The Importance of Five Minutes

anesthesiology, medicine

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.

 

“Every Scar On My Face Is Worth It”

adversity

In London, an unexpected head injury led me into the hands of a plastic surgeon.  When I was rushed to the hospital via ambulance to receive the services of the National Healthcare System—the very institution that I had come to England to study—I felt nervous and frightened.  Countless questions swirled through my head as I attempted to assess the trauma I endured.  All of my questions were ultimately answered by the confident and charismatic plastic surgeon who ultimately mended my lacerated head.  The way in which he explained each step before executing it gave me much needed comfort that night.  His passion for his job and his expertise were evident, but even more so was his ability to treat me as an individual. I have no recollection of this doctor’s name nor could I spot him in a crowd; however, my perception of this man epitomizes a good doctor—someone who is passionate, a healer, and gives positive reactions to unfortunate actions.  I will not only be forever grateful to this physician, but I will forever remember what he did for me in hopes that I can do the same for someone else.

“Code99.” I heard on the overhead speakers in the hospital. Politely and quickly, I excused myself from the patient I was interviewing. Rushing to the front of the Emergency Department, I met my attending physician who had just grabbed the orange airway bag. Together we began rushing to the elevator as a set of nurses followed briskly behind with the stretcher and backboard. He clicked the basement button, and moments later the elevator doors opened. As I stepped out I saw a man on his knees, a puddle of blood adjacent to his limp body.

“Jason, Jason, are you ok?” I flashbacked to that night in London where I had received my very own head injury, when it was my shock, my limp body on the floor with blood adjacent to me.

“Does anyone have a pair of gloves,” I yelled down the hall as more people began gathering around to see what all the commotion was about. “Yes, Doctor… here,” a gentleman handed me a box of latex gloves. I put the gloves on and removed my stethoscope as I asked one of the nurses to hold it for me. Coming up behind the gentleman, I introduced myself and told him I was there to help him. I pulled him up and onto me as I laid us both onto the stretcher. Once he was safely on, I slid myself out moving to the head of the stretcher where I supported his neck as we rushed up to the ED triage area. After we stabilized him, we sent him to the CT scanner to ensure there was no internal bleeding in his head. As he came back from the CT scanner, he was now more lucid but still unsure of what had occurred. I explained to him that we observed the video footage in the hospital and it was highly possible he had suffered a seizure. I moved the loose gauze that was covering his head wound and ½ of his left eye. A 5 cm wound 2 inches above his left eyebrow looked back at me.

“Hey, I’m one of the plastic surgeons here. I hear you had a little accident. Don’t worry, I’m going to fix you right up.” One of my classmates held my hand while my mother was on the speaker phone with another one. The plastic surgeon began numbing the skin to circumvent the wound he was about to suture on my left eyebrow.

“Hello sir, I am Jason again—one of the new resident physicians here. You’ve got a decent size gash above your left eye, but don’t worry. I am going to fix you right up,” I told him as the nurse began cleaning the wound. I extracted the bupivacaine with one needle, then switched the needle on the syringe to one I could use to inject the numbing medication emulating the plastic surgeon from nine years ago. Then I grabbed the nylon suture, the needle driver and began. One suture at a time, I worked diligently and judiciously as my attending peered over my shoulder with a look of approval on his face. Five sutures later I was proud of my work. Well, I was truly proud of the many attendings, residents, and senior medical students who took time out of their hectic schedules to teach me, show me, and create for me the ability to succeed that day.

When I was done, the patient stretched out a smile on his face—he told me I had done a good job today and thanked me. His wife thanked me. And I thanked him for his service to our country and for allowing me to take care of him.

I peered back over my personal statement from medical school when I got home. I read, “I will not only be forever grateful to this physician, but I will forever remember what he did for me in hopes that I can do the same for someone else.” Today was that day. I did what he did for me.. for someone else.