For me, the decision to become a physician was not an easy one. I actually decided against it several times, opting to pursue other things first. However, I was continually intrigued by a profession that combined art and science so uniquely. And, I was captivated by the very essence of healthcare — especially acute care. It’s a daily opportunity to make a significant difference in people’s lives.
Indeed, we make a huge difference. Most of us will see many thousands of patients in our careers. Some encounters are routine. Some are dramatic (resuscitations, natural disasters, miscarriages, cardiac events, helping families cope with a death). Examples abound. We do impact patient’s lives and often change them.
Interestingly, the opposite happens, as well. Patients can change us. Some interactions can affect us deeply, often unexpectedly. We spend so much time working to change things “out there,” it’s easy to forget that patients can make a lasting impact on us too.
Early in my career, I never thought about it that way. But one day, that changed…
My first medical directorship was in a busy, single-coverage ED. Great place, but its community reputation needed work. We got busy making important changes and focused on the “usual things” – aligned goals, better culture, better throughput, better communication, and quick responses to complaints. Six months into it, we were making progress, but the task was huge. I handled many complaints personally, and often, our patients really did teach us how to get better.
One day after a long shift, I stayed to return more calls. To my dismay, there was a stack of 8 new complaints waiting for me: names, phone numbers, allegations. I was tired, but oh well. We said we’d do this.
“Hello, this is Dr. Pilgrim. I’m the medical director in the emergency department. I understand that you were concerned about your patient experience here. Do you have time to talk? I want to help if I can.”
I’d been doing this for 6 months. Most concerns were easily handled by listening and expressing concern. Some needed additional information. Some needed another visit. A few needed different treatment. Important work, but after a while, it was getting to be a blur.
…the doctor was rude; I’m allergic to amoxicillin; your nurse was eating pizza at the desk; I wouldn’t send my dog there; the room smelled bad; I waited forever, what if I was dying; I would be dead; my neighbor is a lawyer; the doctor only spent 3 minutes with me; you people are stupid…
Good thing I’m committed to this. Seven down. One to go.
The cover sheet reads: 21 y/o female—mild abdominal pain for 4 months. I waited for over 5 hours.
I looked through the chart. Normal vitals. No concerning symptoms. Negative ROS. G3P3. Benign exam. Appropriate workup. Discharge instructions fine. Seen within 15 minutes. Discharged within 2 hours, end-to-end.
Not 5 hours.
My weariness took over. I’m thinking, “Why do I have to spend time while I’m dead tired, calling someone who had a world-record length of stay, an appropriate workup for an inappropriate non-emergency (abdominal pain for 4 months??). Great care and still, a complaint”.
She doesn’t need an ED visit. She needs a watch. I was not happy.
“Hello, this is Dr. Pilgrim…”
I was all geared up to explain to the patient exactly how things work around here and why “this” isn’t the place for “that.” All righteous and proper. What followed next proved why I needed to do this…
The patient was a single mother, taking care of three children at home. Following an episode of domestic abuse, she tried for months to find a doctor for her abdominal pain. She was unable to do so. The pain came and went, and it worried her. She had no explanation, and so far, no physician to help.
On the day of the ED visit, she had finally found someone to care for her kids for a bit. The ED was the only place open and available. For months, she had spent her time and energy on her children, trying to give them a better life, as well as tending to her own safety issues. Today, her “sitter” could only stay for a couple of hours, so she was worried that her 4, 5, and 7 year old would be left alone if she didn’t return in time. When she did return, she was met with 3 hungry kids and an angry sitter who yelled at her for taking too long. The sitter told her to call the ED and complain.
(That’s why two hours felt like five.)
Her visit was actually a great example of the ED’s safety net function. Ultimately, she really did need another solution. But she had a medical issue amid circumstances we can only imagine, and a heavy load that would challenge anyone. She had a need. We were there for her.
After we spoke, I remember feeling sad and compassionate, but also embarrassed and humbled. I had looked only at the surface and judged her. I had not allowed room for the huge amount of “stuff” that can be beneath even a routine, non-acute ED visit. And I did that while leading an entire initiative designed to do the exact opposite. Now I wonder how many other patients are carrying a load that I can’t imagine. How many of those do I judge and miss an opportunity to be compassionate and provide much-needed reassurance?
People show up doing the best they can. Sometimes it’s messy and illogical, but it’s the best they can do today. In the ED, we see people when they are not all tidy, neat, and organized, and we rarely know everything behind that. To be clear, we don’t need to excuse or endorse everything we see. And we should try to put things on a good path for our patients. But we must not think we know everything and must never lose our compassion.
I guess I’m not the first guy that figured this out.
Around 450 BC, Plato noted: “Be kind, for everyone you meet is fighting a hard battle.”
Not some people. Everyone.
Especially our patients.
On some level, the lesson seems simple and underwhelming. But it was very significant for me then, and I still remember it to this day. I felt very thankful for this brave young woman who took the time to call me. There was something I needed to learn.
What heavy load might others be carrying? Who needs kindness from me today?
I spent some time finding her a primary care physician who could tend to her medical needs and help with her home situation. I still hope that in some small way, my phone call was helpful. But she will probably never know what a difference she made.
We want to make a difference in patient’s lives. And if we let them, patients can make a difference in ours as well. At a time like this in healthcare, these experiences can renew us, refresh our commitment, and inspire others. We all need that.
So, what patients have changed you?
Author: Dr. Randy Pilgrim, Chief Enterprise Medical Officer, Schumacher Clinical Partners
