Hero doctors

In our weekly anesthesiology morbidity-and-mortality meetings, we swapped tales of derring-do. How, in the face of overwhelming illness or major injury, we somehow saved lives. We conspired to reassure ourselves that poor outcomes were not our fault.

While the details of technical care were turned over and dissected, the subject of our emotions, feelings, fears and vulnerabilities were off the table altogether. These are taboo subjects in the hospital medical culture.

I worked at my last hospital for eleven years. In that time, only once did I hear a senior doctor speak of personal vulnerability, openly, in front of others. He was an obstetrician and gynecologist who confessed to me in the operating room, in front of the nurses, that he hadn’t felt like coming to work that day.

The day before, a cesarean section had gone horribly wrong and the patient nearly bled to death. The surgical team fought for six hours to save her life, replacing her complete blood volume over and over. Eventually she stabilized enough to get her to the intensive care unit. This surgeon told me he was so traumatized by the events, he had just wanted to stay at home today, not operate on a list of gynecology cases.

In the last decade, that is the only time I have heard such a public confession of vulnerability from a senior hospital doctor.

Yet our failings and mistakes injure and kill patients every day. The accepted figure for the proportion of hospitalized patients, who are accidentally harmed in the course of healthcare, varies between 10% and 40% of all patients. Medical error is a leading cause of death.

This internal tension between our heroic, fearless ideal of doctoring, and the reality of so many patients that we cannot save, or we accidentally harm, is a source of tremendous emotional vulnerability.

But when we learn to bring open-hearted compassion to the care of our patients, we learn there is so much we can give beyond technical expertise and heroic doctoring.

It gives meaning and purpose to our work, even when our technical medicine toolkit is empty. With that deeper connection, we also begin to be kinder and more compassionate to ourselves. No need to be a hero.

Making time to care

‘Great interview, darling, but there’s one question you didn’t quite answer.’ My wife is my best coach. She thought the question about a busy orthopedic surgeon not having time to relate to his patients deserved a better response.

My interviewer, a psychiatrist, said he once accompanied a surgeon friend on his Saturday morning round of post-op cases. On the drive home, he challenged his friend with the observation that many of the patients were anxious and frightened. ‘You just ignored their concerns in the hurry to get the round finished,’ he said.

‘Yes,’ admitted the surgeon, ‘I know I’m not meeting all their needs but if I stopped to talk to them all, I wouldn’t have any time left for my family. What do you expect me to do?’

The interview was about compassionate caring. My first response to this question was the scientific evidence relating anxiety and stress to surgical outcomes. A skin incision takes twice as long to heal in stressed subjects. Moreover, stressed and fearful subjects are three times as likely to succumb to infection.

‘So it’s likely your surgeon colleague is creating extra work for himself when he ignores the emotional wellbeing of his patients,’ I said.

I then talked about the importance of investing a little time up front with each patient, to build trust and rapport. The doctors who are skilled at making this human connection save a lot of time. Plus it’s a more satisfying way to practice.

In my interview, I forgot about the research using video-taped interviews of doctor-patient consultations. Patients give us lots of cues about unanswered concerns. The doctors skilled at noticing and responding to patient cues had on average shorter consultations than those who brushed them aside. Responding effectively to patient concerns saves time.

By this time, I started to get off-topic in the interview. I didn’t get back to the reality of this orthopedic surgeon’s practice. Here are two better answers:

Dr Stephen Beeson, a family doctor in California, is one of the happiest doctors I know. His patients love him too – his patient satisfaction ratings are in the top 1% for the USA.

Beeson has an unusual practice: he gives his personal mobile phone number to every one of his patients. ‘Feel free to call me,’ he says.

Insane! Doesn’t he have a family life? When I tell my colleagues to give their personal phone number to patients, they think I am mad. Patients would never let them alone.

Actually, Beeson’s phone hardly ever rings. And when it does, it’s usually something really important. For his patients, just knowing he’s there, and that he cares, is enough.

Beeson is an outstanding physician leader. Many of the clues to his happiness are found in his book, “Practicing Excellence – A Physician's Manual to Exceptional Healthcare”.

The secrets to happy and fulfilling medical practice are often paradoxical.

The more barriers built between doctor and the patient, the more they will demand of you. It’s as if you’re not really connecting, so patients remain unsatisfied.

My experience is that when you take down your barriers and defenses, patients made fewer demands on you, not more. And they’ll do a better job of helping themselves.

One final observation: Most orthopedic surgeons have massive incomes, compared to the national average. What would happen if my interviewer’s friend reduced his caseload and his income?

He could take every Friday off and not have to do a Saturday round. He’d spend more time with his family and would probably be a better, and happier doctor. He might even have time to talk to his patients.