This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning with each new space and time. I’ll explain…
On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,
It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss. They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.
Which got me thinking, we really can be the balogne in the generational sandwich. We really can and do help others that are both older and younger than we are, even when we’re overwhelmed. We play our part and provide space for those two pieces of bread. So many of us do this. So although the beginning of my week was framed with my experience of what doctors say, the end was also about the position where I’m thinking about what parents and patients say to me, too.
Yes, what doctors say in the exam room lingers. But what patients say to doctors, it lingers too.
Which got me thinking, as I completed multiple interviews/meetings this week about my decision to enter social media, I kept returning to the doctor-patient relationship as the main reason I deviated from a typical path in pediatrics and entered social media. I really want to re-align patients and doctors. There is an expansive divide and tactile pulse of distrust right now between those who seek care and those who provide it. Some days it feels like we have seemingly forgotten how much nurses and physicians care, how much they know about preventing and treating illness, and how much they can advocate for patients. We’ve forgotten how doctors and nurses collaborate, how much they ruminate and worry, how much they invest in patients’ outcomes. And how much they give up to go to work to help.
Which got me thinking, after Watson, a computer created to play on Jeopardy, beat two humans earlier this month in a trivia game, I was left entirely convinced that even as computers and robots will be a part of generating differentials (list of possible diagnoses) in health care, my job wasn’t obsolete. Witnessing the computer win left me more convinced that with increasing intelligence, people will still take care of people. Despite the fallibility of people, the dishonor and the malpractice we hear about on the news, we humans will still want empathetic care and connection in the exam room, too. Even as the New York Times published an article within minutes of the end of the Jeopardy game show stating that Watson-type robot medical assistants would emerge within 18 months, I doubt they’ll replace we nurses and doctors. I believe in the nurturing that still occurs in health care. We really need physicians and nurses, assistants and social workers, hospital and clinic staff and volunteers, to listen and heal us in addition to diagnosing us.
Which got me thinking, it’s crazy what people say to me. I’ve written about it before. It’s been a long week for me (read above) and it’s not over. It will be another week or more until I have a day off. So when I walked into exam room #4 this week, while greeting a patient and parent, I didn’t see this coming. I asked how they were, and they were gracious enough to ask the same. I said, “Busy! But good.” The response? “Busy? Working 2 days a week?”
There was sarcasm dripping from the right corner of the parent’s mouth. I was taken aback, my stomach dropped to the floor. Energy filled my ears. It was Thursday, a day where I left the house at 6:40am and didn’t return home until after 9pm. I was exhausted and heavy already with what was ahead (today). It seems I walk a constant tight rope between guilt and longing (missing my boys) and energy (making change and helping parents and children). I chew on the decisions to work this much every day. And a parent, simply out of naivete, challenged that I was working, or even committed. She of course has no idea how hard I work. I’m certain she’s tired, too. I reminded her I had 3 jobs and would also be in clinic over the weekend. And then let it lie. Ultimately she was in the exam room to help her child, as was I. So I moved on to do so, yet I was left a bit dumb-founded. Did this parent, who was in the room for advice and guidance, doubt my commitment to children, to the profession?
Which got me thinking about the mom, later in the day, who said she’d read the blog about Flu shots and various others. And how she just wished I would get a day off.
Which got me thinking again about my mom, her doctor, and the words in the exam room.
Which got me thinking about the comment in the post (on Kevin MD) where a smoker talks about how their physician put her hand on their shoulder and provided comfort and belief. And how that moment translated into a final cigarette.
Which got me thinking about the power of a passing comment and the relationships we forge when the exam room doors are closed. How tiny statements can feel like novels and then huge moments can be championed with steely courage.
Which got me thinking that it remains an utter privilege to care for children and to assist parents in preventing injury and illness. And I awai was in the exam room to help her child, as was I. So I moved on to do so, yet I was left a bit dumb-founded. Did this parent, who was in the room for advice and guidance, doubt my commitment to children, to the profession?
Which got me thinking about the mom, later in the day, who said she’d read the blog about Flu shots and various others. And how she just wished I would get a day off.
Which got me thinking again about my mom, her doctor, and the words in the exam room.
