Human to Human: Making Contact

Sep 22, 2023

By Ron Epstein, MD

Some years ago, I was jarred awake by abdominal pain, quite different in quality from my prior kidney stones. The care I received in the emergency room was excellent, as efficient as expected, and the staff was friendly. Looking back on the experience, one moment stands out clearly.

I was being transported from the ER to the CT scanner along the hallways I had walked for over two decades as an attending physician. It was strangely unfamiliar and unsettling, though. Lying on a stretcher, I could only see the ceiling, and without turning in an uncomfortable position, I couldn’t see the art on the walls or the hospital staff passing by. Along our route, the tech transporting me warned me about the bumps along the way, and at one point, he stopped the gurney, looked me in the eye, and asked, “How are you doing?”

Such a small gesture with a huge impact. He made eye contact and spoke with authentic concern and caring. He was fully present. The tech saw me as a person. Just that momentary gaze and four simple words helped me relax, feel cared for, and feel less alone. That moment was the most memorable of my ER experience.

But why that moment? The checklist items were all A-plus. Timely and efficiently, reasonable pain control, an accurate diagnosis, and clear communication were provided; fortunately, the findings were reassuring. But something needed to be added, something that only the transport tech did. Maybe it was that the staff, who cared for me and asked the right questions, often looked at a screen while talking with me. Also, to some extent, in retrospect, they were looking at me with a “clinical gaze.” The 20th-century philosopher Michel Foucault described the clinical gaze as dehumanizing, separating the objective view of a patient’s body from the patient’s person, the patient’s identity. It’s not an either-or, though. We can adopt a clinical gaze and also remember to honor a patient’s humanness.

People, including patients, feel cared for and respected when the beauty of their humanness is seen. Most clinicians consider their relationships with patients a very important component of career satisfaction; the sense of purpose and meaning from these relationships helps them put into perspective the moral distress and burnout they experience.

But it is so easy to forget. During my dermatology rotation as a medical student in Boston, I realized that I stopped seeing the beauty of the faces of strangers I passed in the hospital, on the street, and on the public transport I took from home to the hospital. I only “saw” the moles and zits.

We know from neuroscience research that seeing is not something that happens to us as much as it is conditioned by what we regard as relevant. Seeing one another as a person is an ethical act. It attenuates distress and burnout and helps us thrive and build healthy teams and organizations. Seeing starts with awareness, noticing what we see, and being open to noticing what we don’t.

Here are two exercises that help you remember what you already know: we can see patients with a clinical gaze and a human-to-human gaze. As an experiment, try them out and note what happens to your perspectives, perhaps even whether they affect your diagnosis and treatment plan.

EyesIn your work setting, note the color of the eyes of those you meet. Start with one person per day, maybe someone you don’t know particularly well.

Something unique: When writing chart notes, include one thing that makes that patient unique as a person. Of course, you’ll have to ask and listen to find out. Perhaps start with, “Tell me about yourself” or “How has your day been?” and note what you discover.

 

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