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.