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Clinical pearls 

07-19-2018 18:41

Life on "the other side of the glass" teaches empathy lessons to all

Summer 2018

James G. Caridi, MD, FSIR, always thought of himself as a “blue-collar doctor”—someone from the Northeast and a family with no medical experience who loved Rocky Balboa, had a close relationship with his patients and a focus on patient care.

Then, in August 2011, he was diagnosed with myeloma.

“On the other side of the glass, it is very, very different. I thought I was a good blue-collar doctor until I went on the other side of the glass and saw how much I was leaving behind.”

Dr. Caridi, from Tulane University Medical School, presented “Seeing medicine from the eyes of a patient, building empathy” as part of the SIR 2018 categorical course “Personal wellness for the interventionalist.” According to Dr. Caridi, the daily work of physicians can go from “routine” to “mundane” to almost knee-jerk reactions—taking things for granted and forgetting the person amid the procedure. He shared advice based on his own experience about how to keep that from happening.

  • Dr. Caridi speaking at a podium about his experience as a patientStay away from dabbling: Be careful when hearing about new procedures, he said. Those experts are doing those procedures every day, and most IRs won’t get the same results without the time and dedication. “If you’re doing one a week or one a month, you’re not doing that patient any kind of service.”
  • No procedure is a slam dunk: Every procedure you perform on a patient is the most important thing that’s been done to them and should be treated as such.
  • First contact: Dr. Caridi learned quickly the nerves a patient feels when going to clinic. Listening to doctors and other staff complaining about other things drops the patient’s mood quickly. “You go in there and smile, and you actually can change their whole mood. They feel uplifted, they feel like you care, and it makes a big difference in their day.”
  • Eye contact: Too many physicians look at their computers, instead of the patient. Make the effort to improve eye contact. “You can read your patient, read how they feel, whether they are listening to you. It’s so important to look at them and make them feel at ease.”
  • Read the chart: “My oncologist was out of town, so I was in the hospital for chest pain and pneumonia. The attending sits on the edge of my bed and says, ‘I have to tell you, you have white blotches on your CT scan. We call those pneumonia.’ Did he read my chart? How much confidence would you have had in him, personally?”
  • Communication and participation from others: When diagnosed, Dr. Caridi entered a “brain fog”—asking himself questions while the physician kept talking. “It’s really important to encourage participation by another person, some caretaker to be there when you’re talking to them because the patient will remember nothing. It’s like there’s Saran wrap around
    the brain.”
  • Ease “scanticipation,” “scanxiety” and “scancellation”: Patients have enough anxiety about going in for labs or imaging. Cancellations worsen the anxiety. “Sometimes you’re talking about a month of hell for them to go through to find out what’s going on. I don’t care if you have to stay late . . . I don’t care if it changes how you do the procedure . . . but don’t cancel these patients.”
  • Keep a “sense of tumor” (humor): That’s for both physician and patient, said Dr. Caridi, who called humor “anesthesia for the soul.”
  • Local and social anesthesia: The best bone marrow biopsy Dr. Caridi’s had done was with lidocaine, which too many treat like liquid gold, he said. Use it liberally because it helps with patient pain. When patients don’t have pain, procedures go better. “And social anesthesia really does work,” he said. “I sing to the patients, talk to the patients and I distract them from what’s going on. When the patient’s not moving around and complaining things go so much easier.”
  • Education and side effects: The more educated a patient is about their condition, the easier it is to take care of them. Explain the side effects to the patients.
  • Minimize reminders: Whenever possible, internalize tubes and think about ways to help patients forget a little about their illness.
  • Exercise: Dr. Caridi encourages patients to get up and move as much as possible because physical fitness helps fight and overcome side effects. It also improves self-image. “The people who know that I have this come up and go, ‘Man, you’re looking good.’ I can’t tell you how good that makes you feel. You don’t feel as sick.”
  • Hope: “You tell somebody they have six months to live, they’re going to live six months. Don’t give numbers because everybody’s individual, everybody’s different. Depending on what they do, they can change those statistics. Don’t give up hope.”

This article, based on a presentation given at the SIR 2018 Annual Scientific Meeting, originally appeared in SIR Today (sirtoday.org).

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