A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.

We always hear about the art and science of medicine, but with our busy practices, the science stays at the forefront, while the art can get lost. Personal experiences or a special patient can help open our eyes. The following are just a few stories from physicians that illustrate the power of enhanced communication and listening to our patients and how both can positively impact patient experiences and care.

Stop and listen: case #1

I could hear raised voices as I walked towards the patients’ rooms. “Uh, oh, someone is not happy,” I thought. As I turned the corner, I saw my 8-year-old niece standing at the entrance to her room. With both arms on her hips, she was scolding one of her several medical teams. “How am I supposed to get better if you won’t let me sleep?” Her voice was loud, firm, and filled with frustration. There were soothing, murmuring voices from the medical team in response. “No, it is not OK. You are waking me up all night long to get my blood, check my vital signs, or do something else to me. I can’t sleep, and I am so tired,” she wailed. Again, soft voices responded; this time, her mother interjected, “You are not listening to her; you need to stop and hear what she is saying.” My smart, sassy, strong-willed niece was recovering from a craniotomy and tumor resection. She was being followed by several different medical teams and was getting blood draws every 2-3 hours because of different orders from each of these teams. This meant uncoordinated blood draws via finger pricks and disturbances all night. Once the medical teams stopped and listened to her, they realized that part of the reason she was so irritable and tired was that she was rarely going longer than 2 hours without someone disturbing her. After coordinating her care to allow for longer periods of uninterrupted sleep, she was back to her happy, silly self.

This often happens in big medical centers. Specialists are so focused on what they need to obtain from the patient to achieve their best practices that they sometimes forget to consider the whole picture of how that care may be affecting patients and their families.

Stop and listen: case #2

Our 17-month-old needed an MRI to rule out osteomyelitis, a condition that causes inflammation of the bone or bone marrow due to infection. As an active toddler, he would need general anesthesia to stay still enough for useful images. After being discharged from the clinic to a hospital room, we were told that he would need to fast starting at midnight and would be hooked up to IV fluids until the MRI. We had to keep a cranky, tired 17-month-old from pulling out his IV. It had taken three attempts to get the IV set, and we didn’t want to lose it. As an anesthesiologist, I advocated for clear liquids until 6:00 a.m., then fasting and asking for clear communication with all of the medical teams. Unfortunately, this did not occur. By mid-morning, with no word from anyone, I called the anesthesia scheduler and found out an MRI would not be available until after 2:00 p.m. According to fasting guidelines, he could have had breakfast and clear liquids for several more hours. At around the same time, my son’s fever had returned. He was miserable, sleep-deprived, and hungry. I asked for ibuprofen, but the nurse needed to check if this would violate his fasting guidelines, delaying his dose for more than an hour. Fasting guidelines exist to help minimize the risk of aspiration. These time windows are useful when you know the procedure time, but when the procedure time isn’t scheduled, patients can stay hungry all day in case a spot opens. Everyone wants patients to be safe; however, prolonged fasting times cause increased pain, nausea, anxiety, dehydration, electrolyte imbalances, and hypotension. IV fluids can be helpful, but they are not as effective as oral hydration and not as satisfying. Additionally, continuous IV fluids are logistically difficult for active children, leading to increased stress.

Improved communication about scheduling and primary team education can decrease excessive fasting times, improving patients’ well-being and outcomes.

Stop and listen: case #3

I have always loved obstetric anesthesia. It has been my passion since I started my training in France. I love having healthy patients, coming in expecting a joyful experience, and leaving the hospital with a new beginning. It is amazing when all goes well … but when it doesn’t, we don’t always realize the impact on those moms who are worried not only for their own health but also for their babies.

I was called by the nursing team for some help getting IV access to a “difficult“ patient who had been hospitalized for two months. I came into the room and introduced myself and barely got an acknowledgement. I explained I was there to place another IV, and this young woman started crying and whispered, “I can’t do this anymore.“ Her arms were so bruised from the many blood draws and IVs. I sat down, took her hand, and waited. She then started talking to me for a long time, explaining how she never thought pregnancy would be so hard and how difficult it was in this environment, alone almost all of the time. We spoke for a while, and she thanked me for listening. All she needed was someone to talk to.

Sometimes, we are so busy with our daily tasks that we do not realize the importance of human interactions. All it takes is a few extra minutes to stop and listen, and that can make all the difference in a patient’s experience.

The art of medicine can often take a back seat to science because of the time constraints of our daily lives as physicians. These examples elucidate the importance of listening to patients and having situational awareness. We should always remember, even on our worst days, that this is probably a worse day for our patients. Listening to their concerns and being compassionate can alleviate anxiety, improve outcomes, and increase trust. These skills are often hard to teach but can be emulated and observed by our colleagues, the entire medical team, and our patients.

Rita Agarwal, Anna Swenson, Barbra Orlando, and Christina Menor are anesthesiologists.