Patient Education and Counseling 94 (2014) 138–139
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective practice
Rock paper scissors§ Melissa Weddle * Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Oregon Health & Science University, Portland, USA
A R T I C L E I N F O
Article history: Received 17 September 2012 Received in revised form 16 January 2013 Accepted 9 September 2013
‘‘Rock. . .paper. . .scissors. Paper covers rock. You win.’’ ‘‘We can do best two out of three if you want.’’ ‘‘Rock. . .paper. . .scissors. Scissors cut paper. You win again. I’ll see her.’’ Two weeks earlier, I had been sitting on the ground at Grant Park watching my son play soccer when Rosie, a lab mutt with a forceful lunge, pulled my arm backward with the leash handle looped around my middle finger. I thought it was a sprain, but after two weeks, the finger was still swollen, still hurting. I had just moved to Portland and didn’t yet have a doctor, so I went to the closest hospital I knew. On Labor Day morning at 10:00 am when the Ambulatory Care Unit opened, I was the lone person in the waiting area. I had forgotten to bring a magazine, but I expected a short wait on a holiday morning. After ten minutes or so, the entrance doors slid open and I watched a woman briskly push a wheelchair holding an elderly man. ‘‘Bad chest pain,’’ I heard, and the door opened quickly, the attendant pushing the wheelchair through to the other side. Soon after, I was called through that same door and seated across the desk from the triage nurse. She asked a few questions about my injury, then sent me to a room in the non-urgent care section. As I sat on the end of the table, I heard the above exchange, a low-pitched male voice directing the contest, the higher-pitched voice belonging to the winner. Rock paper scissors. The loser would see the only patient waiting. Me. For the few seconds between the contest close and the anticipated knock on the door, I wondered what I should do. Should I tell him what I had heard? Should I tell him what it feels
§ For more information on the Reflective Practice section please see: Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Education and Counseling 2004;54:251–253. * Correspondence to: CDRCP, 707 SW Gaines Street, Portland, OR 97239-2998, USA. Tel.: +1 503 418 5700; fax: +1 503 494 1542. E-mail addresses: [email protected], [email protected]
0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.09.011
like to be the patient of a loser? Should I tell him that I teach medical students about professionalism and interpersonal skills, and that he was lacking? He knocked on the door, introduced himself to me as a physician’s assistant, and the woman by his side as a student. He appeared to be in his late 30s, athletic build, taller than average, with close-cropped hair, wearing the ubiquitous khaki pants and pressed button-down shirt underneath a white medical jacket that ended mid-thigh. His student was younger than he, mid-twenties, her eyes on him attentive. He asked, ‘‘So what brought you in today?’’ I told him about my finger. I didn’t tell him what I had heard. Perhaps I thought that he might be embarrassed or resentful. Maybe I worried that he would treat me differently, that he might not take care of my finger properly or would even hurt me. After asking a few questions about how the injury occurred, he carefully examined my right middle finger. He explained why he thought the ligaments weren’t injured and why he thought the bone was broken. He sent me down the hall and around the corner for the X-ray, after which I returned to the same room. The X-ray confirmed his suspicion, that the distal phalanx of my middle finger was broken. He applied a splint and gave me information about how to schedule a follow-up appointment with the hand specialist, and a referral for therapy so that the joint wouldn’t stiffen. A straightforward medical problem treated appropriately, I thought, except for the overheard words. I took the papers with the phone numbers, thanked him, and left. Why didn’t I tell him what I had heard? What could I have said? What should I have said? I had just moved to Portland, didn’t yet have a job, hadn’t yet made friends. My family had moved because of a work opportunity for my husband. I was still mourning my social network and the job I had left behind. I had left a job that I loved, one where I was able to combine patient care with teaching residents and students. I taught medical students about communication skills with adolescent patients. I watched and evaluated residents as they communicated with actors simulating challenging adolescents. I talked to learners about how to convey interest in what the patient has to say, how to show respect for differences, how to honor privacy, and how to choose words patients understand. As a patient, I felt vulnerable. I didn’t know what to say. I could have said that I felt as if I were an inconvenience to him. I could have said that I was angry, that his actions were careless and disrespectful. I could have told him that his behavior wasn’t professional, though I thought that might sound pompous or didactic. I could have simply told him what I heard. He would know he hadn’t been professional.
