Sharon Roman: Notes from the less comfortable chair

sharon_romanAs someone with chronic disease and comorbidity, I have benefitted from the knowledge and expertise of a great number of doctors. Sometimes you’ve only known me as an image on a screen or a cluster of numbers and counts—another name and health number—the ubiquitous patient. Some of you I have met in passing, a shorter but urgent visit. A person, a patient, and yet still a face in the crowd. Then I have my personal network of doctors who know me as a patient, a person, and an individual. Try as I might to avoid you, I know that ours will be a lasting relationship.

Occasionally mistakes occur, messages are mixed, or emotions run high and spill out. While we have not always had a mutually satisfactory appointment—sometimes our personalities get in the way of our working relationship—I need to tell you bluntly that I am worth every ounce of effort and every moment of your time and expertise. Aren’t we all?

Sometimes a consultation can be frustrating or upsetting—perhaps for both of us—and I admit that I have let it get the better of me and delayed making my next appointment. Conflicts do occur, and naturally so. Had we met at a cocktail party we would simply avoid each other for the rest of the evening. You, however, must make a note of our meeting and that note stays with me wherever I go. Our visit becomes part of my medical history and while you may write me off and move on, I cannot do the same. The letter you create is a heavy responsibility, and it is not one to be taken lightly.

Try putting yourself on the other side of the desk in the less comfortable chair—literally. You will be surprised by what you can learn. A specialist initially met my use of the more accessible chair (which, incidentally, turned out to be his) in an empty examining room with surprise. He quickly covered it up and my appointment was finished in this unconventional seating manner. He was willing to adapt to my physical needs and comfort, and he will forever stand out because of it. While I am certain that it made for some interesting table talk, it also made for a remarkable working relationship to this day. Be malleable, each person is different, even if we are all in your office for the same reason.

While years of experience may make for a knowledgeable doctor, years of listening help make a great one. I am aware that I may talk too much, but I also need to feel heard. Listening may also make it a more beneficial visit for you as well.

For better or worse, I have been a part of many residents’ training. They are eager students, patient, straining to catch everything correctly; and while I at times begrudge the extra time and repetition their presence requires, the difference in attitude is sometimes striking. Feeling awkward and overtired can be mutual, but greeting my small stab at humour with a laugh can relieve the tension on both sides. And please, do not refer to me in the third person in my presence. Consider that I am a person first and a teaching example after.

Perhaps you have been a practitioner for many years and think that you have heard and seen it all before. A disingenuous smile can also come across as condescending and well practised. Someone else’s letter may have influenced you. Listen to what I have to say without prejudice, not racing ahead to the answer you may or may not already know.  Allow me the dignity of asking questions and expressing my concerns. I may have some valid concerns and points. If I happen to ask a good question, be generous and say so. If it is not a good question, be gracious and answer it anyway. Encouraging a thoughtful discussion yields better results for us both.

While they may not always be appropriate, the human touches are sometimes needed and can go far in reassuring a patient. After learning that an ugly, visible disease related rash was here to stay, I was paid a quiet compliment meant to soothe. A simple gesture really, but in that moment it helped. Years later, I still remember the gentle brush of my forehead by the post-operating nurse, but not her name. And after my family physician told me to go directly to A&E and check in, his presence startled me as I spoke with the triage nurse. Knowing that I had no family in the city, he gave me his home telephone number and told me to call if I felt that I needed to. I never used it; the solace it gave me was enough. I am not advocating that everyone do these things or that it becomes routine in your practice. These are examples, both large and small, of doctors and nurses who have made a difference in my life.

Remember who you were at the beginning of your career, but use the knowledge you have gained since then. Try to remain engaged and retain your curiosity, open mind, patience, and desire to understand–both the person and their problem. For patients, the feeling of being heard and understood, not just seen, is so important. Occasionally, a patient requires extra time and energy, but the additional effort may make a difference.

This may seem like a lot to ask and some days it will be a chore. Yours is a challenging profession and demanding at times. It includes hard science; some imperfect science; and, occasionally, a hunch. Yet it can also reward: not only you and the person in front of you, but the web of family and friends that surround your patient, and who are also grateful for their care. I write this with thanks and appreciation for the excellent care I have received, the lessons I have learnt, and hope for what this simple note can achieve.

Sharon Roman studied economics at the University of Toronto and Simon Fraser University. She had her first MS attack around the age of 30.

Competing interests: None declared.