Tuesday, May 1, 2012

The Interview

A few years back, my wife and I were sitting on our living room couch watching the local evening news when a segment ran regarding a patient's option, often neglected, to interview a physician prior to agreeing to receive care from that particular caretaker. The interview, the segment continued, could involve questions ranging from professional training to personal attitudes and outlooks on life. Not a bad idea, I reasoned, if the required care was non-emergent. A physician sharing a similar perspective of his patient's well-being could only be beneficial, right? But in an emergency room setting, wouldn't this type of interview only delay necessary treatment? I couldn't imagine a patient with crushing chest pain taking the time to ask me of my residency training (Upstate NY) or how I felt about fitness training (all for it).

Of course, I was wrong. My following shift, I encountered an older, scholarly-looking gentleman who had presented to our department with complaints of acute abdominal pain. After introducing myself to both himself and his wife, I began to ask the patient important history questions when he suddenly interrupted me.

"Doctor," he asked, "before I agree to let you treat me, can you tell me where you went to medical school?" Although surprised, after watching the news segment just two days earlier, I anticipated that an encounter like this would eventually happen. "In Philadelphia," I answered. "And where in your class did you graduate?" "In the top ten percent," I replied. His questions kept coming. "And where did you complete your residency?" "Did you serve as chief resident your final year?" "How long have you been working in this emergency room?" As I patiently answered his questions, I began to wonder if the word "acute" was the right word to describe his abdominal pain.

Finally, though, he appeared satisfied with his interview. "Okay," he said, "I give you permission to treat me."

"Well, sir," I said, deciding to turn the tables on him, "I am not sure I want to treat you." I caught him off-guard. He looked inquisitively at me as I paused for good effect before continuing. "I have one question I want to ask you before I agree to treat you."

"Okay, Doctor," he said, "what is it?"

I took a deep breath and smiled as I spoke. "How will you be paying me for your visit today?" We both laughed. Regardless of his answer, he knew I would be his treating physician.

I hadn't thought about this encounter until just recently, after I had walked into Room 17 to introduce myself and examine a patient my resident was currently treating.

In the dimly-lit room, I found Bertha, alone without company, lying in a cot with hospital blankets pulled up to her chin. She was a 93 year-old woman sent to us from a local rehabilitation unit with complaints of chest pain. She had been placed there recently to recover from a bout of pneumonia. Bertha looked her age, appearing frail in size, her tiny body barely poking it's physicality into her covering sheets. Her face was graced with creviced wrinkles and framed with an unkempt gray bob. Her hazel eyes, however, belied her years. They were fierce and focused, guarded even, glistening with anticipation as I approached to introduce myself.

"Hello, ma'am," I said, reaching for her hand under her covers, "my name is Dr. Jim and I will be following your treatment today with Dr. Brad, one of our resident physicians who I am supervising."

She looked me carefully up and down as I continued. "Is your chest pain gone?" She nodded yes to my question. "Do you need anything right now?" She nodded no. "Is it okay, ma'am, if I listen to your heart and lungs?" She nodded yes.

I pulled my stethoscope from around my neck, placing it's diaphragm on her chest wall while inserting the listening buds into my ears. While bent over her and listening, I watched her face closely, appreciating her unique eyes. Suddenly, though, her lips moved. Unable to hear her, I stood up while removing the ear buds. "What is that, ma'am?" I asked.

With a soft, quiet voice, she asked me "Where did you go to medical school?" I told her. "And where did you do residency?" I answered her again. "Do you enjoy being a doctor?" I told her yes, very much so. I wasn't sure if another interview was in my future, so I flipped the coin on her.

"Why do you ask, ma'am?" I questioned her. "Did you once work in the medical field?"

She shook her head. "No, I didn't. But my daughter was going to be a nurse." I waited for her to continue but she seemed absorbed in her memory. "What happened?" I finally asked, my curiosity peaked. "Unfortunately," Bertha answered, sadness sweeping across her face, "she wrecked her car late one night while driving home from a training shift and died. She was nineteen."

I grabbed Bertha's hand again and held it, humbly reminded that every face I encounter holds a story. And quite honestly, I could not even begin to imagine the pain that would come with losing a child. "I'm so sorry," I said, stroking the back of her hand.