M. Weddle / Patient Education and Counseling 94 (2014) 138–139
What does that mean anyway—professional? As doctors, nurses, physician’s assistants, phlebotomists, we are expected to be professional in our patient interactions. We usually can distinguish between professional and unprofessional actions, but what do we mean exactly? A search for definition of professionalism delivers phrases such as ‘‘adherence to ethical principles’’, ‘‘responsiveness to patient needs that supersedes self-interest’’, and ‘‘sensitivity to a diverse patient population.’’ However, these phrases are abstract and nonspecific, not very helpful to someone who doesn’t yet understand professionalism. I explain professionalism to learners this way: that you should treat patients the way you want your children, partner, or parents to be treated. Listen carefully and communicate clearly. Anticipate and answer questions, those unspoken as well as those asked. Say what you know and what you don’t know, and do what you say you
139
will do. Attempt to understand your patient’s perspective, and convey that you care. Never ever allow him to feel like he is the patient of the loser. When I began writing about this experience, I anticipated writing about professionalism—how the physician’s assistant wasn’t professional and how I felt as the patient. As I wrote, I wondered why I never told him what I had heard. I could have talked to him on my way out the door. I could have written a letter if I needed time to think about what I wanted to say. I wish now that I had told him what I heard. I think he would have wanted to know. He would have been embarrassed. But in the future, he would have been more careful with patients more helpless and less capable of responding than I was. With my minor injury in a new city, I learned what it feels like to be a vulnerable patient, but I missed an opportunity to teach. I write this piece now. Maybe he, or those who come after, will read it.
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective practice
Rock paper scissors§ Melissa Weddle * Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Oregon Health & Science University, Portland, USA
A R T I C L E I N F O
Article history: Received 17 September 2012 Received in revised form 16 January 2013 Accepted 9 September 2013
‘‘Rock. . .paper. . .scissors. Paper covers rock. You win.’’ ‘‘We can do best two out of three if you want.’’ ‘‘Rock. . .paper. . .scissors. Scissors cut paper. You win again. I’ll see her.’’ Two weeks earlier, I had been sitting on the ground at Grant Park watching my son play soccer when Rosie, a lab mutt with a forceful lunge, pulled my arm backward with the leash handle looped around my middle finger. I thought it was a sprain, but after two weeks, the finger was still swollen, still hurting. I had just moved to Portland and didn’t yet have a doctor, so I went to the closest hospital I knew. On Labor Day morning at 10:00 am when the Ambulatory Care Unit opened, I was the lone person in the waiting area. I had forgotten to bring a magazine, but I expected a short wait on a holiday morning. After ten minutes or so, the entrance doors slid open and I watched a woman briskly push a wheelchair holding an elderly man. ‘‘Bad chest pain,’’ I heard, and the door opened quickly, the attendant pushing the wheelchair through to the other side. Soon after, I was called through that same door and seated across the desk from the triage nurse. She asked a few questions about my injury, then sent me to a room in the non-urgent care section. As I sat on the end of the table, I heard the above exchange, a low-pitched male voice directing the contest, the higher-pitched voice belonging to the winner. Rock paper scissors. The loser would see the only patient waiting. Me. For the few seconds between the contest close and the anticipated knock on the door, I wondered what I should do. Should I tell him what I had heard? Should I tell him what it feels
§ For more information on the Reflective Practice section please see: Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Education and Counseling 2004;54:251–253. * Correspondence to: CDRCP, 707 SW Gaines Street, Portland, OR 97239-2998, USA. Tel.: +1 503 418 5700; fax: +1 503 494 1542. E-mail addresses: [email protected], [email protected]
0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.09.011
