It’s simple: you don’t look at them
A patient comes in, and you vaguely introduce yourself while sitting down to your computer (not looking at them), ask them what brings them (not looking at them), ask about their medications (not looking at them), ask about their pain (not looking at them). You turn around and look at them for the exam, but are you? You are looking at the aspect that you are inspecting / auscultating / palpating / precussing. You are not looking at them.
This is not a piece arguing against the use of computers during patient visits, it’s a commentary about how the culture of medicine, particularly specialized medicine, is changing such that it is okay to not afford someone the basic respect of seeing them.
Why does this happen?
Part of the problem is that we function in a broken healthcare framework: a system that incentivizes piling up patients, double and triple booking them, to maximize profits because clinic visits don’t pay as well as procedures. So providers can frequently be booked to see more than 30 patients in a day. For only 30 patients, in a normal eight hour day that’s 16 minutes per patient encounter — that’s working straight, without a lunch break, time to write notes, or run to the restroom. This invariably leads to provider frustration, fatigue, and just “wanting to get the job done.”It is an impossible system that needs to be fixed.
But part of it is a culture problem. Somewhere along the way, in large part because of the system we work in, we forget that most of us went into medicine for the love of the science and the people.
Looking at someone provides them agency and respect, and allows you to indicate that you are listening, allows you to convey empathy, concern, and interest in what they are saying. It is why we teach children to look someone in the eye when they speak. It is treating someone as an equal, another human being, and that in and of itself is healing. It is a subtle but real treatment we as providers can give every patient — the opportunity to be seen, to be looked at, to have their words respected, and to perhaps leave with some relief that they were heard.
Maybe this is because I am coming off of my geriatrics rotation, but now when I see older patients coming into clinic I wonder if this is their only outing for the day. I wonder if they had a challenging time getting here with a walker, a cane, with diminished vision, and slower response times. I wonder how it must feel to have someone who is less than half your age speaking faster than you can hear, not looking at your when you speak, and pecking away at their computer for most of the 15 minute visit. I wonder at what point in my training will I stop wondering about that and just want to power through patient after patient?
I’m not suggesting anything radical. I’m simply saying that when you come into a room, look at the patient when you introduce yourself. Look at them when you ask a question, look at them when they give the answer. Type away in between, maybe explain that you’re going to use the computer. These are simple things you can do in the 15 minute window you do have. Just, remember that looking at someone is part and parcel to making them feel better. Maybe then patients will remember our names.