The growing movement to include the patient voice in medicine through
Motivational Interviewing, patient-reported outcomes, social determinants of health
and shared decision-making
One day in 2011, as a part of my research on ways to improve patient-provider communication about health behaviors, I was shadowing Dr. G., a talented young internist with a cheerleader demeanor. He marched through 12 afternoon patient appointments with confidence and purpose. But when he saw the name of the last patient on his schedule, he turned pale, faced me and said, “I apologize for what you are about to see.”
I must have looked confused. He repeated, “I
apologize for what you are about to see.”
We walked into the exam room. I’m not sure either
one of us knew what to expect. The patient, a white, obese man, was seated,
doubled over. He had a wad of paper towels jammed in his mouth. He threatened
to pull out his own, presumably abscessed, tooth. He refused to see a dentist
because he had no dental coverage, no money and no one to borrow money from. He
said he would use pliers to pull his tooth, but stayed put, rocking in his
seat. At the computer, the young doctor’s white-knuckled hand gripped his
mouse. Click. Click. Click. He searched the patient’s chart aimlessly for help.
Alerts kept popping up about the patient’s missing A1C results. It took two
minutes, but it felt like 20.
Dr. G. left the room and came back a few minutes
later. He gave the patient the name of a dentist who would see him at no cost.
I suspected Dr. G. had called the dentist and said he would pay for the
appointment out of his own pocket. The patient hugged Dr. G. He only wanted
help, and Dr. G. wanted to help. The tension was resolved for the moment.
The absence of burnout does not equal wellness. While the focus on physician burnout as an epidemic is finally gaining more attention, we may be missing a larger issue. Most physicians are not burned out. We are able to function. We get through our days, make it to some of our kids’ activities and even manage to go out to dinner on the weekends. We survive the work week as we look forward to our next vacation. We do this because that is what we have always done. We put our heads down and do our work. We often project ourselves past the next exam or to the next stage of our lives to help us get through the stress. We become masters of delayed gratification. We develop the mindset of “I’ll be happy when…” I get into medical school or match into a good residency spot or make partner or have enough money to retire etc…Along the way, we may have some bright spots – falling in love, having kids, taking great vacations. We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But deep inside, “something is missing”. We have achieved most, if not all of the goals we have set for ourselves. Yet despite our hard work, many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A better job with more money? A different car? A different title? Better vacations?
I have struggled with these questions and many more. How do I stop wanting what I don’t have and start wanting what I do have? How can I fully enjoy the present while also preparing for a better future? How can I spend quality time with my kids while they are still around? How can I have a career that uses all of my potentials? Of all the questions that I’ve asked myself, the most important one was this – How can I learn to flourish and not just function?
Fortunately, I found answers in the relatively new field of Positive Psychology which is the scientific study of human flourishing. Unlike traditional psychology which alleviates distress and moves a patient from a -8 to a 0 or +1 (if they are lucky), positive psychology focuses on a patient that is functioning at a +1 and tries to move them to a +8 on the flourishing scale. We need both areas of focus. There are many people that are functioning well by most standards but are nowhere near their potential level of fulfillment.