A day at the doctor's office

I got a call the other day, telling me I needed to come in for an annual woman's checkup. Since my regular nurse-midwife wasn't there this week, they asked if I'd be okay with seeing one of the other doctors in the office.

I didn't recognize the name. I asked, "Why am I coming in, I don't need a pap, right?" They confirmed that I didn't need a pap, just a standard visit this time. This was a relief since the pap is an invasive and uncomfortable test, and I'd rather not have some stranger doing it to me. So I agreed to see Dr. Lava*.

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At the doctor's office I did the usual dance of filling out forms and handing over identification. I went to go to the bathroom, but it was occupied, so I waited. A person came out and I looked up, she stepped one way, I stepped the other and we pretty much crashed into each other. She was tall, a black woman with a round face, her hair in a bun and wearing red nurse's scrubs. She's squishy, I thought, and I had an odd urge to hug her as we tangled. We laughed, I apologized, she smiled and said, "It's okay" and then I went back to the waiting area.

A few minutes later, I was called in by the very same nurse I had just encountered. This was great, because our earlier run-in made it easy to slide into some friendly chatting. We talked about the weather, she introduced herself as Sheila, she asked me the standard questions. She had just started to pull out the blood pressure cuff when we were interrupted by a knock on the door.

A woman I didn't know poked her head inside. She said to us both in an educational tone, "Hi, Sheila's new, so I'm here to make sure that everything's covered." She didn't introduce herself, just came in and closed the door, then leaned against the wall. Whatever kind of relaxed atmosphere that the nurse and I had been building was now stopped in it's tracks because her supervisor was present. The room got very quiet. Sheila had finished the pre-exam steps and was about to leave when the second nurse told me to get undressed and prepare for my exam.

"But...I'm not getting a pap? What do you mean?" I looked at all of the tools laid out on the counter and thought, are those for me?

"No, you aren't having a pap." She said. "But you still get a pelvic exam. It's part of your checkup."

Then they both left.

I had a few minutes to change into my gown and absorb this new information before the doctor came in. Great, that's unexpected, I thought. Now someone I don't know will be poking around my private bits. Fun-fun-fun, I just hope it's over really quickly.

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Dr. Lava came in. She was a tall woman with dark hair and an uncertain smile that didn't seem to reach her eyes.

She held out her hand and said, "Hi, I'm Dr. Lava, I haven't seen you in a long time." "Um, really?", I said, "Because I don't remember you at all." She insisted that we had met before, a few years ago. I said, "Um, okay." Why are we arguing? Then she asked me to lie down to start the exam.

To clearly paint the picture; I'm wearing a paper gown that opens in the front, held together with ties. So I'm nearly naked, cold in the office air-conditioning and flat on my back on a table about waist-high.

Then there was another rat-a-tat knock on the door, and Sheila came in.  She left the door open behind her as she went to the computer. I'm seeing that door open and I'm thinking, I'm barely covered over here, what's going on, when is she going to close that door? I was about to say something when the mystery-nurse came in and shut it behind her with a snap.

I was a little unhappy before, but now I was really squirming. I was remembering now about another time, during my first childbirth experience at a hospital. Then, a large group of nurses and staff came in to watch the big event; live and up-close. I thought, hey, doctor, I'm not some kind of a circus sideshow to be gawked at, I was a person.

I was vulnerable and a little scared now; with all these feelings and memories running around my head. I made a joke to try to break my own tension, saying, "No, no please, invite some more people in, ha ha."  I started babbling, I think I was talking about my time in the hospital. As far as I could tell, no one was listening to me, or if they did they didn't care, because they didn't say anything.

And that was it. The doctor did her exam, and I was out of there in a few minutes.

I walked out the door relieved that it was over, and feeling like I don't ever want to go back. I don't want to see that doctor again. Next time I'll make a different choice.

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I've had many good, positive experiences with doctors and nurse-midwives over the last ten years. The great ones talk with me, they listen to me. They spend time to build a relationship with me. They treat me like a person, using empathy to build a better connection. This wasn't one of those times, and the lack of empathy in the experience was palpable.

How have your doctor experiences been lately?

If you are a doctor, please tell us about your experiences. Were you trained in empathy, do you see benefits (or lack of benefits) in doing your job?

Janet

*As usual, all names have been changed. 

Medical treatment - should doctors build empathy?

It seems that the news is full of stories about how our medical system lacks empathy, how we need to increase it, and the benefits of doing so.

