A doctor's visit

This note came from a doctor newly arrived in Boston. As you know, MDs can be the harshest critics of care, so it was heartening to receive this.

This letter is to convey my deep appreciation for the outstanding care I received at BIDMC several days ago when I was emergently taken to the Emergency Department for acute abdominal pain, then to the Intensive Care Unit. In a quick series of roller-coaster like events, I developed a bacteremic shock and a liver dysfunction which were very promptly managed, and I was discharged feeling much better in less than a week.

Several remarkable individuals- doctors, nurses and other health care staff were involved in my care. I have never been in a hospital for anything other than minor things; this was my first time at the receiving end of serious care, a valuable lesson that made me reflect what it is that they do that makes a difference between a frightening experience and one that I can look back and learn from, as a physician myself.

First, they explained and reassured. I think the doctors and nurses deserve a lot of credit for keeping me and my family informed regularly of what was going on, in a transparent and objective, yet reassuring manner. This allowed me to be a participant witness of the rapidly unfolding events without panicking. For a frightened patient, uncertainty about the illness is often worse than the illness itself. Reassuring words from a confident physician can make a huge difference, and instill that essential ingredient of recovery, namely hope.

Second, they were empathic and respectful. All those involved in my care evinced the four key elements of empathy (engage, educate, empathize and empower); examples were the nurse who empowered me to titrate my own oxygen use based on my looking at the O2 saturations (but of course without letting down her own guard), and my physicians who listened to my own interpretations of the illness before stating his or her own, backed by good evidence, of course. And the use of good humor made this patient feel special (as one nurse put it, “I was the best patient in ICU because I talked, sat up and provided ample urine output!”)

Third, they provided effective and efficient care which was proactive, and not reactive. My journey from walking into the ED to receiving expert assessments was within minutes. Not a single procedure was delayed, and not a single intervention left out in efforts to make the illness more comfortable to bear. I would especially commend the nurses who, as the key coordinators of care (the “quarterbacks” of the care team as one of my colleagues puts it) were always on top of what was happening and communicated effectively with me and the family all the way through.