Changing the Frame

Changing the Frame

An attending talks about empathizing with a resident and her patient

One of our residents was presenting a patient to me in clinic, and she was clearly distraught or disgusted or upset. Her patient had come from far away, was on a long list of medications, was on disability, and had a lot of complaints which had been worked up with no results. The resident felt overwhelmed by this patient, that she wouldn’t be able to meet the patient’s needs, that there were no concrete answers in any of the records that we had, and that it was kind of a fool’s errand and she wasn’t going to accomplish anything.

She was frustrated and downhearted, and so I listened to her story and empathized with her some. I said, “These are very difficult patients when it seems like we can’t meet their needs, or there is no real good explanation for their symptoms. You don’t know what to do, and sometimes there is a lot of suffering in these patients and sometimes these patients have been abused.” And I talked about the case, “Did you ask about abuse? When I go in there I’ll ask the patient about abuse.” And so we went in, and we spoke to the patient and listened to some of the complaints. I asked the woman whether there had ever been any abuse, and she said, “Yes, my mother died, my single mother died when I was very young. As a ten-year old or eleven- year old, I was really with my aunt and uncle. And my aunt would chase me around with a fire poker and try to hit me, and my uncle was trying to sexually abuse me.”

We didn’t do a lot of counseling on that. We just talked about how terrible and how damaging that must have been, and we talked a little bit more to the patient. We just made some very sympathetic, not trying to cure or correct, statements. The patient seemed genuinely pleased that these doctors cared about her and wanted to hear about her and know about her.

I talked about it with the resident afterwards. I think the point I made to her was just that by knowing the patient’s history, it’s not like we solved her problem, but it gives us empathy with that patient. The reason why some patients are difficult or have pain that doesn’t have a biomedical explanation is related to what has happened to them. Knowing their stories gives us the ability to sympathize and empathize and treat them kindly which, I think, is a lot of why they are here.

One of the things over the years that I have been interested in is doctor-patient relationships. But I’ve come from sort of being a zealot – “You have to do this with the patients” – to realizing that the residents are every bit in need of empathy and sympathy as the patients are. I think that what helped this to be a teaching experience was that I wasn’t judgmental of the resident; instead, I sympathized with her in how difficult it is to be in that situation. Also maybe that helped her to have some empathy for the patient which would, I would like to say, result in good care.