Getting to Know You

Rebecca Bechhold, MD

One of my most memorable mentors was Dr. F. He was 6'4", athletic, and had a booming voice and a piercing gaze. You could not hide from him. You might have expected patients at our university hospital to be somewhat intimidated when a crowd of white coats led by an imposing figure walked into their rooms early in the morning, but Dr. F taught us, while making bedside rounds, how to make patients feel comfortable.

One tip of his that I have used repeatedly is I always note where a patient lives. It not only can give you social context, but if you know anything about the city you inhabit it can give you a jumping off point for a common bond.

You may not live near your patient’s neighborhood, but maybe you know that ice cream store on the corner. “That’s where they have the great soft-serve!” Or you can note their religion, as maybe you pass by their church, temple, or mosque.

Do they have children, grand kids? Where do they go to school? “I always see kids on the slide when I go by there!”

How about finding out where they work? The IRS? “Can I have a direct number for the help desk?”

You get the picture. It only takes a moment to find a sliver of common ground, something to make you two humans trying to fix a problem.

Last week I saw a patient for the first time-incredibly sad. Completely normal life, enjoying her time caring for her granddaughter each day while the mother works. Active, happy, no pain or weight loss-nada as far as symptoms. On a routine physical her liver enzymes are abnormal. CT shows a pancreatic mass and diffuse liver metastases. Biopsy is as expected. Inexplicably she is sent to a specialist who has no role in her care, says as much, and tells her she has 3 months-specifically 3 months-to live. Then she’s off to an oncologist who recommends immediate chemotherapy.

When I saw her she came with her husband and a sibling. She was devastated and had trouble controlling her tears. She and her spouse were very intelligent and had excellent insight and questions about her cancer and her options for treatment. It was such a difficult conversation for her that I was searching for any positive note. I asked her about her granddaughter and she mentioned a pony. With that I found my opening. I ride, my daughter rode and competed. I asked if she had any pictures and cell phones were immediately produced bearing dozens of photos of the child, her horse, and her show ribbons. Smiles came out, anecdotes, commiseration over the costs but also recognition of the immense benefits of taking care of a horse and the maturity it instills in a child.

I am not saying finding personal interests to discuss makes it all better-the cancer is still there, the patient and family still have a grave disease to confront-but in this case it allowed this patient to voice her joy over what she had been able to do with her beloved granddaughter. It was an important accomplishment in her life and, as we both agreed, it is something that will positively impact her granddaughter’s life forever.

A former colleague used to refer to patients by their diagnosis, as in “the lung cancer in room 3.” I would cringe when I heard that. Perhaps it was a form of self-protection. I admit I sometimes struggle to keep my own emotions in check, but I would rather fight back my tears than never have that personal connection, however thin, to each one of my patients.