Provider empathy: a patient’s tale

Jacklyn Munn
Arlington, VA

 

In the practice of medicine, empathy may be the greatest prescription of all. It can provide a patient with confidence, comfort, and the understanding that their healthcare provider knows them as an individual, not just a series of diagnoses and treatments. It creates an opportunity for providers to establish trust and build rapport with their patients, which leads to a more fruitful partnership. Consider the following scenario:

Patient Jane Doe is a single mother of three who works full-time as a third-grade teacher for the metropolitan school department. She wakes before dawn each morning, exhausted from an action-packed weekend full of kid-centric activities, and begins her mornings by waking each child and getting them prepared for the busy day ahead. After lunches are packed, two children are ushered onto the school bus and the third is dropped off at daycare, she then rushes over to the elementary school to begin her day.

Jane somehow manages to balance a box full of art supplies while hurrying through the parking lot, practically running into her school’s principal. He reminds her that her lesson plans are late, again, and due by the end of the day. As she enters the building, she catches a glimpse of the “Caution: Slippery When Wet” sign just as she begins to fall, feet flying over her head, art supplies raining down on her as she lands with a heavy thud on her side. Her head whips as she crashes to the ground and she is pretty sure she heard a pop as she tried catching the weight of her fall with her outstretched hand. She begins to tear up; partly from the pain of the fall, but also from the humiliation of falling. This is the worst moment for an injury: there are bills to be paid, students to teach, mouths to feed, and activities to attend.

Lying disheveled on the floor, her box of supplies now spread chaotically across the hallway, she notes her principal poking his head out of the office. He rolls his eyes and shakes his head without extending a helping hand.

“See Mary at reception and she’ll get you all the paperwork you’ll need to file a workman’s compensation complaint.”

Just as he heads inside, he turns around and looks her in the eye, “But I really do need those lesson plans as soon as possible, you know.” And he vanishes.

Jane’s mentor and coworker, Darcy, scoops her up in the hallway in a motherly fashion and ushers her to the medical clinic – complete with all necessary paperwork – where they both patiently wait for the healthcare provider to see her.

Sitting in the waiting room with a bag of ice on her wrist, she begins picking at the Band-Aid with the Disney character that Darcy lovingly applied to her arm – apparently, she had also managed to cut herself during the drama of the fall. Her head spins with a laundry list of things this will inevitably ruin and dreads the thought of the money she is likely to spend on this  little fall.

“Ms. Doe? The provider will see you now.” A squat elderly nurse shouts across the waiting room.

Darcy gives a small, pitying smile as Jane’s snaps back to reality. She clumsily gathers her things and meets the nurse at the door. She goes through the rigmarole of intake – vital signs, pertinent past medical history, updating prescription lists – before she is finally taken to the exam room and told that her provider would be in shortly.

“Shortly,” Jane knows, is code for “the provider is actually swamped today and will get to you whenever they get to you.” Jane’s past experiences with medical clinics have taught her that doctors, nurses, and staff are busy seeing too many patients in a day, meaning she would have to wait for an undetermined amount of time before being seen and examined for less than five minutes.

To her, these appointments were filled with staff who would invariably stare at computer screens, asking her private and personal medical information without ever making eye contact. “Last menstrual period? Are you sexually active?” What does any of this have to do with falling in the hallway? All it did was remind Jane of her divorce, her children, and how she constantly felt she was failing as a mother, teacher, and human.

Knock, knock, knock

Jane’s attention is whipped back to reality as a brown-haired, thirty-something year-old woman wearing a white lab coat and a kind smile enters the room.

“Good morning, Jane Doe, my name is Betty Jones and I’m going to be the nurse practitioner taking care of you today.”

The nurse practitioner makes eye contact with Jane, maintaining her warm smile, and begins to raise her hand to what Jane thinks is going to be a handshake – don’t shake my right-hand you idiot, that’s the one I fell on! But instead, she gently places her hand on Jane’s shoulder. Almost simultaneously, Jane feels relaxed, at ease, and comforted.

“The nurse who did your intake told me about your fall. That sounds like a really rough way to start your day,” the practitioner says with genuine concern.

Jane’s eyes begin to water. For once, someone was looking her in the eyes and seemed like they cared.

The nurse practitioner began to ask Jane a series of questions about her fall, with Jane retelling the events of that morning. She gently examined Jane’s wrist, fingers, cuts, and bruises. Jane flexed her fingers, twisted her wrist, and responded to the nurse practitioner’s inquiries. She examined her head, her back, and all her limbs; going over each with delicate interest and care, all the while asking questions and taking note.

“I think it’s best we send you for x-rays. An injury like this can fracture your distal radius – that’s medical speak for a broken bone in your wrist.”

Cue the water works, Jane begins to think. The nurse practitioner seemed to noticed, sitting down on a stool and scooting herself directly in front of Jane.

“I can imagine how frustrating an injury like this must be – especially as a mom and a third-grade teacher.”

Jane stared in disbelief. This provider actually knew something about Jane besides her medical history. Jane wanted to finally confide in someone that her life was not as peachy and perfect as she projected. Deep down, she wanted someone to help, someone to listen. No judgment. No pity. Just someone to hear what she had to say.

“I know you’re here for your injury from this morning, but is there anything else you’d like to talk about?”

Wow, Jane thought. Does she actually care?

All the worry, anxiety, doubt, and depression spilled out of her like a gushing dam. Her job, her family, her divorce, her physical and  mental health – all of it. She felt like she talked for hours, but when she looked up at the clock, only a few minutes had passed. And though she felt like she rambled on, the nurse practitioner sat patiently in her chair. Everything about her body language said she was truly listening and hearing everything Jane had to say.

“That’s a lot for any one person to process, Jane. You’re human. These feelings, these emotions, these worries and concerns – they’re all valid and real. It’s okay to be upset about falling in the hallway – it’s rotten luck. But I promise I’m here to help you through this. Let’s talk about a way forward together, what do you say?”

From that moment on, Jane made every effort to be seen and cared for by that nurse practitioner. Together, they worked on ways to meet Jane’s health goals, giving Jane a sense of empowerment and control over her healthcare.

In time, Jane’s wrist healed in the midst of her demanding life and career, but instead of focusing on the limitations of her injury, she worked on maximizing her health. She felt a new sense of stability in an otherwise chaotic life. She went to routine check-ups, followed-up with a mental health provider, and started paying more attention to the ways her mental and physical health influenced her daily life. Jane felt more likely to seek medical care and use health advice because of an encounter with an empathetic provider. Because we all live so many shared experiences, perhaps we should take a little more time to truly relate to one another.

 

References

  1. empathy. (2017). [online] Available at http://en.oxfordictionaries.com/definition/empathy. [Accessed 23 Dec. 2017].

 


 

JACKLYN MUNN is a former military officer turned board certified Family Nurse Practitioner based in Arlington, Virginia. Her interests include patient advocacy, destigmatizing mental healthcare, and integrative therapies for health management.

 

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