The memory is still fresh in my mind more than 40 years later: I was a fourth-year surgical resident at the University of Michigan, shadowing an experienced endocrine surgeon. I watched as he walked into a patient’s room, pulled up a chair and spent the next several minutes chatting about her surgery, listening to her fears and answering all of her questions. The surgeon was present, engaged and willing to spend as much time as needed to put his patient at ease. The conversation was an extraordinary lesson about the power of empathy and compassion.
It’s a lesson worth repeating at a time when doctors face ever-growing pressures to be time-conscious and efficient. Walk into any medical exam these days and you’re likely to find a doctor focused on a computer screen, furiously documenting the visit while barely looking over his or her shoulder at the patient.
This need to work quickly is exacerbated by the relentless demand for productivity. As we quantify the work of medicine, however, we spend less time healing patients and teaching our young doctors.
Physicians receive little formal training in the art of listening. Still, many experienced doctors can identify, often with great passion, how the best attitudes and practices are developed.
The answer, they know, rests in role modeling. Medical students and residents learn by observing how skillful physicians interact with patients and families. This is the “hidden curriculum” of medical training, and it may be the most powerful knowledge we impart on those entering the profession for the profound impact it has on patients.
I’ve learned these lessons by watching some of the best in the business.
When I was in medical school in Philadelphia, I distinctly remember an esteemed gastroenterologist remark that he tried to maximize eye or hand contact with patients without interruptions during exams – both important for earning trust. In other words, he was very much present in the exam room and tuned into his patients. I can’t imagine how he would have reacted to our modern necessity for electronic medical recording of information, which too often takes doctors out of the moment and away from actually interacting with patients.
My surgical idol in medical school allowed me to spend a month with him in the OR and in his office. I remember on one occasion when a patient, cured of lung cancer after a lengthy surgery, bitterly complained about the amount of the bill, asserting that the doctor had no “compassion.” Instead of responding with hostility, the surgeon offered to reduce the bill to what the patient thought was reasonable and consistent with his resources. The surgeon’s composure and willingness to work with the patient taught me even more that day than what I learned in the operating room where the patient’s life was saved.
I’ve learned these types of lessons as a doctor and also as a patient. In 2008, I was diagnosed with breast cancer. I underwent a mastectomy and was referred to an oncologist for follow-up treatment. Rather than see me in her office, the oncologist insisted that she visit me in mine. At the end of her long day, she spent more than an hour reviewing the decision and rationale for chemotherapy and radiation treatments. As she prepared to leave, she embraced me. Her kindness and dedication were nearly overwhelming to me.
I continued to practice medicine and see patients during my illness. In the years since, I have tried to use the many lessons I’ve learned – as a doctor and a patient – in my own practice as a vascular surgeon.
When I meet with patients, I sit down with them, look them in the eye and feel totally engaged. I don’t take calls during these times. The night before I perform surgery, I make a brief tuck-in call to patients at home and tell them that I’ve looked over their X-rays and charts, and that we’re all set. I ask if they have any questions. These calls take just a few minutes, but they are incredibly important. They remind me of how much I depended on my oncologist when I was sick, listening for every nugget of information, every nuance in her comments.
I see positive change afoot with others in my profession. As the surgeon-in-chief at Cedars-Sinai in Los Angeles, I receive written compliments virtually every week about the care and dedication of our physicians and the residents they train. These comments come from patients, families and staff members, and outnumber complaints by a factor of more than 10. Patients commonly write about the time and effort residents take explaining complicated conditions or ensuring that the right food and diet are in place to help patients heal.
When we evaluate residents, we review surgical outcomes and a wide range of behaviors often grouped under the broad category of “professionalism.” While all of this is important, it is just as significant to ask whether we’re teaching our doctors how to listen and to treat patients with the dignity and respect they deserve. That is, after all, our calling card as healers.