"Don't be," she said, "I still had a wonderful life." She went on to explain that she had six children total, four of which were still alive but unfortunately not nearby geographically. This explained why she had been placed into a rehab unit from her assisted-living arrangement while recovering from pneumonia. "They are here, though," she said, lightly tapping her heart with her free hand.

After another pause, I had to ask my next question. "What happened to your other child?" "Oh," she answered thoughtfully, "we had a retarded son that died in adulthood. My husband and I managed to care for him at home until he passed." She went on to proudly explain that it was no small feat to raise a mentally-challenged child in earlier days--that most were institutionalized. "And your husband?" I asked. "Well, he and I were married for 53 years before he passed away. That was quite a few years ago. But, we managed to stay together and keep our love the whole time." We talked a few more minutes, her insightful words leaving a significant imprint upon me.

Finally, I finished my exam. Before leaving her, I thanked Bertha for her time and for sharing her life story with me. Happily, she did very well for us in the ER and was admitted to observation.

Just returning from my recent unplanned medical leave, I felt Bertha's story grab my shoulders and shake me. Not just shake me, but rattle my soul. My encounter with her was a well-timed reminder of just how privileged I was to be an emergency physician.

And suddenly, it dawned on me. I was the one who benefited most from the interview process with a patient. Sure, there is history-taking involved with my job, to find out the specifics of an illness that might help me provide the most focused and complete care to a patient. But this other "stuff," this personal information that a patient shares with me, isn't this more like an interview? I don't necessarily need to know everything a patient shares, but doesn't it all provide a much more complete picture of the person I am trying to help? And, besides, can't some of my patients' shared life experiences help me along my own life's journey?  

A resounding yes and yes, if you ask me. I think I'm going to call the local news station and thank them for their meaningful segment...

As always, big thanks for reading. Also, a HUGE thank you to all the personal emails and posted comments from my last posting. Your warm welcomes and kind words are greatly appreciated. I have some of the coolest readers ever...                 


Lisa said...

Unfortunately most patients requesting an interview are rebuffed by the scheduler. I've never been granted one and it only lends to years of doctor shopping.

Liz said...

dr. jim: thanks for posting this poignant story. i've never interviewed a doctor before, but i am so thankful for those doctors who are surrounded, not by a wall of professional aloofness, but by a warm, compassionate nature. i know you say you're the lucky one, but it's clear your patients are pretty damn lucky as well.

jimbo26 said...

Sometimes , just being there , is healing in itself .

Katie Axelson said...

I've never interviewed my doctor. Although, last time I called to make an appointment, I had to have a new patient appointment because I hadn't been in so long (and then I ended up moving before it came to fruition). But I've been to the travel doc twice and never done an interview, just basic conversational questions.

<>< Katie

Shash said...

Lovely story. Thanks for sharing a true revelation for you.

I did walk away from further care with a doc who treated me in an emergency. She was not an ER doc. Her clinic was miles closer than the ER however. I appreciated her taking care of me in an emergency situation. I did not appreciate her overall attitude that I could not be trusted to think for myself.

It was an experience with a doc like you (one who listened) that made me go find someone else for my continued care. Because, you see, I knew that that I could find such a doctor.

Thank you for listening to our stories.

sew said...

I switched care providers late in my first pregnancy after it became clear that my values did not align with my doctor's. If I had done an interview early on, I might have chosen someone else at the outset.

Later I lost a baby and had to have a D&C. I interviewed that doctor too and he turned out to be wonderful.

I hope learning more about your patients can help protect you from some of the cynicism out there. And boy, it is *really* nice to read your posts again. Thank you for coming back to this blog.

Amy said...

Great post. Great hearing from you again :)

Anonymous said...
This comment has been removed by the author.
kate-monster said...

My better half is an emerg doc and your blog has helped me immensely to better understand both the rigors of his day to day but the often overlooked joy it brings too. Glad to hear you are back, healthy and happy just in time for a beautiful summer.

CT tech said...

Thank you for this story. It reminds me of why I work in helath care. There are such amazing people out there, if you can take the time to find out about them.

Winking Doll said...

Thank you for sharing. I just finished my first medical clinical training at a Canadian hospital. I agree that it is a privilege to listen to the stories of the elderly clients, some of whom are almost centenarians. Many have lived through The Great Depression and both World Wars. Stories about what matters in life when one looks back upon it.

