We had 50 minutes to take a patient history. In a typical office visit, patients are seen for 15 minutes in which time the physician must assess, diagnose, and come up with a treatment plan. All I had to do was take a history.
We all sat down to present our cases to the attending, and I went last (and took the longest to say my piece). I finished speaking, and someone who worked in the clinic spoke up first. “Your patient told you all that? We’ve had him in here before and he’s never been that open with anybody.” The attending didn’t have any questions. Just commented that it was “very thorough” and he thanked me.
At first I felt pride — did I do something good? Did I do something right?
And then... I felt a twinge of sadness. Because I did not do anything “special.” I talked to this person conversationally, and that must have been something he has never received before in a healthcare setting. I skipped questions that seemed nonsensical, followed up with things he felt particularly excited or worried about, laughed at his attempted jokes. These things felt obvious to do. But often, in a clinical context, we don’t do them.
It made me wonder how many people have never had a comfortable experience when trying to take care of their own health. How many people consider the doctor’s office a scary place where they get poked, prodded, and patronized but never get their questions answered. And why we allow this system of non-connection to continue year after year, decade after decade.
The experience reminded me of something I think about often. It’s the concept of “good enough” in medicine. That is, where is it okay? Where is it not? And how did the current system get it so backwards?
Right now, we think we have to be perfect when it comes to tests scores. Our self-esteem comes from our performance and we use it to compare ourselves to our peers. We spend our time and energy here because we think the better we do on exams, the better clinicians we’ll be.
What is sacrificed, in that case, is our ability to connect and listen. Our humanity skills. Making eye contact and reading another person, touching them appropriately, and putting ourselves in their shoes. This is where we think we can be “good enough”—as long as we ace those tests. We think it’s okay to emulate Dr. House: brilliant, but callous and disrespectful. It’s not. That is an abdication of leadership, an abuse of power, and a disgusting sense of entitlement.
Our priorities should be perfectly opposite.
Where it’s okay to be good enough: Didactic skills. Be competent with the material and figure out how to figure it out. Don’t spend all day here. The ability to recite the amino acids or the anterior compartment muscles of the forearm are irrelevant for meaningful patient care.
Where we must be excellent: Emotional intelligence. Figuring out what someone’s goals are, what mental blocks they’ve been going through, and what’s important to them will far exceed the importance of anything we would be able to memorize. Touching someone in a meaningful, respectful way completely alters their healthcare experience. Finding something to bond over is therapeutic in its own right.
The medical system is not set up to prioritize this, so we must do it for ourselves. Practice it constantly. Spend extra time where it matters. The things that make us human are what mold us into excellent clinicians.
Let everything else be good enough.