March 26, 2019
by Autumn Dawn Galbreath, MD, MBA
Drunk, rowdy, and foul smelling, he came into a busy clinic last night. He was roomed immediately to get the disruption out of the waiting room, but his volume penetrated the walls and disrupted multiple other clinic rooms. He had no ID, wouldn’t tell us his name and had no chief complaint. We helped him look through his contacts in his phone, and came up empty—a son who didn’t answer the phone and a girlfriend who told us they had split up and he was “on his own.” What were we to do with him? No idea why he was there, no idea how to help him and no one to call for assistance. He sang and flirted with the staff, but when asked about himself, he would only say “I’m here for a broken heart.” A broken heart is not a medical problem. Or is it?
As physicians, we are trained to gather information, diagnose and treat. But how do we implement this training with lonely patients whose hearts are broken? What do we have to offer them? In the absence of a medical problem or diagnosable psychiatric problem, what is our role? Patients with emotional stressors and a lack of social support can be frustrating—we feel we can’t help them, and they often can’t help themselves. Our treatment plan might not be feasible due to their isolation. And most of all, they take so much time, which is already at a premium in every medical practice. If we do spend the time to talk with them, find community resources and offer support, what difference does our effort really make?
While my particular patient didn’t have an obvious medical problem, his lack of emotional well-being actually put him at higher risk of developing one. As one study showed, “Patients with higher baseline levels of emotional well-being have better recovery and survival rates than patients with low levels of emotional well-being….Subgroup analyses indicated that emotional well-being is related to both survival and recovery.” And in another, “positive psychological well-being was associated with reduced mortality in both the healthy population…and the disease population.” And a study of diabetic patients showed that when patients move from emotional distress to diagnosable depression, depressive “symptom severity is associated with poorer diet and medication regimen adherence, functional impairment, and higher health care costs in primary care diabetic patients.” In contrast, an NIH paper says, “…optimism is a mental attitude that heavily influences physical and mental health, as well as coping with everyday social and working life.”
These studies seem to show that an intervention that improves a patient’s emotional well-being can actually improve his physical health. That idea really gives me pause. How many times when clinic was busy have I dealt efficiently with medical complaints, but never stopped to really hear my patients? To really listen to their fears and frustrations? It might take a little time, but it’s an essentially risk-free intervention that can improve their overall health. There are certainly not very many risk-free interventions I am overlooking on a regular basis, day after day, patient after patient. Why this one? Of course, a lack of time is part of the explanation. But is that really all? Or is it just a convenient way to explain away my failure to get involved with my patients? Am I hiding behind the “busy doctor” façade? How much of my failure to get more personally involved has to do with just not wanting to? Just not caring enough to spend the time listening? How much is due to fear of what they might say? Fear that the conversation might turn spiritual and I would “have” to share the gospel? Fear of the emotional burden I will inevitably bear after hearing about theirs? And how much of it has to do with my own emotional distress? Am I emotionally healthy enough myself to be able to help others down that road? I’ve written on several occasions about the emotional distress we doctors experience as a profession. We are fatigued, overwhelmed and burning out. With that starting point, how can we expect to assist anyone else with improving their emotional health?
There are certainly reasons not to get involved. But then there is Galatians 6:2, “Carry each other’s burdens, and in this way you will fulfill the law of Christ” (NIV 1984). And Romans 12:5, “so in Christ we who are many form one body, and each member belongs to all the others” (NIV 1984). And Philippians 2:3b-4, “…in humility consider others better than yourselves. Each of you should look not only to your own interests, but also to the interests of others” (NIV 1984). And Ephesians 4:2, “Be completely humble and gentle; be patient, bearing with one another in love” (NIV 1984).
Over and over, God calls us out of the darkness of isolation and into the soul-baring light of community. Over and over, we are challenged to get involved; to be humble and vulnerable in showing our own distress, so others might help carry our burden; and to be gentle and patient in carrying burdens for others.
My patient completely lacked community. No contacts in his phone, no Facebook friends, no one to call to pick him up when he wandered into a clinic too drunk to drive home. I don’t know his entire story, but I know his isolation could be killing him. Successful recovery from acute illness and management of chronic illnesses are both impacted by emotional well-being, which is found—at least in part—in community. Even as I tried to help him that night, I was challenged to look at my own isolation. Where in my own life am I alone? What things am I choosing not to share? Where am I determined to go it alone? And what effect is that having on my own emotional and physical well-being? As healthcare professionals, we tend to be isolated. What are you doing in your own life to overcome this? Where are you connecting in a meaningful way with others? And how are you helping your patients do the same?