Improve Doctor-Patient Relationships With This One Question

Doug Lake, MD

Disclosures

April 05, 2021

One day, I was called to perform a biopsy on a 40-year-old woman with probable breast cancer. She told me that for 2 years she'd been telling her doctor that she could feel something growing in her breast, but her doctor always attributed the cause to an earlier injury to the breast that she had sustained.

After hearing this, I did something all too uncommon in our profession: I asked, "How does this make you feel?"

She didn't hesitate. "I'm scared about what this could be." I expected that response. Then she said, "But I am so relieved. My complaint was finally taken seriously."

Relief before a breast biopsy? That floored me.

This interaction was only possible because I, as a consulting radiology physician, changed the way in which I interact with my patients. Doing so has broken down the physician-patient barrier in ways that have benefited both sides.

I changed because my life changed, and in the most excruciating way possible.

My infant son Ben died of pulmonary vein stenosis. Then, Caroline, our rainbow baby (the term for a child born after losing another child), was diagnosed with the same condition. Our family obviously experienced a lot as a result, but one sliver of it is the way we became intimately familiar with the patient perspective.

As a doctor, this experience planted a seed from which grew a deeply personal empathy for the emotional impacts of receiving medical care. It pushed me to "go there" with my patients — even though I see many of them only once — in what are brief but inherently emotionally charged interactions.

My experiences with my children clearly revealed how much more intense it is for patients coming in for imaging that could reveal life-altering news. As a consequence, I made it a priority to reach out to patients to ask, "Where are you with this? How does it make you feel?"

A Common Complaint Yields an Uncommon Discussion

My process began to change when considering an issue that often brings patients to my office for an esophagram: trouble with swallowing food and the sometimes terrifying feeling of having food stuck in the esophagus.

I know how it feels, both physically and emotionally. I've snuck away from Thanksgiving dinner while a vise grip squeezed my chest. I've had the thought, Am I having a heart attack? I know the symptoms can be a signifier of cancer. I've felt like there is nothing that can be done about the discomfort.

Those experiences would be easily recognizable to my patients, yet for most of my career it never occurred to me to share them. Nothing in my training addressed how to do so, and I've never heard another doctor, in my professional life or as a patient, share their personal experiences. Then there were other things stopping me from doing so. I wasn't used to showing vulnerability like that. I maybe feared that it would take too long. But mostly I wasn't sure what good it would do.

The first time I said to a patient, "You know, I've had a similar problem for years," the technologist in the room swung her head around, wide-eyed. I believe that she had not seen or heard such a thing in her experience. She definitely had not while working with me.

Not long after, I told another patient struggling with food getting "stuck" that this has happened to me, and I explained what I do when it happens. In an act I've since seen repeated many times, the patient immediately looked at me, locked in, and intently listened. In that moment, I not only knew for sure that this was the right thing to do, but I also wondered why I hadn't started doing so earlier.

How a Personal Touch Translates Into Better Care

Physicians make a common error in believing that their patients hear and understand them. The truth is, patients don't retain everything. In high-stakes situations — like a new cancer diagnosis — data show that patients remember just half of the conversation. I've found that framing some of the information in personal terms helps patients better understand my message. You quickly find out how much this means to them.

I had a patient who hadn't been given answers from previous doctor visits or tests. I could see a stricture clearly on the esophagram, so I explained her issue and shared some thoughts on possible next steps.

Even though I saw her just that one time, she wrote to thank me for spending more than 20 minutes with her, answering questions and giving advice. I was glad to know I had been of help but was blown away by her recollection. Twenty minutes? Given my normal schedule, it was probably no more than 10 minutes. I realized that the few minutes I spent had an outsized impact on her; she perceived it to have been much more than it was. To me, this is proof of the power and importance of connecting to patients in this way, even for subspecialists, where repeat visits may be rare.

Letting down the curtain between doctor and patient is still not a majority stance. It may never be. New, life-changing information may always be more appropriate coming within the context of an established healthcare relationship rather than from a consulting provider. That said, my children's life-changing diagnoses were explained to my wife and me by pediatric cardiologists whom we had just met. They didn't perform the tests, send the report to our pediatricians, and expect them to explain it all to us. Why should I leave my patients in the lurch?

I share information when I can be reassuring, letting patients know when I don't see anything that alarms me. For example, when I've done an esophagram, the first words out of my mouth after we finish are often "I don't see anything that looks bad — no esophagus or stomach cancer." Cancer is the least likely result, but it is what patients have on their mind. I watch shoulders relax, hear long exhales, or see eyes brighten every time. Why make them wait a few days or a week? They'll be back with their healthcare provider soon enough to figure out how to handle whatever they do have.

I educate them, letting them see what I see and visualize what is going on in their bodies. When I can, I also offer helpful information grounded in my own experience. A patient will get a full rundown from their primary doctor, but I can bring immediate practical relief when possible. I did this for years by jotting down my own simple three-step process for handling an "esophagus attack" — the sense of food getting stuck. I received such grateful responses from patients who tried out the basic technique that I wrote a book, expanding on the topic from both my personal and professional experience.

Concrete information helps, and patients are eager for it. But it's still second to what happens when I say, "I know something about what you're going through because I've been through it too." As social creatures, we respond deeply to the simple message "You are not alone."

So, the next time you're conducting a procedure or involved in an interaction that is surely stressful for a patient, take a few seconds to check in on their emotions. You might be surprised by the response you get back, as I was with that breast cancer patient. When presented with a chance to bring some relief to a patient, why not take it?

Dr Doug Lake is a radiologist, father of three girls, and author of Esophagus Attack! The 3-Step Method to Enjoy Eating Again. He works full-time at the McFarland Clinic in Ames, Iowa, and is an adjunct clinical associate professor in the Department of Radiology at Stanford.

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