[Purple Cohort] Module 7

[Leslie Kao]

Please submit your SOAP Reflections below:

[Ahmed Yeddi]

Substance abuse is often a cause of homelessness. Addictive disorders disrupt relationships with family and friends and often cause people to lose their jobs. For people who are already struggling to pay their bills, the onset or exacerbation of an addiction may cause them to lose their housing.
In many situations, however, substance abuse is a result of homelessness rather than a cause. People who are homeless often turn to drugs and alcohol to cope with their situations. They use substances in an attempt to attain temporary relief from their problems. In reality, however, substance dependence only exacerbates their problems and decreases their ability to achieve employment stability and get off the streets. Additionally, some people may view drug and alcohol use as necessary to be accepted among the homeless community. Breaking an addiction is difficult for anyone, especially for substance abusers who are homeless.
To begin with, motivation to stop using substances may be poor. For many homeless people, survival is more important than personal growth and development, and finding food and shelter take a higher priority than drug counseling. Many homeless people have also become estranged from their families and friends. Without a social support network, recovering from a substance addiction is very difficult. Even if they do break their addictions, homeless people may have difficulty remaining sober while living on the streets where substances are so widely used.
There is evidence to support the recommendation that treatment and recovery approaches should not be limited to professional interventions. Self-help models have been highly successful in helping individuals recover from alcohol and other drug problems and in preventing relapses. Long-term sobriety without peer support is extremely unlikely. In addition, sobriety cannot be maintained without adequate housing and job training.

[Ahmad Abu-Heija]

Empathy in our profession is largely under-rated, initially it is taken for granted that as physicians we automatically expect ourselves to be empathetic with our patients and share a portion of their burden by placing ourselves in their shoes. However, as time passes and burdens of working long hours worsen, we can easily over-look empathy in the workplace and the very essence of our reasoning behind entering this field is lost with it, as patients become just one more case of HFrEF, PE, Pneumonia etc. Hence, checking in with ourselves every so often, can bring us closer to our patients, our family and our friends as better listeners and better empathizers we are definitely better physicians.

[Emmanuel Akintoye]

Being a supportive and empathetic listener is fundamental to connecting with our patients and gaining their trust. Although, we are often pressured with time in discharge of our daily activities, showing the patient that you are with them at that time of interaction goes a long way win their trust. When interacting with patient, we must be present, show connection with body cues, and make the patient understand that they are the most important person to you at that time t. Patient love it when they know that the physician is connected and concerned about the problems, they are more willing to open up and tell the physician all they need to know. As a physician, we are also better of when patients trust us because they volunteer the necessary information that will need to make management decision. I have personally found out that the interview process is more efficient when its conducted with a supportive and empathetic manner

[Wadah Ameen]

I believe most of the issues we encounter as primary care on every day basis can be resolved by just listening and being emphatic to our patients, rather than just giving our assessment and plan. In my personal experience, I found it effective especially with patients requesting pain medications. Being emphatic make us more sincere to our patient in regard that there are alternative options (PT/Pain clinic) that can actually help them. Empathy/listening/support sometimes are ALL what your patient is looking for…not a pill.

[Carli Denholm]

Empathetic listening is essentially active listening while putting oneself in the shoes of the speaker and acknowledging their feelings. I feel that it is something that, while not necessary to be a good doctor, IS necessary to be a good clinician. Empathetic listening makes the patient feel heard and improves their trust in the physician because they feel like the physician cares. Often, getting a sense of validation, respect, and empathy is as important, or even more important, than treatment for their condition. As physicians we also benefit from the improved relationship with the patient, which can promote adherence to treatment plans and such. For some patients, whose problems we cannot fix, such as addicts, we are often frustrated by lack of progress and poor adherence. We may not be able to offer these patients a quick treatment, but we can offer them empathy. Physicians also benefit because this type of listening helps us identify underlying needs and barriers for our patients which we can then address. However, practicing empathetic listening with every patient can be emotionally exhausting. As mentioned during the discussion, it is important to recharge after each encounter to avoid burnout and present each patient with our best selves. It is also important to reflect on your encounters so you can continue to improve your empathetic listening skills. I plan to work on these last two points to improve my effectiveness as a healthcare provider.

[Muhanad Taha]

Empathy is a main component of the patient-physician relationship. We should agree to the fact that not all physicians are good listeners or practice clinical empathy with every patient. Clinical empathy is expressed as the skill of understanding what a patient says and feels, and effectively communicating this understanding to the patient. To be a supportive and empathetic physician, one should start with planning. Empathy is a skill that we should learn and practice with every patient. Follow up the feedbacks from patients is important. Practicing empathy in a clinical setting leads to greater patient satisfaction, better compliance and better clinical outcome.