like to be the patient of a loser? Should I tell him that I teach medical students about professionalism and interpersonal skills, and that he was lacking? He knocked on the door, introduced himself to me as a physician’s assistant, and the woman by his side as a student. He appeared to be in his late 30s, athletic build, taller than average, with close-cropped hair, wearing the ubiquitous khaki pants and pressed button-down shirt underneath a white medical jacket that ended mid-thigh. His student was younger than he, mid-twenties, her eyes on him attentive. He asked, ‘‘So what brought you in today?’’ I told him about my finger. I didn’t tell him what I had heard. Perhaps I thought that he might be embarrassed or resentful. Maybe I worried that he would treat me differently, that he might not take care of my finger properly or would even hurt me. After asking a few questions about how the injury occurred, he carefully examined my right middle finger. He explained why he thought the ligaments weren’t injured and why he thought the bone was broken. He sent me down the hall and around the corner for the X-ray, after which I returned to the same room. The X-ray confirmed his suspicion, that the distal phalanx of my middle finger was broken. He applied a splint and gave me information about how to schedule a follow-up appointment with the hand specialist, and a referral for therapy so that the joint wouldn’t stiffen. A straightforward medical problem treated appropriately, I thought, except for the overheard words. I took the papers with the phone numbers, thanked him, and left. Why didn’t I tell him what I had heard? What could I have said? What should I have said? I had just moved to Portland, didn’t yet have a job, hadn’t yet made friends. My family had moved because of a work opportunity for my husband. I was still mourning my social network and the job I had left behind. I had left a job that I loved, one where I was able to combine patient care with teaching residents and students. I taught medical students about communication skills with adolescent patients. I watched and evaluated residents as they communicated with actors simulating challenging adolescents. I talked to learners about how to convey interest in what the patient has to say, how to show respect for differences, how to honor privacy, and how to choose words patients understand. As a patient, I felt vulnerable. I didn’t know what to say. I could have said that I felt as if I were an inconvenience to him. I could have said that I was angry, that his actions were careless and disrespectful. I could have told him that his behavior wasn’t professional, though I thought that might sound pompous or didactic. I could have simply told him what I heard. He would know he hadn’t been professional.
M. Weddle / Patient Education and Counseling 94 (2014) 138–139
What does that mean anyway—professional? As doctors, nurses, physician’s assistants, phlebotomists, we are expected to be professional in our patient interactions. We usually can distinguish between professional and unprofessional actions, but what do we mean exactly? A search for definition of professionalism delivers phrases such as ‘‘adherence to ethical principles’’, ‘‘responsiveness to patient needs that supersedes self-interest’’, and ‘‘sensitivity to a diverse patient population.’’ However, these phrases are abstract and nonspecific, not very helpful to someone who doesn’t yet understand professionalism. I explain professionalism to learners this way: that you should treat patients the way you want your children, partner, or parents to be treated. Listen carefully and communicate clearly. Anticipate and answer questions, those unspoken as well as those asked. Say what you know and what you don’t know, and do what you say you
139
will do. Attempt to understand your patient’s perspective, and convey that you care. Never ever allow him to feel like he is the patient of the loser. When I began writing about this experience, I anticipated writing about professionalism—how the physician’s assistant wasn’t professional and how I felt as the patient. As I wrote, I wondered why I never told him what I had heard. I could have talked to him on my way out the door. I could have written a letter if I needed time to think about what I wanted to say. I wish now that I had told him what I heard. I think he would have wanted to know. He would have been embarrassed. But in the future, he would have been more careful with patients more helpless and less capable of responding than I was. With my minor injury in a new city, I learned what it feels like to be a vulnerable patient, but I missed an opportunity to teach. I write this piece now. Maybe he, or those who come after, will read it.