N. Love, RN said...

Having worked in the ER for many years, I do miss the "medicine" yet it's the "stories" that made it worth while---whether being asked(Oh! How I loved to speak of my children and my experiences in my work)or told,(an inner city hospital presented many "stories"...)I miss those aspects of the work the most. Thanks for validating that aspect of the work for me.

SeaSpray said...

Beautifully written Jim. Thanks for sharing.

My favorite sentence, "I grabbed Bertha's hand again and held it, humbly reminded that every face I encounter holds a story."

Would love to have you as a family physician. :) Your patients are blessed. Of course you are ED doc and so would like to know any ED doc I encountered was as thoughtful and compassionate as you are. I agree ...shared life experiences can help us on our journey ..as well as sharing our stories can help others.

Karen said...

Funny how life gives us lessons. Beautiful post.

Empress Bee (of the high sea) said...

gosh i missed you doc. i am so glad you are back, i love reading your posts...

smiles, bee

J-Quell'n said...

I used to read your blog when you first started writing a couple of years ago, but life got busy, and I wasn't able to keep up with it. Luckily, life is slowing down as Medical Technology school is coming to a close, so I am able to keep up with my medical blog readings much better. I'm happy to have jumped back on board and see you are still the same amazing writer I read long ago. As always, thank-you, Dr. Jim for your inspiring stories.

Tony said...

This kind of post is the reason I'm volunteering in Hospice. Thanks for sharing. Very good stuff.

Anonymous said...

I've kept you on my favorites list, waiting for your return. Thankful that things went well with you. Glad you're back!

Anonymous said...

I had an interview for a PhD program the day after you wrote this post, so it was interesting to think about the many dimensions of "the interview" before attending my interview.

Cait said...

As a grocery cashier, I am continuously surprised, educated, and moved by the stories my customers share with me on a daily basis. I draw a parallel between these experiences and those I observe as I shadow physicians in preparation for medical school (applying this summer). I have taken note of the medical professionals who take the time to truly listen to their patients. What an invaluable skill. Thank you for recognizing and writing about the importance of seeing the patient as a whole being.

Cait said...

As a grocery cashier, I am continuously surprised, educated, and moved by the stories my customers share with me on a daily basis. I draw a parallel between these experiences and those I observe as I shadow physicians in preparation for medical school (applying this summer). I have taken note of the medical professionals who take the time to truly listen to their patients. What an invaluable skill. Thank you for recognizing and writing about the importance of seeing the patient as a whole being.

Anonymous said...

Glad you're ok! Glad you're back!
I appreciate reading your insights.

Quilters' Quarters said...

My family doctor retired after forty-or fifty years of providing medical care. I miss her common sense, no nonsense approach to care. "It only hurts when you do this? Then don't do this."

My neurologist retired just as I was trying to figure out how to tell him that I was switching to a female neurologist. I went to him for only a few years, but they were significant diagnostic years; I titled my book Multiple Sclerosis, an Enigma because I was his enigma. Even now, when something happens to my health, I think that he will be surprised ... but he won't, because we are not in contact.

Doctors become family.

Quilters' Quarters said...

Thank you for writing this, and sharing the experience with all of us here.

I have never interviewed a doctor; finding one that would take on a small family (when my doctor of many years retired) was challenging enough.

I'm fortunate now to have a family physician again, and he is the quiet center of the medical 'team' of physicians who are specialists and who treat me for various ailments that came along in my retirement. I have many 'osis's': multiple sclerosis, hyperhidrosis, osteoporosis, scoliosis, and more recently, depression, malignant melanoma, and hypotension causing syncope and secondary seizures.

I have specialist doctors for all of that, but consider my family doctor as the doctor to go to when I just want someone to pay attention to me as a person.

He does that well. I bet you do, too.


Peter said...

Having worked in ED I was aware of the level of competency of each treating Doctor. Be they a newbie or not. Having said that, junior doctors that is, if ever they had a problem they would seek the guidence of the senor ED doctor.

The cost of treatment was never a task of a doctor; which was left to the ED clerical staff.

Overall I was happy with the level of care given to a patient by their treating doctor.

Take Care,