The Importance of Five Minutes

Originally published in July 2019 edition, ASA Monitor (citation below)

‘Unexpected death of a colleague,’ I read in the subject line.

As I combed through the remainder of the email, I came to learn that a second-year resident had died in a car accident near his hometown. It was his name that gave me pause.

Just a few weeks prior, I entered one of the campus cafeterias for a meal. There, I noticed a young man sitting alone wearing a navy-blue jacket. A University of Pennsylvania Perelman School of Medicine crest was stitched on his chest.

“Hey, man – I happened to notice your jacket. Did you attend UPenn?”

“Yeah, I did. I’m Joe! Nice to meet you.”

“It’s nice to meet you, too. A few of my closest friends also graduated from there!” I replied.

A conversation started, just pleasant banter that danced around the east coast versus west coast biases, shared colleagues and friends, Portland’s city designation with its small-town charm, and our respective medical specialties. The dialogue was short but delightful and lasted approximately five minutes in total. Before I left his table, I suggested we take a photo together to send to our mutual friends.

Our smiles are in my phone now.

In the five minutes when we spoke, a connection was formed, a foundation of trust laid. Unlikely as it seemed at the time, this simple exchange was similar to the swiftly created bond that forms when an anesthesiologist talks to their patient prior to surgery.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be “wasted.” Knowing how much joy interacting with people brings me, they were disappointed that I would spend most of my medical practice with unconscious patients. My answer: there is a unique responsibility born in that five-minute interaction prior to surgery. In those five minutes, I may have the ability to connect to a patient, gain trust and portray a sense of safety to a complete stranger in a way someone else may not. My communication skills could be the difference between someone entering the operating room with wild fear or measured ease.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be ‘wasted.’

I am not alone in feeling this way. “I have five minutes to convince someone I can take care of their life,” Dr. Marshall Lee – Oregon Health & Science University (OHSU) attending physician – stressed during residency orientation. This time restraint is a challenge that should be decorated for anesthesiology rather than seen as a reason to choose another specialty. A patient waiting in the preoperative area is possibly in one of the most vulnerable states of their lives. Patients may find themselves anxiety-stricken for the surgery itself, fearful regarding the aftermath, pained by the financial burden of the surgery and concerned for the risk of death. Most encounters we have with our patients are brief and delicate. A patient in this highly vulnerable state – concomitant with a short window of time – clings to every word from our lips. After a postoperative call to verify the patient is recovering appropriately, it is probable you will never see nor hear from them again. This does not detract from the memory of how you made them feel – one they may carry with them for a lifetime.1 

When recalling my conversation with Joe, I can no longer remember the nuances nor the minute details, yet I felt more connection and delight upon walking away from the table that day than after many hour-long discussions with others. As anesthesiologists, we only have a few minutes to gain the trust of the patient and family member, positively frame one’s outlook prior to their surgery, and provide the sense of comfort and reassurance they are seeking. During this brief encounter, we must gather information, set expectations and address concerns a patient may have – several factors underlying high-quality patient-physician encounters.2 One underestimated key is non-verbal communication – a grounding component of a therapeutic patient-physician relationship.1 And one example of this is evidenced in a study which demonstrates that sitting over standing is highly favored by patients as it creates a less dominant environment and more empathetic space.3 

As I embark on my anesthesiology journey, I will recall my feelings after I left Joe and the impact of a high-quality conversation – regardless of its brevity. It is a remarkable challenge that is requested of an anesthesiologist. At OHSU, attending physician Dr. Miko Enomoto is known for her saying, “the safest anxiolytic one can administer to a patient is their time, their attention and their care.” Let us never forget that in five minutes we have limitless influence on a patient and their family during one of the most vulnerable phases of their life. They may not remember the details of the conversation, but they will most certainly remember how we made them feel.

References:

  • Ha JF, Longnecker N . Doctor-patient communication: a review. Oshcner J. 2010;10(1):38-43.
  • Simpson M, Buckman R, Stewart M, et al. Doctor-patient communication: the Toronto consensus statement. BMJ. 2010; 303(6814), 1385–1387.[Article]
  • Strasser F, Palmer JL, Willy J, et al. Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. J Pain Symptom Manage. 2005; 29(5):489-497.[Article][PubMed]

Jason L. Campbell; The Importance of Five Minutes. ASA Monitor2019;83(7):44-45.

 

From Beacon to Shadow: The African-American Community is Waiting…

“‘More blood! Stat!’” I read. The first line in “Gifted Hands.” As a 15-year-old African-American student aspiring to one-day practice medicine I could barely put down the book my mother gave me. The story of Ben Carson MD—many believed to be the guiding light if you were poor or African-American or academically challenged—was the beacon illuminating a journey from adversity to achievement. The first words in “Gifted Hands” by Ben Carson, MD sets the scene within an operating room in 1987 at the Johns Hopkins Institution in which a medical milestone occurred. Two 7-month-old conjoined twins requiring copious amounts of blood, twenty-two hours of procedure time, a seventy-member team led by him and gifted hands resulted in a successful separation of two Siamese twins—Patrick and Benjamin.

 For Dr. Carson—one of the most academically impactful members of the African-American community—the fall from grace has been anything but subtle. When questioned on May 21st, 2019 by Congresswoman Porter he was asked to define a basic housing term—an REO (Real Estate Owned)—a term used to describe a class of property owned by a lender after an unsuccessful sale at a foreclosure auction. Seemingly unknowing of the term he responded with “Oreo?” at first to which he needed clarification—a surprising response in his position as Secretary of the United States Department of Urban Housing and Development (HUD). Dr. Carson once pillared his accomplishments on the power of knowledge. Now—dismissivae of a fundamental term a person in his position should use commonly this is in stark contrast to the image the black community grew up honoring. One contemporary of the once-esteemed surgeon noted he knew firsthand what Dr. Carson went through and it was nothing short of incredible. But watching his devolution has been a pitiful sight to see.

This playbook has not changed and still illuminates the story of a poor black kid from Detroit overcoming multiple barriers—poverty, academic strife, and a system constructed against him—to become director of pediatric neurosurgery at the Johns Hopkins Hospital and perform the successful separation of 7-month-old Siamese Twins when others said it could not be done. Few African-Americans, in any field, have come from very little to achieve such success. In the last chapter—entitled “THINK BIG”—Dr. Carson writes how each letter illustrates an important piece to success. The ‘K’ stands for ‘Knowledge’ which he defines as “‘… the key to all your dreams, hopes and aspirations. If you are knowledgeable, particularly more knowledgeable than anybody else in a field, you become invaluable and write your own ticket.’” Where have these words now gone? Once so important he wrote them in a book to inspire generations to come.

A man who once changed lives with words and saved lives with actions has now perished to an online trend seemingly devoid of the basic knowledge required in his current position. The surgeon who changed history in 1987 in that operating room in Baltimore, Maryland will forever be remembered by the African-American community, but the man we see today appears to be a shadow of his former self—at best.

This is a perpetual discussion intertwining history, race, culture, politics and medicine. Some of my colleagues may not agree but I desire a return from the former Ben Carson MD.

I declare to you Dr. Carson it is never too late to give a young woman of color, who once wrote to you because her mother like yours was a maid, hope and promise that she too can make something out of very little. I declare to you Dr. Carson that there is a young black male facing academic hardship who needs you now. I declare to you Dr. Carson that the African-American community is waiting…