Which got me thinking about the comment in the post (on Kevin MD) where a smoker talks about how their physician put her hand on their shoulder and provided comfort and belief. And how that moment translated into a final cigarette.
Which got me thinking about the power of a passing comment and the relationships we forge when the exam room doors are closed. How tiny statements can feel like novels and then huge moments can be championed with steely courage.
Which got me thinking that it remains an utter privilege to care for children and to assist parents in preventing injury and illness. And I await the ongoing comments in the exam room. I’ll work hard, each and every day, to choose mine carefully.
And that there, that’s an amalgam.
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Heather Peterson, MD says
Thank you for posting this. I am a general pediatrician who works part-time in clinic and also teaches medical students part-time. You and I actually were in the same high school class in MN. I struggle with the same issues of balancing a rewarding career and being the mother of three young children on a daily basis, too. I frequently remind my students of the importance of their comments (both good and bad) and that you never know what one thing a patient/parent will come away from an encounter with. It is very refreshing to see your comments on the impact of a patient’s remarks. Even though I feel that I am doing a good job at both mothering and doctoring, I have felt the sting when a patient’s parent says “I could never put my child in daycare,” knowing that I have children in daycare so that I can be there right then taking care of their child. I agree we all need to put some thought into choosing our words.
Wendy Sue Swanson, MD says
Hi Dr Peterson! Well nice to see and reconnect here! HS was quite a while ago, I’m afraid.
Yes, I hear you. I’ve written about this issue elsewhere, the “I’m just so fortunate I get to raise my children and stay at home,” “I would never put my kids in day care,” “I can’t imagine working as much as you do.” Not entirely helpful, of course, and yes, it’s a silly thing to say to a pediatrician-parent. But rising up against those comments in my mind did me no good in the past, and only forced me into the “mommy wars” in my head. Those comments continue in my practice but I don’t seem to take notice (at least right now) as they have faded in their ability to pierce my skin. Maybe it’s just timing, or maybe maturation for me as I understand my own quandary with the balance of work and motherhood….but yes, confusing and hurtful at times, yes…
Thanks for commenting! Maybe I’ll see you at an upcoming reunion??? geesh.
Julia says
I don’t think robotic medical assistants will ever replace real ones. Perhaps for the sake of saving money a job will be created which is part nurse/part medical assistant to cut down on staff (which will exhaust and frustrate an overworked staff!) but I can’t see people accepting a robot taking care of them instead of a human. The media hypes how narcissistic/uncaring the younger generations are and how we’re moving toward a future of narcissistic sociopathy, but so far (as a 40-something mom) the kids I meet in their teens and 20’s are much wiser than I was at that age, and very concerned about others and especially the environmnet.
I agree that what a caregiver says is so important. When I went to therapy for panic disorder I started with a therapist who did a lot of analyzing and put a label on me as ‘mentally ill” and “sick” and she was going to teach me how to cope with being that way. I got so depressed seeing her that I quit and found a different therapist. The second therapist put a label on me as “Healthy but coping with panic disorder” and consistently told me that with work anyone could overcome panic disorder and I just needed to keep trying until I found what works for me. My rheumatologist also talks like that about my RA “Don’t worry, if something doesn’t work, we’ll just keep trying together till we find what does.” My rheumatologist always reminds me that I’m a “healthy person with an autoimmune disorder”. That kind of encouragement has really helped me a lot!
Katie says
What you should have done was given her this URL so she could read for herself how busy you are! 😉
The relationship between medical professional and patient is such a complicated one. There is so much to be gained and lost by even a few words gone awry. I think it is very important for both sides to make sure they choose their words carefully. That being said, I know that I tend to be one of those people who hear one “negative” comment and let it eat at me, instead of focusing on all of the positive things have been said. I hope you are able to keep a better perspective than me and know that a) the majority of your patients and their families know how very hard you work and are grateful the what you give to us and b) you won’t be able to please everybody, no matter how hard to you try.
