Tag Archives: empathy

Nurses Show Us the Way: The Simple Beauty of Connecting in Healthcare

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.


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The Changing Focus of Medical School Admissions: People Skills Required!

When I was applying to medical school in 1991, a stellar GPA and near perfect MCAT (Medical College Admissions Test) score would almost guarantee admission to a student’s medical school of choice.  Typically, interview days consisted of meeting with one or two esteemed faculty at the school, a tour with current students and a brief talk with the Dean of admissions.  Sometimes offers of admission would be made “on the spot” by the Dean.  Little time was spent evaluating the social skills or personality of the prospective student.  The best medical schools focused on packing their classes with valedictorians, published researchers, and other scholars.  Activities outside of academics including volunteer work and service were important “window dressings” on the application but the real focus was on the numbers.  Today, more than ever, we need to train doctors who can effectively communicate.   As healthcare costs continue to skyrocket out of control, so much of healthcare in the future is going to focus on prevention.  As I have said many times before, prevention starts with patient engagement.  Engagement requires that physicians are able to interact effectively with patients via multiple modalities including good old fashioned face to face encounters as well as via electronics and other mHealth applications. Effective in person, patient interactions require that a physician is guided by ethics and is able to understand and apply the concepts of empathy and compassion.

Technology based education has become heavily emphasized over the last decade.  Recently, many physicians have expressed concern over the tech-bias of newly trained doctors. As I have referenced in a recent blog, many senior physicians worry that the ability to interact and relate personally with patients and colleagues may be missing.  An article in the New York Times from April 2012, reported on the new focus by the AAMC (Association of American Medical Colleges) on integrating social sciences into medical education.  The MCAT is has been redesigned to include a section on ethics, behavioral and social science.  This is a very nice thought, but how can we accurately measure empathy, compassion, and the direction of one’s moral compass through a standardized test?

In the Wall Street Journal this week, Jonnelle Marte discusses the fact that medical schools are now emphasizing “people skills” as they select students that will make up future classes.  Certainly grades in undergraduate school and MCAT scores remain important but many of the best medical schools are expanding the admissions process to include a full day of interviews with multiple faculty members.  Some admissions committees are requiring personality tests as well as interviews with trained psychologists.  Other institutions are creating “mock patient encounters” for prospective students in order to gain insight on the applicants ability to relate and interact with potential patients.  I believe that much of this is a move in the right direction.  Just as in most professions, “book smarts” and academic prowess isn’t always enough for success.  The most successful CEOs not only have a Harvard MBA (or equivalent) but also have the ability to make those around them feel good about what they are doing.  A recent global CEO study conducted by IBM found that companies in which CEOs embraced and fostered a culture of openness and collaboration outperformed others by nearly 30%.  It is clear that successful leaders engage followers and motivate them to function at the highest levels and reach potential.  These same principles arguably can be applied to produce more connected and interpersonally engaged physicians.

As healthcare continues to evolve, so must our ability to educate young doctors.  The US has one of the finest systems for medical education in the world today.  Students and doctors from all over the world come to America to train.  However, in order to select and train the best candidates our system must continue to evolve as well.  Now, more than ever, we must ensure that doctors are not only skilled healers but skilled leaders, motivators and communicators.  Although many of these interpersonal skills are learned over time, we must be able to identify potential and cultivate these abilities when selecting students to enroll in the medical schools of the future.  The new emphasis by the AAMC and MCAT on social and behavioral sciences is a move forward but we must remember that it is just one small step in crafting the caring, compassionate, empathetic physicians of tomorrow.