William Cayley: Awkward is when they need us

bill_cayley_2“I just hate this sort of thing.” When I overheard that at a recent funeral, as we waited in line to greet the bereaved family, I thought to myself, “How sad . . . and how true.” Sad, because times of grief are when others need us most, but also true, because most of us find talking with the grieving awkward, and we don’t like it.

Before entering medicine, I trained as a hospital chaplain. One of my wise teachers impressed on me the principle that—when talking with patients—if something difficult, challenging, or awkward about the situation crosses your mind then the patient is probably already aware of it. For example, if you think a patient may be concerned about cancer, they probably already are, and broaching the topic may actually be more of a source of comfort that someone is actually listening, rather than a distressing introduction of a new worry. Listening to our own inner sense of discomfort can be a decent indicator as to when a patient is in particular need of comfort, support, or companionship.

A similar thought crossed my mind recently as I contemplated a phone call. Right now, I know two people (fellow doctors, no less) facing imminently terminal cancer. While driving home recently, I thought about making a quick phone call to one of them for a check-in—to catch up and see how he’s doing—then my next thought was how tired I was, and that I may not be ready for a potentially emotional phone call. In the end, I did call and was glad I did, but I realized later that had I hesitated and not called, my feeling of awkwardness over the hard situation my friend faces day in and day out could have potentially robbed him of whatever small comfort my call may have offered. When you get down to the nuts and bolts, the more important consideration is that my friend needs comfort and support, not that I need to escape feeling awkward.

Another periodic (though hopefully not too frequent) place of awkwardness, is when we as doctors make mistakes. In a recent blog, Richard Smith eloquently argues that “the best doctors not only acknowledge and learn from their errors, but journey with the patient through the pain they’ve created, no matter how uncomfortable the journey.”

As medical professionals, we are called (I was going to say “trained” but maybe our training for this is not the best) not simply to care for our patients, but to help them deal with the tough stuff. Babies may deliver naturally much of the time, but the obstetrician who is trained to deliver babies, is trained to be there not only when it goes well, but to pick up the pieces when things go badly.

So too, we as physicians are called, and should be trained (I hope), not just to discuss risks, benefits, evidence, and numbers needed to treat, but also to be there to journey with our patients through the awkward patches. And this applies whether those awkward patches are of the patient’s making; are seemingly random “bad luck” events (a cancer diagnosis, death of a family member); or even awkward moments of our own making (a missed diagnosis, a procedure gone badly, an expensive medication misprescribed).

In another recent blog, Neal Maskrey makes a passionate case for “the importance of kindness” (please read his blog—it’s excellent). There are many different ways to bring more kindness into medicine, but I would argue that one important way is to keep our emotional perceptions tuned in to when we feel the most awkward. Is it the angry patient? Is it the mistaken diagnosis? Is it the bereaved spouse? Is it the upset or hurting member of your own family?

I am far from perfect, and I feel a bit of personal conviction even as I write this, but I think it’s true that we can use our own internal sense of discomfort, hesitation, or awkwardness to get a sense of when those we are with may need us most.

When it’s awkward, that’s when they need us.

Dedicated to TS, DE, and CB.

William E Cayley Jr practises at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: “I declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare beyond a passion for clear and critical thinking.”