[Jasleen Kaur]

Life has a funny tendency of unexpectedly throwing things your way. We, physicians, deal with this regularly. You never know what’s lurking about to put a huge dent in your day and sometimes few days. Similar happened to me on floors last month. And I was even facing some conflicts with Empathy towards me. I felt alone.

And just few moments later I had to address a family meeting where I had to explain the prognosis of acute events to the patient. As I spoke to them I realized that my concerns were nothing close to them, they are going through much more. I chose to be me… empathetic towards the patient and family and re-do the same the next day and the day after that. Needless to say, they trusted me more and we bonded so well.

The lesson? You can choose how to respond to any conflict, anywhere. The power lies in your hands. It’s another application of empathy, that time-honored quality we doctors are supposed to possess.

Understanding another’s mindset and tailoring your approach from their perspective can make all the difference.

[Hala Nas]

This week’s discussion was rather an interesting one, shifting the focus to patients having drug abuse/addiction. When I was younger, I had a “black and white” view of things: If a person is an addict it’s their doing, if they refuse help it’s their issue and they should endure the consequences, however this view has shifted a bit since starting residency, now I can relate a bit more to the fact that maybe a patient like that had a rough time growing up, was not having a good family/parent support to stay on the right tract, and maybe their coping mechanism is weaker than most of us given certain lack of privileges they endured.

I have a clinic patient who I started seeing after hospital discharge for acute alcoholic hepatitis, he was remorseful, determined to change certain behaviors, and wanted to live for his daughter. We started talking about the need to quit drinking period for his liver to heal, he would be able to abstain for good amounts of time, then binge whenever surrounded by family/friends. We agreed early on that he will tell me everything, and I promised if he did that, I won’t utter any judgmental comments, I will just listen and try to help as much as I can. Even though I couldn’t help him quit, but I was satisfied over the fact that he knew he had a safe place to come to whenever he felt his dependence would ruin things and we can figure things out to help

I learned a valuable lesson after I started seeing the addiction spectrum through residency: Try your best not to judge, listen; by making someone feel safe and accepted you will be able to reach out and maybe change a life for the better and imagine yourself in their place, how would you like to be treated?

[Yahya Ibrahim]

Expression of empathy and sincerity in our daily interaction with patients can go a long way. Last month, I had a patient that had Broca’s aphasia. It is a condition when the person’s comprehension is intact but the person would mostly speak non-non-comprehansible words. This pt expressed frustration because she is unable to express herself fully and kept complaining of multiple issues at the time. Her IV access was compromised and we needed to establish a new one in order to deliver treatment but the pt was refusing any attempts to place a new IV line. I approached the pt and explained that I know it is frustrating to you. I know that now you understands us better than we understand you and it is hard. I hope this will improve with time but for the time being we need your permission to establish a new line in your vein to deliver medications. She was calmer and said “Yes” in agreement not just with placing a new line but also with everything I mentioned. I have explained to the nursing staff that it would be important to be patient and more elaborate in everything we do with the patient to lessen her frustration. This was an unforgettable encounter to me.

[ABDELRAHMAN M AHMED]

Expressing empathy is at the core of being a physician. This can be reflected in taking the time to listen to the patients, knowing more about their lives and addressing their concerns. It can lead to stronger doctor-patient relationship and patient adherence.

[Antonio Smith]

A young male that was very accomplished in powerlifting presented due to palpatations and syncope. In recent history his home heart rate monitor would register rates as high as 140 beats per minute at rest. He initially claimed to be previously healthy. However on further inquiry, he admitted to having some occasional diarrhea and he noticed it took little effort to warm up at the gym with frequent instances of soaking his workout clothes. His prior history was significant for cocaine use intranasally with last use 5 days ago. ECG significant only for sinus tachycardia. There was the urge to knee jerk to a diagnosis of drug induced tachycardia, however we knew this deserved the full workup. His thyroid function revealed that he was experiencing thyrotoxicosis. Once on treatment, his tachycardia resolved and he was discharged in good health.

another patient was an older gentleman with a few well controlled chronic medical issues, presented to clinic in healthy condition. The only thing of concern was his heart rate which was in the 110-120s. He had recent visits with another physician in which an extensive cardiac workup was done including CTPE. The results revealed nothing. The covering primary doctor decided to start from scratch and get a full history to see what he could glean. During the discussion of social history admitted to using cocaine frequently, often before clinic visits. His drug use was never documented in the past. The use was beginning to interfere with both social and economic aspects of his life. His tachycardia resolved once abstinent. The patient is now in rehabilitation.

It is important to be a balanced physician. Fixation on the patient’s drug use may interfere with exploring other medical conditions known to present similarly. On the other hand, failing to obtain a thorough social history may lead to lack of high value care manifesting as unnecessary referrals, tests, medications etc.

