The Gift of Time With Patients
Rediscovering a love of medicine in the midst of a pandemic.
Posted Jul 02, 2020
Guest author: Tricia Brady, an anesthesiologist in northern Florida.
I know this sounds strange, but hear me out ... in the midst of a pandemic, I found the joy of being a physician that I’ve been missing for some time. I don’t mean the giddy feeling of getting a pony for my birthday or the brief joy of family reunion during the holidays. This joy is deep and powerful; a soul shifting kind of joy that energizes and empowers. It is pride in being true to my calling, to care for my patients during their perioperative experience. My joy is reconnecting with the physician I’ve always wanted to be. In the midst of this pandemic, the barriers between me and my patients have been stripped away. I am no longer told to divide my time between 20 patients all anxiously awaiting surgical procedures in a single day; the constant nagging ring of the phone in my pocket that acts like a choke chain keeping me tethered to the pressure of efficiency in the name of profit; electronic medical records that I drag around like an anchor stopping me from getting too close to my patient; the toxic work environment created by a chronic shortage of nursing and support staff.
Today is Monday, on week six of quarantine due to the COVID-19 crisis. I’m the solo anesthesiologist (physician that specializes in anesthesia and critical care) on service today. Any normal Monday would find me overwhelmed with the tasks ahead but this is a Monday during a pandemic. But today, for the first time in years, I sat with a patient who needed me. There were no elective cases to rush me through this morning. No deciding whether the needs of my patients and their families or the wants and demands of this machine we call medicine were more important. Today there were no angry texts from a hospital administrator distracting me from my patient’s medical history. Today I didn’t try to convince a patient to trust me after reading about her in an electronic medical record and a two-minute interview. Today I sat with a patient who needed me.
My patient, in her mid-60s, found a lump in her breast six weeks ago. Her only child, a “mid-life miracle,” sits protectively beside her, gently nudging her back to the present as she wanders through memories of easier times, “Don’t pull down your mask, Mom." “Six weeks she’s been strong,” her daughter tells me, “but I had to give her a nerve pill this morning, I hope that was OK." I reached over and held Beverly’s* hand. She started sobbing, her daughter quietly weeping in the chair next to her. I sat down.
Twenty-one years ago I began training to become a physician. I was taught this meant caring for a patient both physically and spiritually. I was taught to listen, to comfort, to diagnose and to treat, all parts equally necessary in practicing the “art of medicine." In medical school, a well-meaning professor said, “The heart is just a pump with tubes coming in and tubes coming out that pumps blood in and blood out." Obviously he was trying to simplify a very complicated system for students brand new to the material, but his message has stuck with me. It was the first time I heard the human body described as just another highly complex machine. But for me, a patient’s humanity is inextricable from the rest of their physiology. We are not merely technicians tuning intricate machinery. We are physicians charged with caring for the humanity of our patients as compassionately as we care for their bodies. In the current state of medicine and ever-increasing demands on physicians, humanity is a luxury.
Hospitals, management companies, and insurance companies know physicians are their source of revenue. The revenue generated by each physician supports 17 others in health care. Only six of the 17 are directly involved in patient care, the rest are in some area of administration (1). Administrative cost account for 34% of health care expenditures in the U.S. (2). The cost of billing and insurance-related activities alone account for up to 25% of the revenue generated by physicians (3). As the administrative sector of health care grows, physicians are asked to increase patient volume and to reduce other costs. We see more patients in less time with less support. We must attend to the electronic medical record at least as intently as we do our patients. We must diagnose with less testing, defend our decisions, and adhere to ever-changing regulations. None of these demands serve our patients, to whom we took an oath to make our priority, always. These demands serve a balance sheet and a corporatized system of care.
You deserve better, as a patient. You deserve the care and compassion physicians were trained to provide. We deserve better as physicians. We were taught that the relationship between the physician and patient is the cornerstone of care and healing. We were taught to build rapport quickly and to be genuine in our interactions. It was never intended to be transactional like having your car serviced, though many days I think my car mechanic might know me better than I know my patients. We deserve the time to build relationships that will allow us to all experience the joy Beverly and I did. My car mechanic knows more about my life than my physician does.
It took a pandemic for me to have the freedom to be the kind of doctor I have wanted to be for twenty years, and the kind of doctor every patient deserves, every time they get care.
I clasped Beverly’s hand and promised her I would see her through her mastectomy safely. We talked about her fears. We talked about the battle ahead. We talked about faith and love and humanity. There was no need to hurry away. I sat with a patient who needed me. When it was time to leave for the operating room her daughter smiled at me, a little less on guard.
The COVID-19 crisis has given us an opportunity to pause and reassess many aspects of our lives. There are some things that should not go back to the way they were before this crisis. The physician-patient relationship is one of them.
With acknowledgment to Wendy Dean, M.D., for her critical assistance in developing and shaping this work.
*The patient's name and all details have been changed to protect privacy.
2. Papanicolas, I, Woskie, LR, Jha, AK (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA; 319(10):1024–1039. doi:10.1001/jama.2018.1150
3. Tseng, P, Kaplan, RS, Richman BD, Shah, MA, Schulman, KA (2018). Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. JAMA;319(7):691–697. doi:10.1001/jama.2017.19148