Things like this: Thomas Dahlborg "How a lack of Empathy Affects our Healthcare"

And this: Danielle Ofri "My Leap of Faith in Medicine"

And this too: Jessie Gruman "Adding Empathy to Medical School Requirements"

I see (from the patient's point of view) a big difference in how I'm treated by different doctors, and how it makes me feel.

In a typical doctor visit, I check in at the front desk. I wait in the waiting room. I wait in the examination room. The nurse examines me and asks some questions, then the doctor comes in to talk or examine or give results. I've been having doctor visits just like this for all of my life.

However I've noticed that some doctors interact with me quite differently than others. Case in point; the story of Dr C and Dr V.

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Doctor C

Recently I've been having this twitch around my eye that won't go away. So I took the problem to a doctor, to see how he could help me.

When Dr C arrives, he asks me, "How are you doing?" He makes eye contact. He listens to me talk for a good few minutes, then examines me. He says, "Well, I think it's a muscle spasm, named (whatever)." I say, "Okay, what does that mean?"

He says, "Well, it could be an easy fix, but I'm not certain, so let's talk about your options." I told him about what I had read on the internet. He gave me more information about what I had read; how it could be something simple, but it could also mask a more serious problem. He suggested that I go to a specialist. He also asked me to "let him know" how things go with the specialist.

I thanked him and left.

My reaction coming out of this appointment? I felt listened to, and cared for. I felt like this doctor genuinely was interested in my well-being. I would want to share with this doctor how I was doing in the future. His comments were made in an empathetic way, and it made an impression on me. This was brought home even more when, a few weeks later, I got a call from Dr C's office asking if I had made an appointment with the specialist. I told them "Yes, I'm seeing Dr V next week". They reminded me again to please send the results of Dr V's visit to Dr C when I'm done. I asked, "Why do you need that?" and the nurse replied, "Dr C believes in holistic healthcare; knowing the whole picture about a patient."

This seriously could have been a scene from Little House on the Prairie, people. It felt that good, and I still had no idea what was wrong with my eye! :)

Dr V

After several appointments and tests with Dr V, today I had arrived to get (hopefully) some final results. After waiting in the waiting room and in the exam room, Dr V came in and sat down. He looked at his computer monitor and said, "So, you are here for the results of your test, hmmm?" I said yes. He said, "Hmm, well according to this report, (long string of completely unintelligible sci-babble)." I said, "Okay, what does that mean?" He looked up, and was about to reply when the phone rang in the next room. He said, "Oh, excuse me" and went next door to answer it. I know he was answering the phone because he left my exam door open. I know he was talking to an insurance agency, because of the things he said on the phone.

I was a little embarrassed, because I was sitting on the exam table with the door wide open. I was dressed, and all, but still it was a little odd. Then I got a little annoyed, because I did all of the waiting I'm supposed to, and here he is having a phone call. I mean, I realize that my time with him is limited but seriously? Taking calls?

So yeah, I'm feeling a little miffed but not too much, because I'm imagining reasons why he answered the call (his nurse is out today, he's expecting an important call, etc). I'm trying to keep calm and wait for the translation of the results.

Then he hangs up, and takes another call.

So I'm not feeling particularly respected or cared about at this point. I considered walking out, but I still needed to know what all the technobabble meant. So I waited for him to finish his second call.

Then he comes back in, says, "I'm sorry." He looks back at the computer screen and tells me my diagnosis. I've got a torn disc in my back and a pinched nerve in my neck. I look at him. "What does this mean?" I asked. He said, "Well, you are young. You don't need surgery. Just don't lift anything heavy and come back and see me in four months. Try to relax. Lose some weight."

So here I am, sitting there a little shell-shocked by the diagnosis. I still am trying to process this, and I asked him about ways to treat it and things I can do. I took out my notepad to make some notes. He said, "Don't bother writing this down, I'll print out this report for you with the names of the issues," (which he didn't.) We moved on to the second part of our visit, which was a follow-up test, and that was it. He walked me out. End of visit.

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I can't help but feel the different types of treatment from the different doctors acutely, because of all this thinking about empathy. It's clear to me that Dr C wants to show that he cares about the feelings of his patients. It's also clear to me that Dr V, regardless of how much he cares about his patients, doesn't find it important to show that to us. I feel disrespected coming out of Dr V's appointment, and as a result I feel like I want to take my money and my business elsewhere. As good as he may be at 'doctoring' he hasn't made me feel good.

Dr C and Dr V could be anyone's doctors. I can't help but feel bad for the people who only have Dr V's in their life, and grateful that we have some Dr C's around. 

More empathy in healthcare? Yes, I agree. We definitely need it.