In today’s healthcare environment, we are all driven to see more patients in less time and do more with less support. Obviously most of this is financially motivated–the delivery of medical care had unfortunately become more of a business than an art. As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now crafting the rules of engagement. Physicians no longer have the luxury of time for a leisurely patient visit. No longer do we have the time to routinely ask about the grandkids and the most recent trip that our favorite patients have taken in their retirement. Ultimately, it is the patient who suffers. Those who are ill and those who love them often need more than pills, blood tests, IV fluids and heart monitors–they need support and genuine caring. These patients and families need a doctor or other healthcare provider to sit on the edge of the bed and unhurriedly listen to their concerns –to simply chat for a bit. Unfortunately, this is no longer the norm. Luckily, we have dedicated caregivers on the front lines in our hospitals who can often fill the gap–nurses.
I was moved last week as I read a wonderful article in the New York Times by Sarah Horstmann. In the essay, Ms Horstmann (a practicing Registered Nurse) describes her special connection to a few patients and their families on the orthopedic unit in which she works. Ms Horstman chronicles her struggle with remaining objective and professional in her role as nurse when she becomes emotionally invested in her patients. She paints a picture of an engaged and caring nurse who is able to put everything on the line for her patients. Her internal struggles with “crossing the line” in her care for the patient is one that we all as healthcare providers have faced at one time or another. However, she handles her feelings and her patients with absolute grace. We can ALL learn a great deal from Ms Horstmann. We should all strive to feel and care as deeply as she does. Our patients and the care we will provide them will certainly benefit greatly.
In my experience in medicine, it is the nurses that often lead the way for all of us. I have particular poignant memories from my training of nurses on the hospice care unit at University of Virginia hospital These nurses set a remarkable example of compassion and connection. I have been forever impacted by witnessing true caring–crying, grieving and comforting dying patients and their families.
As a whole I have found that many nurses go beyond what the physician is able to do in short encounters. Nurses spend the time required to get to know the patient–their fears, their thoughts about disease, their thoughts about their own mortality. Nurses understand family dynamics and can help in managing difficult family situations. Nurses make sure that above all, the patient comes first–no matter what the consequences. The very best nurses that I have worked with over the years are ADVOCATES for those who are too scared or too debilitated to advocate for themselves. Many times early in my career, I did not pay attention or listen to the lessons that were all around me on the hospital wards. However, as I approach mid-career I am much more attune to these very same lessons that I may have missed earlier. There is much gained when we watch and listen to others who are caring for the same patient–maybe in a different role–but caring for our common patient nonetheless. I now realize that nurses have “shown me the way” many times and for that I am truly grateful.
In my opinion, emotional investment and developing patient connections can improve care and assist patients and families with acceptance and with eventual grieving and loss. I believe developing bonds with patients is a wonderful expression of love for another human being and is completely acceptable in medicine–as long as we are able to remain objective when critical clinical decision making is required. In medicine we strive to provide excellent care for all patients but every now and again there are special patients that we develop emotional bonds with. Just as in everyday life, there are certain people that you are able to connect with in a spiritual way–whether they are co-workers, colleagues, friends or significant others. We must stop and appreciate the way in which nurses provide care–we can learn a great deal from them and ultimately provide more “connected” care for our patients. So, next time you are in the hospital, find a nurse. He or she will likely be haggard from running from room to room, and it is likely that they have not stopped to eat lunch. Thank them for caring for our patients. Thank them for showing us all how to provide better care for our patients. Then, stop in and say hello to your patient–sit on the edge of the bed and take time to simply just chat.