I walked into a patient room last week and he was on the phone. I thought to myself, "oh, he'll get off the phone now that he sees that I'm here.". Nope. He kept talking. And talking. Long enough that I felt awkward and like I was listening to a conversation I shouldn't be privy to. I felt totally disrespected, like he didn't value the appointment, or my time, or me. I even thought to myself for a quick second that I didn't deserve his attention as my patient anyway. I didn't know what to do, so I just sat there, playing with the computer mouse. When he finally got off the phone, he made some small comment as a shallow apology and put his phone away. Of course, I didn't know what to say so I said, "oh, it's ok". Actually, it wasn't ok. Not at all. He was completely disengaged. And it felt awful. Later that day, I started thinking about myself as a health care provider and how I engage or disengage with patients. I remembered times when I may have come across to my patients as disengaged. How, I've walked into the room with a diagnosis already "figured out" and I'm looking for the history/information to back up my diagnosis. All before I even meet the patient. My nurse tells me, "this patient is complaining of _____" and I think to myself, "oh, it's this. or that. but most likely *this*. Let's see if I'm RIGHT. I have other patients waiting so I hope this is quick." (Thankfully I haven't done this often.)
As a health care provider, I have worked to engage my patients for the most part. To convey I honestly care and to listen to them. But there have been times when I haven't done a good job of conveying that. And honestly, there have been times when I am completely without a doubt, disengaged.
These days too often there is a disconnect between providers and patients. And patients and providers.
That patient that texts the whole office visit? Not engaged.
The provider who stares at the computer screen the whole visit and never makes eye contact with you as a patient and keeps his/her legs and arms crossed? Not engaged.
Technology has brought us far in medicine, increasing early diagnosis, improving treatment, extending life expectancy. But, it's also provided an excuse to distance, to disengage. To not show up.
I recently discovered the amazing work of Brene Brown. Her ideas around showing up, engagement and vulnerability made me really evaluate and see how disconnected and disengaged we really are. As providers. And as patients. As people, really. How would health care be different if we chose to show up, to engage?
In her book Daring Greatly, Brene Brown talks about the importance of people sitting on the same side of the table, both literally and metaphorically. She talks about leaders, teachers, parents, anyone living their mission:
"How would education be different if students, teachers, and parents sat at the same side of the table? How would engagement change if leaders sat down next to folks and said, "Thank you for your contributions. Here's how you're making a difference. This issue is getting the in the way of your growth, and I think we can tackle it together. What ideas do you have about moving forward? What can I do differently to support you?"
As Brene says, it takes vulnerability to do this.
"How do we create a safe space for vulnerability and growth when we aren't feeling open? Armored feedback doesn't facilitate lasting and meaningful change--I don't know a single person who can be open to accepting feedback or owning responsibility for something when they're being hammered. Our hardwiring takes over and we self-protect." And, "Victory is not getting good feedback, avoiding giving difficult feedback, or avoiding the need for feedback. Instead it's taking off the armor, showing up, and engaging" (Daring Greatly)
I would like to posit that this same principle could revolutionize the health care system. If both patients and providers came to the table and sat on the same side, connection, health, trust, and positive outcomes would be the norm. As opposed to disengagement, disconnection, steam rolling, and distrust that is all to common today. Might I dare say we would have a HEALTH care system instead of a dis-ease care system?
How would you feel if your provider said to you, "I can see you doing an amazing job at ________. You've really done well. I'm so happy for you. How has that felt in your life/body? What I notice is that _______ still has room for improvement. What are your thoughts or ideas around this? Is there a better way I can support you? What do you think might be contributing to this? What goals do you feel are realistic around this? Is there anything I can do for you differently than I am now?"
Same side of the table.
And, how would we as providers feel if our patients engaged with us and gave us meaningful feedback? What if a patient said to you, "I really appreciate you being my provider. I love the way you do _____. However, I've noticed that you never ask me about _____. And, it's something that's really important to me. I'd like to discuss it with you. Would you be willing to have a conversation with me about this?"
Same side of the table.
Mutual respect and willingness to come to the table and engage is really core to connection. And connection with each other, ourselves, and our bodies is essential for growth and health.
It wasn't too long ago that when a doctor walked into the room, nurses had to stand as a sign of respect. This is no longer regular practice. And, I'm sure some doctors would argue that it's the way things should be. I personally am happy I am not expected to stand when a doctor walks in.
I'd like to suggest that respect is absolutely essential for doctors/providers. I'd also like to suggest that it's just as important for patients. We are all human, after all. A white coat doesn't take away your humanity.
It's important to remember health care providers, specifically doctors, are in a position of influence. Much like students, children and employees look to teachers, parents and CEO's for leadership. In health care, it is true that your providers are trained to help you be as healthy as you can be. However, many providers mis-use this trust and influence. They steam roll patients, don't listen well, or never engage. Likewise, many patients either let their providers steam roll them, or don't respect them, or never engage either. What's left? Two people standing next to each other inhabiting two completely different worlds. The distance between them simply cannot be measured because it's too large.
I would guess that LGBT people may experience a level of dis-engagement from their health care providers on a higher level than the general population. The reasons are varied: the provider is uncomfortable, doesn't have the knowledge/skill set to know specific health care issues, fear, judgement: in short, lack of cultural safety. Lack of engagement. Lack of showing up, for whatever reason.
We need to work together to improve our health, our hearts, our minds, our world. Whether you are a provider or a patient (or both!), I encourage you to engage. To allow yourself to be vulnerable. I've learned from Brene Brown that at the heart of vulnerability is connect, trust, and courage.
You may be surprised what miracles happen in your life if you decide to show up and engage. As a side note, there are plenty of providers out there, so if you engage and your provider remains disengaged, then find another one who will meet you at the table. On the same side.
That's the kind of provider I want to be. That's the kind of patient I want to be. That's the kind of person I want to be.
I'm choosing to show up. And, it's a pleasure to meet you on the same side of this table.