Popper does." They too couldn't seem to get enough of the various videos posted on YouTube. And like Emma, more pus equaled more entertainment. Pus that flew across the room--well, that created a giddiness that could not be contained.  

"Yes," I would answer, "sometimes I have to drain an abscess from someone's armpit or groin due to an ingrown hair. Sometimes I have to drain abscesses from wounds, too." For good measure, I added, "And sometimes I have to drain a thrombosed hemorrhoid." I know there are many more invasive procedures we perform in the ER that could be considered similar, but I couldn't think of them quickly enough. At least, I thought, I would get asked what "thrombosed" meant, right?

I was wrong. After finding out that most of my procedures were performed on problems smaller than the size of a tennis ball, my people lost interest.

As the last few years passed, I was happy to catch an occasional YouTube video of Dr. Pimple Popper. Dr. Lee's contagious personality and warm smile, combined with her intelligence and skills, helped her to create a spectacular vehicle, by use of videos, to share the fascinations of her profession. She was a natural at bringing some amazing stuff to eager viewers who were insatiable for her.

On a recent trip with friends to Toronto to celebrate the arrival of 2019, we had returned to our hotel rooms one afternoon to rest for a few hours after a very late previous night of fun. While channel-surfing, I was excited to rediscover Dr. Lee and learn of her new television show on TLC. Desperately needing a nap, I committed myself to just watching her for ten minutes, maybe fifteen at most.

Fifteen minutes turned into two hours. In the blink of an eye.

This time, though, watching Dr. Lee was a very different experience. Yes, all of the fascinating lumps and bumps and lesions that needed squeezed, drained and excised still existed. Yes, white and brown and green and black pus still oozed from the majority of her patients. Yes, many of her patients still found brilliant ways to hide their ailments for years, under wigs and baggy clothing or with caked-on makeup.

This time though, among all the hoopla, I was able to appreciate Dr. Lee's magnificent mannerisms, her empathy, her compassion--her realness, so to speak--in dealing with her patients. Recognizing these things initially, I believe, had gotten lost within all the other excitement. I was more focused on how fast she could duck away from some flying pus rather than her gentle approach to patient care.

For example, after a patient was kindly greeted by office staff and placed in an exam room, the real magic began. Dr. Lee would softly knock on the door of the treatment room before entering, wearing a smile and exuding warmth. As she approached the patient, hand extended in greeting, she would establish eye contact with the patient and introduce herself with a gentle and calm voice (sometimes simply by her first name). From there, if anyone else was in the room, she would turn her attention to them, making sure to introduce herself, repeating the process until she was acquainted with each person in the room. After introductions, she would sit down (yes, sit!!!) and begin her interview with the patient, involving the patient's company, learning everything she could about the reasons a patient was visiting her. Respect was given and received. Eventually, a wonderful level of comfort was achieved.

I could continue on with the importance of Dr. Lee's empathy and compassion while performing a detailed exam, explaining her findings of the exam, reviewing test results and options to treatment, and mapping out the future course of dealing with a patient's ailment, but it all seems rather obvious, right?

Or does it?

You would be surprised at the number of patients who go through the process of a medical encounter only to leave with confusion, frustration, or feeling worse than prior to their encounter. No introductions. Standing at bedside with arms folded, appearing disengaged and aggravated. Rushed conversation. No updates. Abbreviated result explanations and dispositions. This is the reality of an encounter for many patients.

Ugh.

Recently, a close friend of mine had to take his elderly mother to a rural ER twice, in a span of two weeks, for some serious and concerning symptoms. To hear him talk of the vast difference in the care they received, by the same facility but different treating teams, was upsetting. During the first encounter, introductions were made, respect was given, explanations were provided, and a detailed treatment plan was initiated. During the second visit, there were no introductions by either the physician or nursing team. His mother was dismissed or hushed each time she tried to explain her symptoms in some depth. They were made to feel like a nuisance. No rechecks were performed. They sat around for five hours wondering what was going on. Their questions brought no answers. "And Jim," he said, "only about five of the twenty rooms had patients in them." My buddy's family was truly disheartened and discouraged by the encounter.

Years ago, during my emergency medicine residency in Syracuse, we had a physician who gave lectures to us on the importance of empathy and compassion. Being young-guns in a big trauma center, Dr. Ruth's lectures were not nearly as exciting to my buddies and I as compared to lectures on how to drain an expanding epidural hematoma (a potentially fatal arterial brain bleed) or perform an emergency thoracotomy in a trauma patient (rapidly opening the chest between ribs to clamp a sheared aorta or contain bleeding from a punctured heart or lung, for example).

Yet, it was during residency when I truly realized the power and magnificence of empathy and compassion in medicine. Of respect and dignity. Of smiling and bringing into a patient's room good energy. Of sitting down if even but for a few minutes. Of introductions and eye contact to all in the room, not just the patient. Of a warm handshake. Of explaining findings of the exam, of the testing and procedures to be done and the ensuing results, and of a plan moving forward. Of rechecking the patient during their medical visit. Of properly closing the loop of their visit with a goodbye or good luck wish.

Of being human.

This was a crusade I took up while working with our residents as a core faculty advisor. I became Dr. Ruth, insisting on my residents bringing their very best to each patient encounter. While empathy and compassion and ease of conversation was inherent and easier for some residents, for others more time and work needed to be invested to improve this part of their patient encounters. An investment, I stressed, that was worth pursuing.

