10 Things I’ve Learned from Interviewing Patients for Over 10 Years

I walked into the room and before I could even introduce myself, she erupted into tears.

I’m not a rocket scientist but I knew this visit wasn’t going to be simple.

She had a story to tell but wasn’t sure just how to tell it.  She was overwhelmed with her circumstances.  And in her hopelessness she was reaching out for help.  Possibly for the last time.

So I sat down.

Looked her in the eyes.

And listened.

Here’s 10 things I’ve learned from interviewing patients for over 10 years and getting to the heart of the story.  The real story.  The story behind the story.

1. Listen without judgment.

Let people talk.

You don’t have to agree or disagree with any of the decisions they have made.  It doesn’t matter if that’s the way you would have done it or not.  It doesn’t matter if their actions mesh with your religious views or not.

Many people simply have no one to talk to.

2. Don’t give advice.

When people are talking, they don’t want to hear my words of wisdom.

This took many years to figure out.

After all, “I’m their doctor” I thought.  “They’re here for my advice. Right?”  Well…..kind of.

Only give advice when the person asks for advice.  Or when it’s actually time to give recommendations.

Interrupting someone’s story just to throw in your 2 cents is not helpful.

This sounds easier than it is.

3. Be available.  Not pushy

Not everyone is on my timeline.

There’s an old proverb that goes like this:

The best time to plant a tree is……20 years ago.  The second best time is today.

Stopping cigarettes, changing a diet, or losing weight isn’t a priority for everyone at every visit and no one wants their faults shoved down their throats every time they come in to see the doctor.

Give people the freedom to be imperfect.

It’s less stressful.  Trust me.

Most folks know the things they need to work on.  Eventually the’ll ask you for help (see rule #2)

Make yourself available when the person actually needs you.

4.  People are emotional

People are more likely to stop smoking if their grandkids have some illness that is sensitive to smoke than just knowing what it could do to them.

People make emotional decisions.  Not rational.  Not logical.

When you realize this, you’re better able to help people make good decisions.  You just need a bit of empathy.

Also, sometimes you can change someone’s state by changing yours.  Let me explain.

I have patients that I know are going to be in a depressed state.  Because it is their baseline.  So I try to be the opposite.  I go in positive and smiling and confident.  Does it always turn their moods around?  No.   But they leave smiling more often than not.

5.  Be the hero you are, not the hero they want

Most doctors (at least early in their career) suffer from imposter syndrome.

People come to us with their problems and if you are worth anything, then you will always feel a little inadequate.  Like maybe your previous hard work, accomplishments, and achievements mean nothing.  Like maybe you should just close up shop and start selling shoelaces instead.

But just as important as knowing your patient…..is knowing yourself.

Self awareness is crucial.  Self criticism is not.

Your flaws may be just what was needed to put you in the place you are today.  Just think about that for a minute.  All your failures, hurts, disappointments, calluses, bruises, and broken bones have made you who you are.

The truth is….You don’t have to be perfect to help someone.

You don’t need a degree from Harvard.  You don’t need a best selling book on Amazon.  You don’t even need hair on your head.

You just need to be yourself.

6.  The human condition is progress, not perfection.

Everyone wants every drug addict to somehow be superhuman.  Clean up their act and then be perfect.  (Although no one expects this same perfection from diabetics.)

It’s a lot easier to make small changes over time.  And small changes add up.  Small changes work.

It’s a lot easier to relax and quit trying so hard.

So for my patients, I try to lay the framework to give them the ability to make small changes.  And to point their lives the direction that they want to go.  Maybe that’s less medications and more exercise.  Maybe that’s less fluctuations in blood sugar.  Maybe that’s reducing their risk of stroke or heart attack.  Maybe that’s no more weekend benders with adderall and alcohol.

You don’t inhale your cigarettes any more but you still smoke 2 packs per day?  Hey….it’s a start.

7.  Pain heals.  Chicks dig scars.  Glory lasts forever.

This is a quote from The Replacements.  An overlooked Keanu Reeves classic.

A friend of mine pointed it out to me.

Most people that suffer from depression have self defeating thoughts.  These thought processes are very hard to change.

But if you can apply this philosophy to your life….you’ll be dang near resilient.

Anti-fragile, as the kids are saying these days.

8.  Lies, damned lies, and statistics.

I joke with my Sunday school class that you can believe anything you want.  You just need to find enough Youtube videos to back you up.

The same can be done with medicine, research, and statistics.  There are plenty out there.  Some better than others.

I like informed patients but too many are reading webMD.

Medicine is an art.  Not a science.

No studies can replicate all the variables that make you YOU.   Which means I have to learn the science but I also have to learn my patient.  And this takes time.

Some of the work is making assumptions, and then adjusting as needed.

You’ve got to use your experience, your knowledge, your intuition, and you’ve got to be flexible.

Also….you can’t always trust the pharmaceutical studies.

9.  Dr House had his demons, but he got this one thing right.

I haven’t watched House in over 10 years.

But I remember he used to send his minions to people’s homes.  They had to see the environment if they wanted to figure out what was going on.

That was smart.

You can’t really know someone if you have no idea where they come from.

I’m not talking about house calls (but that’s cool too).  I’m talking about having an understanding of what people are going through in their normal every day lives.  It’s not always unicorns and rainbows.

If someone can’t afford to pay the light bill, then their blood pressure medication is probably low on the priority list.

10.  The Big Truth

Last but not least is one of my personal philosophies.

It’s one of the most important things I’ve learned.

And I want all my patients to understand.

YOU AREN’T AN ACCIDENT!

Your life has meaning and your scars are important.

You are here for a purpose.

How do I know for sure?  I don’t.  But it’s a good guess, because just think about this:

Right now….

you’re sitting on a ball of fire and water….

spinning 1000mph…..

hurtling through space.

And you took the time to read this.

You tell me…..accident? Fate? Destiny?

Meaning or meaningless?

You choose.

p.s.

I sum up my rules for being a good doctor this way:

Treat patients the way you want to be treated

I call this…. the golden rule.

p.p.s.

If you’d like to read more of my musings, you can check out my book, because it has words and stuff.