Erica Brown, MD says
I just wanted to second Dr. Peterson’s comment, and commend you on putting into words some of the thoughts that rattle around in my head quite often. I find the doubting comes from all angles sometimes. I hear other pediatricians comment on how nice it must be that I have so much free time, or complain that they feel they take too much of the burden because I have chosen to work part-time so that I can care for my own small children. It surprises me how critical, and sometimes outright mean, pediatricians can be to one another when it comes to “not showing enough commitment” to career. I had sort of thought that among all medical specialties, pediatricians should understand the most. I find that we, as a group, do this to parents as well sometimes. I hear disparaging remarks made about parents who don’t spend enough time with their children while they are in the hospital, and I have to think to myself if the doctor has taken the time to ask the family why they aren’t present. Is that parent worried that if they miss one more day of work they may not have a job?
Perhaps we should all try to be a little less judgemental, a little more kind, and consider our words before we speak.
Chris Johnson says
Twenty years ago, even ten, I would often ruminate for hours, sometimes days, over comments parents of my patients made to me, comments that annoyed or even angered me. I have to say I rarely react that way now, more than thirty years on. It’s not that my skin is thicker, or that I’m overly cynical; if anything, I’m far less cynical than I once was. (Beware the doldrums of that second decade of practice.) It’s a cliche, of course, but I think I’ve just come to realize that when parents say things like that it really isn’t about me at all; it’s about their perceptions of me and what I do. So my worrying about what they say can be a kind of solipcism.
After all, anything parents say is useful because it gives me insight into their world view and makes it easier for me to understand them. I don’t need to like them, or they me, and I don’t need their approval. I need to enlist their help in taking care of their child. Listening to their comments, even the snide ones, can help me do that.
Wendy Sue Swanson, MD says
Yes, Dr Johnson, I agree, all of the things families share about parenting their children, and their vantage point, help me relate and understand them better. I did, and do, recognize the benefit of these interactions. And maybe in 10-20 years, I too, will ruminate less. 🙂 But this just hit a raw spot, I suppose, because I already spend so much bandwidth evaluating my commitment to work much more than I ever expected and thus, it caught me off guard when someone mistakenly felt I wasn’t working enough.
Viki says
Reading about your exam room exchange reminded me of your “protocol” post. She might be thinking how quickly your two days fill up when she needs to get in to see you. Hope your next encounter is better!
Bryan Vartabedian says
Liked the post, Wendy. Reminds me of one of my fav books, ‘If You Give a Pig a Pancake.’
I don’t think the robots are far off. It’s inevitable that much of what we do will be replaced. But not all of it as you suggest. Who could have predicted that the CT scan would replace the abdominal exam in the ER?
Tanya says
Thank you for this thoughtful post. This is just what I needed to read today- balancing mother-wife-md act failed today. And your post brought me back to balance. Again… Thank you.
Kate Land says
Yes, exactly my thought; your amalgam to our pediatric minds was an “If you give a Mouse a Cookie” post! And one so close to my own thought of balancing my own ill mother, three kids and more than enough work. Days in the office juggled with work that takes other forms so is not immediately “visible” to those who may judge. So – waste no time letting the judging affect you – it is spoken without knowledge. You are doing an impressive and inspiring job. You also echo my own thoughts this week about the intersection of words spoken and heard.
DS says
Wow – I would have a very hard time clearing that parent’s comment out of my head. Or heart, I should say. I’m sure I have said equally clueless and thoughtless things, some of which I doubt I am even aware of – but wow.
I tell residents all the time that a career taking care of patients will take absolutely everything out of you that you are willing to give, especially if you do as wonderful a job as you do, Wendy Sue. It is up to each of us to protect the non-work parts of our lives.
Reminds me, too, of a story I read by a man who had horrible problems with rage, much of which came after several tours of duty in the Middle East. He went through serious therapy and recounted a story soon after where he was standing in line at a grocery store and the woman in front of him was socializing with the cashier. She had a young infant with her and he found himself becoming furious as the cashier held the infant and chatted with the woman ahead of him. He found the strength to use his relaxation techniques and did not explode, as he would have done previously. When the woman ahead of him left, the cashier thanked him for waiting and explained that the baby was HERS, and that her friend brings the baby to see her while she works because she worked several jobs due to her husband being gone on active duty in the Middle East. It rocked his world and he recounted feeling very grateful to have done what he needed to do to stay calm enough to hear something that changed his perspective so dramatically.
Sorry – lots of rambling, although maybe that fits right in with the theme of this post (not that you rambled :->). Just reminds me that we never know what else is going on in someone’s life and I wish that parent had realized that before she made her comment to you.