REFLECT

Model stories written by young professionals/students.

Little Things, Big Results

A student notices that the little details of a patient’s visit, from the smallest conversation to the biggest smile, have a profound impact on their overall care.

The hustle and bustle of a clinic can be overwhelming for some, especially when that clinic contains a very busy Starbucks store. Nurses grab their coffees as they get off shift, doctors in their white coats chat in small groups, and patients and their families sit quietly to the sides. It is a very impersonal and transitional space, a place where patient care has been pushed aside and replaced with a self-absorbed personalization of a Frappuccino. However, I believe that as soon as a patient walks through the doors of the clinic, patient care begins: how that patient feels in the clinic environment and what interactions they have with passersby can completely change the way their upcoming visit is about to go. As that patient veers left to avoid the Starbucks insanity and instead enter the Neuroscience Clinic, the atmosphere shifts. The staff are prompt to make eye contact and give a smile. The noise from the greater clinic drifts away as the patient approaches the desk, to be replaced with the sound of the calm and collected voice of the receptionist. Patient care begins at the Neuroscience Clinic before the patient sees a single healthcare professional, and its effect is obvious.
 
The conversational tone of the receptionist is an aspect of patient care that permeates through the entire Clinic, from the desk staff to the doctors. Dr. Green*, the doctor I had the opportunity of shadowing and a specialist with memory disorders, is no exception. Upon seeing his first patient, Dr. Green took the time to take a thorough personal history, making sure to focus on his patient’s home life and personal pursuits. While it is true that these components of a patient may be more important for memory disorder patients than others, Dr. Green makes sure his visits seem more social rather than medical no matter what the diagnosis. It was apparent, especially with this patient, that Dr. Green’s friendliness was key to reducing the anxiety of the patient. His hands, which had been nervously shaking in the beginning of the appointment, relaxed onto his lap after just a few minutes of talking to Dr. Green, and the quaver in his voice all but vanished. Even as the patient passed and failed memory tests, Dr. Green remained positive and talkative, combining the perfect amount of attentive medical care with personal care.
 
Dr. Green’s positivity does not stop there. Throughout every visit, he makes certain to stay open and welcoming with his body language. This includes sitting down at the patient’s level, leaning forward when speaking to them, keeping eye contact as much as possible, and most importantly, always having a huge smile on his face. It is obvious that the patients feel right at home when Dr. Green enters the room, almost as if they’re meeting with an old friend as opposed to their physician. I had never really considered the importance of posture and facial expressions before working with Dr. Green, but now it is one of the first things I notice when observing other physicians. Dr. Green does not only care for is patients in the medical sense, but also on a personal level, and it shows in the way they respond to him during his visits.
 
While Dr. Green’s primary focus during appointments is on the patient, he also takes time to speak to the family in the room, using the same kind words and big smiles he uses with his patients. He comes across as accessible and knowledgeable, encouraging family members to add their thoughts to the patient’s story when he feels that they may have something to contribute. In one specific instance, Dr. Green was questioning an older, female patient, asking, “Why are you here today?” The patient laughed, saying, “I wouldn’t be here if she didn’t drag me here,” gesturing to her daughter who was sitting to her left. “I just got a little lost one time.”

Dr. Green looked at the daughter expectantly, but didn’t ask her anything. The daughter, obviously not trying to respond negatively to her mother, but still wanting Dr. Green to know the truth responded, “She did get lost once. But we also talk every day on the phone and every day she tells me the same stories. She doesn’t drive long distances anymore, and she is alone now most of the time. I’m worried about her.”

In this way, Dr. Green was not outright asking the daughter if her mother's statements were true, but rather looking to her to provide more information if there was any. The daughter contributed multiple times throughout the visit, but it was clear that she wanted her mother to control most of the conversation. The daughter also tried to reassure her mother as Dr. Green began the memory tests, telling her that he was only asking her to try her best and nothing more. The open communication Dr. Green used with both the patient and her daughter, taking both patient and family into account, was key to the success of the visit. It allows both the patient and their family to feel important and validated, something that does not often occur in specialty visits. It was visible that the daughter felt empowered and confident, which made her mother feel less anxious, which in turn made her daughter more relaxed. Something as simple as considering the family present at a visit not only benefitted the family, but also the patient.
 
Dr. Green is, as one of his patients dubbed, “the man” when it comes to memory disorders, speaking to his excellent clinical skills. But I believe that his people skills are almost more important in the success of his care, evidenced by the major effects the smallest of his actions had on his patients. His conversational and friendly tone when speaking to patients helps them to feel more at ease in the visit, and more like a participant than a test subject. Dr. Green’s open body language and kind demeanor again invite patients to confide in him and elicits their trust, allowing him to better diagnose and treat them. His special attention to the family involved in the visit allows for all involved in the patient’s care, as well as the patient, to feel validated and empowered. It has been proven that patients who trust and have a positive relationship with their physician are more likely to adhere to medical advice heal faster[1]. For these reasons, I believe that while receiving high quality medical treatment is of the utmost importance, it is also crucial that patients receive high quality personal treatment, from the medical staff and all others involved in their care. As medicine moves more and more towards standardized and impersonal – almost Starbucks-like – care, it is imperative that physicians take the time to realize that their patients are people too, not just a name on a list. They need to remember that a simple smile can change the trajectory of a visit, and a kind word or two can put a patient's mind at ease. It is positivity, kindness, and support that truly make a difference in patient care.
 

-Emma Valee

[1]Berry, Leonard L., et al. Patient’s Commitment to Their Primary Physician and Why It Matters. Ann Fam Med 2008 6:6-13.