The PRAXIS Nexus The PRAXIS Nexus

More than.

Posted on April 28, 2022   |   

Written by Michael W. Hess, MPH, RRT, RPFT.

One of the first things our respiratory instructors taught us way back in the day was that we were to treat the patient, not the number. Focusing on what the numbers say can prevent you from seeing the bigger picture, whether it’s the oximeter that is reading the saturation of a bedsheet or the person who has been in an exacerbation so long their respirations have come back down to normal despite their tripod breathing and cyanosis. Actually looking at the person in your care can give you a much clearer picture of what’s going on.

I have taken that advice to heart throughout my career and passed it along to many a new therapist starting out. It has helped me, for example, understand why we cannot just focus on any singular metric when we talk about COPD severity. As I’ve gotten further along in my career, I’ve discovered that it still comes up short in one very important way. Just as numbers should not define the entirety of the patient, the word “patient” alone cannot be allowed to define the person in your care.

It can be easy to forget that in this era of unimaginable stress in health care, where visits are compressed and hurried, and where efficiency is often prioritized over empathy. However, it is still the key to truly effective patient care. I learned that firsthand a few years back when I had the chance to develop a COPD-focused chronic lung disease program in a primary care clinic. One of the first things I did was to ask my friends in the COPD community what an ideal clinic space might look like to them. I knew I would not have the leeway to do any major redesign or remodeling of the clinic space, but I wanted to know how to get people comfortable with the place from the jump.

Almost unanimously, the answers revolved around making it not look like a clinic. People with COPD usually spend an awful lot of time in the trademark austere environment of health care facilities. They see the same physiology posters over and over again, the same flyers exhorting them to quit smoking and eat better. In these places, they are examined by various clinicians and given both good news and bad. But despite the intrusiveness of those examinations, many never really feel seen in these places. Instead, they feel like just another appointment box to check off, just another problem to be solved. It is very difficult to build any kind of rapport under these conditions, let alone the long-term trust that goes along with effectively encouraging behavior changes like reducing tobacco consumption or adhering to medication regimens.

My office was different by design. I was often questioned by the other clinicians in the office why I displayed a Mr. Spock teddy bear so prominently, jammed the shelves with other sci-fi trinkets, or hung an oar with “Row the Boat” emblazoned on it onto my wall. Maybe that sort of thing was commonplace in a pediatric practice, but to them it seemed frivolous in a space where I was telling grown-ups to quit smoking and take their meds. But the truth is, every one of those things was a potential conversation starter. Not many people know the thousands of hours of Star Trek lore that I do (for better or worse), but almost everyone knows who Mr. Spock is. Having that bear started more conversations than I can count, allowing people to think back to their own childhoods, then allowing me to segue into sharing Leonard Nimoy’s own COPD story. Suddenly, they had something in common with a famous person and they were no longer alone. The Row the Boat oar, signed by our popular local college football coach, allowed me to share with them my belief that only by communicating across the entire health care team can we be effective, and that my mission was to earn their trust so I could facilitate that communication and facilitate rowing them to better health.

Every item in there had meaning, and sharing that reminded us both that we were people. I wasn’t yet another person in scrubs or a white coat scolding them for smoking or not getting enough exercise. I wasn’t there to solve their problem; I was there to help them solve it themselves to the best of their ability. I wasn’t just a clinician, they weren’t just a patient, and we weren’t just there to check off boxes. I know the conversations held in that office were truly meaningful and impactful for many, and that knowledge has helped me get through those days that feel more futile. So never forget that you’re not just taking care of a patient. You’re taking care of someone’s spouse, someone’s parent, someone’s child…and they, in turn, are also taking care of you.


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  • Very well said, Mike.
    I think it's important to develop a good relationship with a medical person. You will see he or she very often. You both should feel comfortable with each other. People are people. People like gadgets and trinkets and neat stuff. Displaying these items gives a feeling of comfort. A patient is more able to absorb information if he or she is comfortable.
    In my pulmonologist office, there is the same inhaler poster everywhere. I am sooooo sick of seeing that. The place has no personality. No character. No charm. I had read reviews, and one said that doc has the personality of a pickled herring.
    I once said to my doc- It's good to listen to patients. You can learn alot from them. You can't just go by the book. Each patient is different in many ways.
    Just as we count on our medical team to be trustworthy and caring, they should in turn trust what we say, and listen to what we say.
    So, when you have your next medical visit, and you see a teddy bear on a bicycle in the waiting room....go ahead and smile! Be comfortable at your visit. Learn all you can, while you do a little teaching!!!
    • I think we all feel blessed when we encounter a doctor or other medical personnel who treat us as people -- not just a collection of symptoms. I like most of my current doctors, but they never ask about aspects of my life or history that does not involve medical or genetic stuff. Last year I met a nurse who talked about Jesus and ghosts and the terrible orange juice they stocked at the hospital, and she showed me pics of her family. In other words she treated me like a person, instead of a patient or a medical subject. I liked her a lot.
  • Thank you, Mike, for this post. It's so important that we see individuals impacted by COPD as just that - unique individuals with meaningful lives of their own. We can learn a lot from them by listening and talking "with" them instead of talking "at them."
  • Thank you Mike. I think that seeing the patient as a person is a skill that helps the clinician better understand what treatments to suggest. If you know that I love to dance then you know that a medication that has a side effect that causes strain on my feet and legs might not be the way to go if there is an alternative treatment.

    I was speaking with a young pulmonologist the other day who was making this same point and said that no where in his training did he have any session that spoke to this issue.
    • Caroline, that's a great example of what we're talking about here. I'm not giving up on the idea that someday there will, indeed, be training for med students and other allied health professionals on this issue.
    • I think sometimes the training is where you find it. We didn't have any specific kind of coursework regarding this in respiratory school, but in my general ed program, I took classes like interpersonal communications (which actually WAS required), Buddhism, and similar things. That's where I learned more about taking a broader view and not simply being a "technician."

      I can't help but wonder if the larger problem isn't a lack of knowledge, but a lack of time/space to actually EMPLOY that knowledge, because of system problems...
    • Mike, if only some of the "broader view" courses you mention here were required for med students as well as other allied health care professionals, that would be a game changer. You're right - time and space is not often available -- but again, I believe that someday these types of courses will be considered enough of a priority for those who shape the curriculum to find that time and space.