The Patient Is Always Listening
- Geoffrey Rubin
“Excuse me? I’m lying right here, ya know. C’mon!”
The voice came from behind the cloth curtain of the test bay, in a tone of defensive disbelief. It belonged to a patient who had Brugada Syndrome and an implanted defibrillator awaiting her stress test.
I had been discussing Brugada, the potentially lethal and heritable “sleeping sickness” marked by unheralded syncope (loss of consciousness) and sudden death. My colleague and I were enthusiastically running through the electrocardiographic characteristics, diagnostic uncertainties, defibrillator firings and death rates when the conversation turned to the patient.
“If she were to drop dead during exercise…” I had started to say.
Well, “she” was the patient behind the curtain. And she was very much alive, with excellent ears.
I was horrified. I had become so numb to a patient’s presence that I objectified her potential death even as she was sitting before me. In that moment, I embodied what I loathed about the stereotypical burnt-out senior trainee: a doctor who treats patients like lab rats instead of humans, who assumes they aren’t listening and wouldn’t understand a clinical conversation anyway.
But language matters: what we say, how and where we say it. In medical school, I was taught to say “woman” instead of “female” when presenting on rounds. A patient isn’t “a congenital” or “CHFer," but rather “a young man diagnosed with Tetralogy of Fallot and heart failure." Our own humanity as physicians depends on maintaining the humanity of our patients.
If there were a microphone recording you in the hospital at all times, would you feel comfortable airing it to the world? If your mother were the patient, would you be comfortable with the doctors objectifying her illness right in front of her? At the start of my cardiovascular fellowship, a mentor advised, “You are your reputation.”
The patient’s doorway on the wards or in the lab is not a concrete, soundproof wall. Physicians must assume the patient is always listening. Furthermore, we can’t assume that patients don’t mind when we talk objectively about their sickness and outcomes at the bedside. In the hospital, we have to be careful about subtle dehumanization that lightly cushions a doctor’s psyche but hurts the patient to a disproportionate degree. Always assume the patient is your mother and is critiquing your every word.
I apologized to my patient several times, and she graciously accepted. Her stress test was fine.
New York, New York