As a new physician, Viveta Lobo, MD of Stanford University Department of Emergency Medicine had one mantra: Keep it short. Dispo fast.
It was not until she was struggling to cope with the in-home illness and death of her father while trying to learn to breast-feed her newborn that she began to suspect there was a missing piece to her approach. “I used every advantage I had, walked through the back door…just to get a few things done.” She encountered many roadblocks and every step took a great deal of time and effort. It was hard, especially for someone used to a ‘Chest pain? Admit. Next!’ approach.
Viewed from the other side of the stethoscope, Lobo realized “Patients and families all have a story and as physicians, we just get a snapshot of that.” There is a wide spectrum of both disease processes and treatment options and in failing to account for individual circumstances, “I may have been efficient, but I wasn’t effective…I missed the bigger picture,” Lobo shares.
Why does the patient with strep throat need an injection instead of a prescription? Why would it make more sense to coordinate outpatient care for the patient with CHF instead of admitting? Because of individual circumstances only learned through listening and asking.
Shortcuts that skip the listening portion not only shortchange the patient, they lead to a myopic view of care that vastly circumscribes what an emergency medicine physician is capable of experiencing and delivering.
There is a line from the movie Gross Anatomy when medical school-teacher-turned-patient Christine Lahti says, “I just wonder about some of these brilliant doctors of mine…with their minds for medicine and their hearts for real estate. I wonder what they’d say to some lonely terrified patient, who grabs their hand and says, ‘Can you explain this to me? Can you help me accept this? Can you at least sit with me so I don’t feel so alone?’ Well, I bet they don’t say anything because I didn’t teach them to.”
But sitting and listening does much more than enhance the patient experience. It is critical to transforming care and outcomes.
Following her father’s death, Lobo joined Stanford’s Patient and Family Advisory Council (PFAC) for oncology. She subsequently created a PFAC for the emergency department and helped identify and implement policy changes that not only relieved patient anxiety but also led to a more robust intake and care experience that involves family members and subsequently more effective treatment.
A PFAC is not a grievance committee any more than a university is a book club. PFACs transform grievances into action and ensure that the humanity of healthcare is always present, balancing the business side. For Lobo, “I’m reminded of why I chose this profession and it has worked toward my own wellness and professional satisfaction.”
But one does not have to participate in a PFAC to reap the benefits of an expanded patient perspective. Lobo’s message is simple: listen to patients. Listen to their families. Consider their input AS important as their vital signs.
Several years after her father’s death, Lobo was again a patient, coping with harrowing circumstances that left physical and emotional scars. She delivered a 25-week premature daughter but lost her identical twin sister. Her daughter spent more than three months in the NICU. Lobo’s challenges, and also privileges as an on-staff physician, determined treatment, but only because the physicians and nurses listened. In a time of extreme sorrow and anxiety, that ability to help inform the discussions and guide the care was an important part of the recovery, and, she feels, greatly influenced the outcome.
“This,” she explains, “is the most precise of precision medicine.”
Watch Dr. Lobo’s FIX19 talk below!