I had the opportunity to observe a primary care physician interact with an elderly patient yesterday. The physician was sitting at eye level with the patient, making good eye contact, and asking open-ended questions. He seemed to genuinely care about the patient and asked how he could help her. The patient, clearly in pain, expressed concern about her rapidly declining physical condition. She said her back hurt constantly, that nothing she did seemed to help. She’d never been in this much pain in her life.
The physician’s response astounded me. He said, “Well, you’re 84 years old. You’re kind of like an old car – you can only keep it going so long before everything starts to break down.” The patient, who had been smiling and looking at the physician, eager for an answer, dropped her eyes, curled her shoulders inwardly, and sighed heavily. Her body language communicated how deeply his words had wounded her.
Words that Heal
It might be true that at her age, the patient is facing a future that includes more medical needs than in the past. When faced with a patient in pain and distress, should that be the primary focus? Wouldn’t a focus on the patient’s current condition be a better first step? If I were the patient, at a minimum, I would have hoped to hear something like, “I can see that you are in pain – let’s see what we can do to help with that”. Those simple words would have healed.
Since the patient was someone near and dear to me, I was expecting much more. If I wrote the script, the physician would say, “I can see that you are in pain. Let’s get you some relief first and then figure out what’s causing the pain to see if we can prevent it from coming back. You may need to come to visit me more often than you have in the past, and that’s okay. I’ll be here to partner with you in addressing your needs.” Those would have been words that wowed.
“First, do no harm” the fundamental healthcare principle that physicians learn to apply when considering an intervention that carries an obvious risk but a less certain benefit. Wouldn’t it be nice if we all applied the same principle to the words we used when addressing patients and each other?