Patient relationships: Can you care too much?

As I mentioned last week, journalism wasn't my first chosen profession. After a tough realization that nursing wasn't for me, I studied creative writing for the remainder of college. What I took away from that education was an ability to articulate the most intimate of thoughts and emotions to an audience of acquaintances. A writer's goal, if he or she gets really lucky, is to eventually gain the opportunity to share these uniquely personal musings with total strangers (maybe even for pay, though that hope may be pushing it).                                        

I was exposed to a similar--and far more terrifying--progression in nursing school. Take injections, for instance. First you read about the procedure in a text book; then a professor might demonstrate in front of a class how to inject saline into an orange. Next, you get to try out your new skill set on your classmates (not wildly different from the peer victims forced to read and critique my early stabs at poetry and prose). Finally, someone hands you a syringe and reminds you which quadrant of a man's buttocks to jab it into, like a dart.

The first time I did this, my elderly patient cried out--loudly--that I'd hit a bone. Unlike the relationships, I'd formed with my classmates--in which we built trust, admiration and a healthy rivalry or two--I'd had no opportunity to bond with this man before "administering" his medication via a sharp and unfamiliar implement.

As I did every week of my first and last clinical rotation, I'd gone to the nursing home I was training at the night before to research my patient. I read his chart and other nurses' notes to get an overview of his needs, what medications he was on, and whether he'd have pressure ulcers to examine and tend to.For eight out of the 10 Thursday mornings I returned to the facility, I was lucky enough to not have to hastily start this process over because my patient had expired during the night.

So back to my first--and last--injection patient. I can still picture his face clearly, twisted around in anguish and confusion, staring into mine from his prone, totally vulnerable position. Chances are he was suffering from a form of dementia and that I didn't actually run aground with my needle. But he was frail. And fragile, physically and emotionally.

I had not the skill set at the time, nor inborn talent most health professionals naturally possess, to connect with or comfort "my" patient before, during or after our encounter. I don't remember his name, just the horror we both felt at that moment. I did complete many weeks I had of that rotation, but I knew at that moment I would not be donning a stethoscope in the fall, let alone for a summer CNA job like most of my classmates.

As a writer, I'd like to think I do have the ability to connect with my audience, even though I'll never learn most readers' names or see their faces. Having never been formally trained in journalism, I struggle with the concept of professional distance.

All of what I know about reporting I've learned on the job and am making an educated guess that at some point I missed a lesson instructing on how to not become emotionally involved. With the help of good editing, I do my best to present all sides of a story in an objective manner, but I'd be lying if I said the emotions of my sources didn't have an effect on me. Take a recent story I wrote for my state medical society about medical marijuana, for instance. How could anyone not let themselves feel the passion and concern conveyed by these doctors on both sides of the issue?

My job is to simply be the messenger of my sources' ideas and feelings, and they're more real and effective if I leave as much as I can of the personal side of medicine intact. It's a balance I'll likely spend the rest of my career striving to get just right.

How this all connects to you, finally, is the dilemma you as healthcare professionals face in finding the right balance between clinical objectivity and doctor-patient rapport. An article published in Medscape Today this week covers the issue nicely, though it offers no definitive answers.

As you can see, reading it got me thinking about my brief and utterly unsuccessful attempt to connect the person and the patient myself, and how difficult it can be to translate that concept in the job where I actually belong.

I'm aware that we've published several articles over the past three years of FiercePracticeManagement discussing the importance of the physician-patient relationship, the role of empathy, rapport--and how it's critical and not optional for healthcare providers to not just "care" in the sense of performing assessments and treatments, but to allow themselves to feel and even let it show.

There are doctors I know who do this beautifully. But the fact that there's such a volume of writing about it in the industry illustrates that for a great deal of well-meaning, altruistic clinicians it poses a challenge.

Drawing from the parallels of my own experience, the best advice I can offer is that it's a constant learning process. The way we get involved and insulate ourselves will evolve over time, and vary from case to case. But as always, I would love to hear from you. Is it possible to care and not get overly caught up? If so, what is the secret? I'm sure your peers will appreciate your insights. - Deb (@PracticeMgt)