First Place 2019 Empathy in Medicine Essay- Joan Hager

Joan’s First Essay, “To Be or Not to Be Wellbutrin”

“‘Let’s talk about getting you off the Wellbutrin,” said my nurse practitioner during my annual physical exam. “‘You’ve been on it for, how many years?” She moved through a few screens on her computer, searching through my medication history.

I hear myself blurt, “No!” – a sudden and surprising reaction. “I mean, ‘I’m kind of afraid to be off of it. ‘Don’t worry; I see the prescriber – a psychiatrist – once a year for a medication review.”

I feel panicked to have this compartmentalized, this secret, side of me exposed. I ‘don’t really want to revisit the depths of old situational depression, the trials of finding the right SSRI that helped, along with talk therapy, to get to the relatively high-functioning person I am today.

The N.P. ‘didn’t seem convinced and before I had much time to think about it I told her more than she would ever want to know about succumbing to depression after my older brother – my only sibling – took his own life. And before that awful time how, as an 18 year old I had been abducted by a stranger, robbed and raped at gunpoint then left in a dark muddy field on a freezing November night in Detroit, Michigan.

Or, WAS this information “”more than she should ever want to know””? How does a patient come to feel comfortable enough in the clinical cold of an examination room, in a 20 minute block of time to reveal…confide…purge… the reality that is at the forefront of my mind every single day of my life. Is this information appropriate to a physical exam? I never had the urge or need to share this before and only did it because my coping mechanism – the Wellbutrin – was being challenged.

The “big reveal” did turn out to be a bit too much. The following year, another P.E., another review of medications ‘I’m on, another year of my “talisman,” Wellbutrin XL popping up on the computer screen.

“Well, I know enough not to ask you about the Wellbutrin!” the N.P. teased. I felt my face flush. “And we ‘don’t need to bring up that other nasty business.” Evidently meaning the suicide and the armed abduction and rape. She was keeping the mood light, giving me back my compartmentalization of bad things that happened in the past.

I think about this experience the N.P., and I had together. A benign question about a medication became a big elephant in the room. Was it appropriate for me to blurt my personal story out on an unsuspecting health care provider? Surely my whole being is, sadly, affected by these experiences – as much as I would like to say otherwise. Is that relevant in a primary care office?

Disclosures of this type – very much outside the realm of blood pressure, heart rate, respiration – are part of who I am. Where does it fit – DOES it fit – in an annual physical examination? My nurse practitioner ‘didn’t seem ready for the conversation. I spent 30 years NOT talking about it, and now ‘I’ve had 2 years post-disclosure, and I still ‘don’t know if it was the right thing to do.

Will the #METOO era help advance disclosures in ‘doctors’ offices in order to work toward optimum health? Shine a light on what was once secretive, shameful. To me, that seems like a legitimate pursuit to whole health.

Joan’s Second Essay, “Can You Hear Me Now? “

It was a bad five months – so bad that retelling it sounds like a sad country-western song. My dog died in July. My dad died in September. My mom died in December. All the deaths were expected, just not in one fusillade of reality raining down on my head.

The next month, January, I had my annual physical exam with Dr. A. He came into the exam room with his electronic tablet, shook my hand, made some awkward small talk, then got down to the business at hand. As he reviewed my medical record on the tablet, I set right in telling him about my parents passing, first because their deaths by colon cancer (dad), and CHF and dementia (mom) are relevant to my family medical history. Secondly, I felt the stress health-wise from those recent events.

Dr. A. typed intensely, trying to keep up with the information I was giving. There was a long pause as I waited for him to finish. At last, he had it all typed to his satisfaction and moved on to the actual physical examination.

I walked out of that exam room feeling exhausted, having just revealed emotional information to a doctor who did everything required of him in terms of checked boxes, but who gave me no reaction or feedback to what I told him. To him, our time together was complete.

It was not long after this that I took my cat to our family veterinarian, Dr. O. He had seen us through our ‘dog’s Mast Cell carcinoma from which she succumbed the past July. Dr. O. asked how the family was doing since then. I told him that there was still a hole in our lives without the dog, and on top of her dying, my parents had passed away within months of her.

Dr. O. set down the folder holding the ‘cat’s chart, walked around to where I stood, and put his arm around me in a comforting gesture that set off a flood of tears I had not expected to shed during a rabies shot visit.

I believe a couple of things were going on here in terms of the different reactions from these two doctors – and I ‘don’t mean because one was a human doctor and one was an animal doctor. Dr. A. was right on with his careful documentation using the latest in electronic medical record keeping. But the use of his computer tablet broke any connection, any give-and-take, he had with me as his patient. My words, describing a relevant medical note, fell on closed ears and closed mind. It ‘wasn’t just frustrating for me – it was sad to be so unattended to.

Dr. O., who did not use EMR to chart, ‘didn’t do much more than jot a few quick notes in my ‘cat’s paper record in real time. This allowed him to be present and available to his patient and her owner. These differences between Dr. A. and Dr. O. came from their tools used for record keeping. EMR shut me out. Paper and pen helped include me in the exchange of information and validated my physical and emotional truth.

The Boston Globe, on March 4, 2019, wrote an article, “Wired into the Wall: Voice-recognition system promises to automate data entry during office visits.” This may be the technology that finally frees physicians and their patients from the disconnect of note-taking. I look forward to exploring that possibility with the hopes of a more authentic relationship with healthcare providers.

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