President's Perspective April 2012

Michelle ButterworthLook, Listen and Feel: A Patient's Perspective 
By Michelle L. Butterworth, DPM, FACFAS, President
 
As I travel home from San Antonio, I’m filled with positive energy--what a great conference! The sessions were top notch, attendance was record breaking, and the experience of my Presidential inauguration was awesome. I started to reflect on the topics presented and how they will help with my practice. I learned a few surgical pearls I am anxious to try and how to incorporate EBM into my treatment plans. Plus, I witnessed great panel discussions, which made me realize personal experience should remain part of the practice of medicine and surgery.
 
Then, I thought about our keynote speaker, Dr. Abraham Verghese, who focused on the patient-physician relationship. While I gained a wealth of knowledge from the conference, I realized that this presentation, which was neither academic nor surgical, had the greatest impact upon me. He really hit home and reminded me that our focus should be on the patient. It seems he stated the obvious, but think about a patient you saw today and ask, “Did I really focus on my patient and interact with, listen to and examine them as I should have?” Embarrassingly, my answers were mostly no. How many times has a patient come in with typical heel pain and we’ve already made a diagnosis without really listening or examining them?
 
Vergehese’s perspective became more eyeopening while at the hospital, not as a doctor but as a visitor. As I sat in the ICU next to my mother’s bed, I watched the interaction of the doctors and staff with her and I thought about Verghese’s lecture. He talked about today’s practice of medicine and how the purpose of hospital admission is to render the live 3D human into a 2D image. He stated medical rounds are now typically removed from the living patient and are centered around the “ipatient.” During his talk, I thought about how truthful his comments were, how guilty I was of this practice, and how unfortunate it is for our patients. Sitting in the ICU, I saw things through a more patient-oriented perspective and I feared my mother would become an ipatient.
 
I was amazed though to see that the staff understood that patient interaction and bedside exams are vital to care despite today’s idea of mainstream medicine and advancing technology. The staff was compassionate and took a hands-on approach. They asked “Is there anything you need or anything I can do for you?” before they left the room. What a simple question, but think about how you feel after being asked it.
 
As my mother’s health improved, she was transferred out of ICU and again I expected she will become an ipatient. I was fortunately wrong again—I witnessed the continuation of hands-on personal interaction. They listened to her, validated her, and most importantly examined her. This combination helped turn an awful event into a positive experience. By the time my mother went home, everyone there had gained her trust not by being the smartest but for being the most human. As a doctor, observing from a patient’s perspective, they also gained my respect and made me take a closer look at how I treat my own patients.
 
As a result, I’ve made changes to my practice. I take the CPR training motto, look, listen, and feel, and use it during my patient encounters--and it has made a huge difference! I first look and make eye contact with my patient, shake their hand, and ask them how they are doing. Next, I simply listen to their complaint; no computers—just human interaction. Then, I begin my physical exam and feel. Even if I am sure the diagnosis, I do a thorough exam to give them the attention they deserve. At the end of the visit, I ask if there is anything else I can do for them to ensure they’re satisfied.
 
In the age of EMR where computers and iPads are in our exam rooms, we’ve seemed to misplace our focus. As we enter information about our ipatient, let’s remember to look, listen, and feel. The real patient should be our focus and with whom we should be spending the majority of our time. Let’s concentrate on our live patient and the importance of personal interaction and physical contact and not get lost in the “ipatient.”
 
Questions for Dr. Butterworth? Write her at president@acfas.org.

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