Yes, the ER gets busy. Crazy and insanely busy. I get it. I've witness it firsthand for 22 years as an ER attending physician. However, all of these things mentioned above take just a few extra minutes. Providing anything less is met with too many excuses. Occasionally, in the emergency setting, it truly is beyond our control that we simply can not provide more empathy or time to a patient (think about a car accident with four critical victims arriving at the same time). Otherwise, if it were me or my family or friend lying in that hospital cot as a patient, I would greatly appreciate those few extra minutes of kindness and compassion provided by the treating medical personnel.

What if it was you or your family member?

Returning to Dr. Lee's TV show, then, on that lazy afternoon in Toronto, I greatly appreciated her kind approach to each patient. Sure, she might have more time working in an office setting that is more predictable and controlled compared to my working environment in a big trauma center. Sure, she is being taped to splice together some great scenes and moments of the various care she provides. Sure, anyone might give a little more of themselves if they know they are being watched. However, Dr. Lee consistently demonstrated her excellent bedside manner with each patient encounter I watched. She excelled and inspired in a part of medicine that is often ignored and overlooked, all for the sake of moving more patients in and out and increasing the billing so more profits could be made.

I could have cared less about how much pus would fly out of her next abscess or where it would land. I was enthralled on simply watching a great doctor doing her job well, from every perspective.

I hope Emma was, too.

Thanks, Dr. Pimple Popper. It was never really about the pus...

As always, big thanks for reading. What are your thoughts and experiences?   

Feel free to forward or share this post. To visit some of my favorites listed from the archives, visit Thank You...

I continue to be amazed with the amount of support and readership. My heartfelt appreciation to all...   

9 comments:

Anonymous said...

Dr. Jim, YOU are the inspiration. I work in the medical field and can only wish for the day I work with a physician like yourself. I discovered you recently and have read through every essay, laughing and crying and cheering and reflecting along with you in each of them. Such amazing storytelling with each of them.
This post is exceptional (sadly, I can't watch Dr. Pimple Popper--too much "juice" for me! LOL).
Please keep them coming. I am a fan!
Kathy

jimbo26 said...

Ah , Dr Lee sat down and talked to the patient(s) and relative(s) , carers . So , she talked TO them , not DOWN to them . Only way to do it .
Thank you Jim .

Katie Axelson said...

I had an appointment not long ago where I felt like the doctor just wanted to push an agenda. His advice and his thoughts were good, but he didn't know enough about me to know they're already part of my lifestyle. I didn't feel like he wanted to know. He just wanted to save the world with his "radical idea" I was already utilizing. Needless to say, I didn't go back. I felt like his methodology was inline with mine but if he didn't want to ask questions to learn that, he wasn't going to listen when I raised concerns (which he didn't). Contrast that with a different appointment that I thought was going to be stressful. The doctor I was seeing had already declined the request I was making once. I went in ready for a fight and a few other concerns I would only bring up if I felt like it was going well. She started the appointment knowing exactly why I was there and with her stamp of approval to go for it. She addressed every single one of my concerns and adequately prepared me for all the realms of possibilities. It was definitely 100% my fault she was running late for the rest of the day, but I greatly appreciate her time and empathy!

Katie

Unknown said...

Jimmy K, Dr Ruth would be proud of you. And Dr Lee has nothing on you either. Its just your style.

Annika Kostrubala said...

It is all about the relationship with the patient. When working in the ED, I always tried to find something in common, and because we are human, there is always something in common. I am no better than any one that is in front of me, just perhaps made some better life choices at important times. I am fallible, and I have made mistakes, too. "Oh my! You cut your hand cutting open an avocado? Its people like you that make me cut them a different way! Thanks! I am glad for vicarious learning!" Or letting the musician know that I understand how important their hand is to them, my hands do my work, too. I won't tolerate anyone being mean to my nursing staff, but I also expect them to realize that we are part of their journey and its are job to help make that as smooth as possible. Standing next to a family member during a code and knowing that my being there is the reason they are standing still, making a kid smile even though they are scared, and having a 90 year old wink at me- these are my reasons for showing up.

I am SO glad you are back with us here in Cyber world!

Donna Ecclestone said...

Excellent post! Fan of pimple popper too! Wish this could be shared with every medical provider - great info!

Beth Nelsen said...

I, too, have learned from Dr. Ruth. As far as I can tell she still does a lot with narrative medicine and healer's art. (I was a med student and peds resident at Upstate, and I still work there!)

Anonymous said...

I have suffered greatly for MANY long years with an excruciating and mortifying condition that tempts me to social isolation. The specialist is Dr. Curt Snooty, and I always leave feeling worse. Now I just won't go. My primary care person says I need to find another specialist. And how am I supposed to do that? I doubt too many doctors like to think of themselves as Dr. Curt Snooty. I can't just phone and say "I have horrid condition X. Will you treat me kindly and like I have half a brain? Or are you Dr. Curt Snooty?"

Advice welcomed.

Ida Rather-Notsay said...

I have suffered greatly for MANY long years with an excruciating and mortifying condition that tempts me to social isolation. The specialist is Dr. Curt Snooty, and I always leave feeling worse. Now I just won't go. My primary care person says I need to find another specialist. And how am I supposed to do that? I doubt too many doctors like to think of themselves as Dr. Curt Snooty. I can't just phone and say "I have horrid condition X. Will you treat me kindly and like I have half a brain? Or are you Dr. Curt Snooty?"

Advice welcomed.