[Kendall Bell]

I had a similar patient as Dr. Smith in clinic at DCC. Patient was 50 year old male who was presenting with tachycardia. He had this tachycardia for the past 3-4 visits, each time he was seen by a different resident. Patient was tested for anemia, Thyroid function, and even worked up for pheochromocytoma with urine metanephrines all of which were negative. As in Dr. Smith example I took a very detailed history, including social history, and the patient initially denied drug use. However he seemed awkward when answering the questions about drugs, I reassured him that I was not asking the questions to judge him, just to help him with his problem. It turns out he was previously addicted to crack cocaine, and had recently relapsed and began smoking crack again. I referred him to the counselors at the DCC clinic, and I recently seen the patient again in clinic and he is now clean for 30 days. The tachycardia has resolved as well. It made me feel good that I was able to get the patient to open up to me about his addiction.

[Msutafa Ajam]

There is increasing evidence suggesting that empathy directly enhances therapeutic efficacy and patient-physician relationship. Engaged communication was found to reduce patient anxiety and, for a variety of illnesses, decreasing anxiety has been linked to physiologic effects and improved outcomes. Different studies on the way physicians deliver bad news concluded that patients cope better in the long term if their doctors are emphatic

[mowyad Khalid]

Empathy and listening to pts is part of our roles as doctors. Pt is the source of history, and what he tells us directs our differential and managemnt. Also listening to family and friends increases social support and rapport qhich benefits us. In essense, Listening and not interrupting pts should be practiced by each physician

[Ghaith Alhatemi]

When it comes to patient care, empathy is an essential component that strongly affects the outcome. A lot of time providers do excellent job addressing their patient care needs but forget about the emotional component of care, the thing that makes them robot- like. There is no doubt active listening is sometimes all what need in some patient encounters to reach the diagnosis or at least a narrow differential. For me, I like my doctor to always listen to my concerns and put them as a priority and not only treating me as a object.

[Raya Kutaimy]

Almost every clinic week, I meet at least one patient with substance abuse( alcohol, drugs). I try to counsel them. Once I had interesting conversation with one of my patients, tried to understand why she uses heroin. She was homeless after she had an argument with her boyfriend. She was depressed and felt that heroin is helping her. I counseled the patient in details on substance side effects and offered resources to help her stop using it. She promised me she will try and I never saw her after that. What I learned from that experience that listening to people with empathy and understand their reason is a better way to help than being judgmental. There is no excuse for substance abuse but there are circumstances that can lead to that and listening with empathy and have solid communication with the patient can result in patient’s understanding.

[Bayan]

Substance abuse is a problem we deal with all the time as physicians especially in this era. It is a problem that requires time to fix as the opioid epidemic is part of it. Being an empathetic listener means to listen to the patient while putting yourself in their shoes. This benefits not only the patient as it improves the physician patient relationship but also should be used all the time when listening to people’s problems around us. It is a skill to be practiced.

[Ali Alateya]

substance use disorder is one of the major health problem in united states, i can affect pt on multiple levels, i mean on personal, social & health levels, recently i had a pt who has a history of substance abuse, prior to that she use to a successful lady running a business worth ~mil $, has a wonderful family & was a health person, because of her substance abuse she lost her business, family & became a thin homeless poor looking lady, pt was emotional when i interviewed her, after taking a detailed history from her she stated that she tried ti quit multiple times but unfortunately the psychiatrist she was refereed to were not helpful, pt was tearful during the interview & was asking for help, we as a team made sure that she was refereed to a good psychiatrist for her help.

[Pranav Shah]

I personally find drug abuse a very challenging disorder to deal with. Although I have been trained and currently use empathy in my interactions with patient to deal with drug abuse, I find little success. More often I find that like children, patient’s learn from fear. I had a patient come in two days ago who went to the hospital due to her heroin abuse and overdose. In the hospital she was incidentally found to have Hep C and also H.Pylori. Patient came into my clinic this week with the goal to “get her life back on tract.” Unfortunately due to my experiences at DMC I have become a bit jaded in believing in success, but I tried to be empathetic.

I asked the simple questions open ended questions: “How are you dealing with this new diagnosis? What plan have you set up for yourself to help you quit Heroin? Do you have a support group? How are you dealing with the withdrawals? How are you handling all this?” Putting yourself in another person’s shoes is simply understanding what they are going through – unbiased. It’s about not interrupting with personal anecdotes or saying things like – “I had an experience just like this.” It is valuing each experience for its unique circumstance, personalities, and outcomes. Although this process is in my mind – protective for the physician, I hope to find success in this process with patient’s and their struggles with substance abuse.

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