Kindness matters in the patient experience

Issue: July 10, 2019

Michael H. Rotberg

In March 2013, Michael H. Rotberg, MD, was diagnosed with thymic carcinoma, a rare form of cancer arising from the thymus gland, forcing him to leave his North Carolina ophthalmology practice indefinitely.

Since then, Rotberg has been spending time with his family, volunteering his nonsurgical primary care services with a local organization and making time to author his book, Practice: Becoming a Better Doctor, Patient, and Person, a chronicle of both his journey through treatment and the lessons learned along the way.

Healio.com/OSN spoke with Rotberg regarding his experience transitioning from a doctor to a patient, as well as the many lessons he hopes to impart to his peers, helping them to better understand their patients.

What are your experiences as a patient that are relatable to the ophthalmology community?

Different people have different ways of interacting with patients. Some do it mechanically, expressing through their actions the belief that this is a scientific enterprise and that doing the right thing for the patient is all they need to do. We can all fall into the trap of thinking that we are scientists, the data says do x, y, z, and there should be no question about it. But the data are just facts. What is more important is how the patient understands these facts and how the doctor explains these facts. There is nothing in the facts that determines how we interact with the patient.

I came to the realization that what we all want is for our doctors to be honest with us, and we doctors want to be honest with our patients. Being kind does not undermine honesty. You can be kind to somebody and still be honest; you can be brutal and still be honest. It is better to be kind.

As a patient, what do you know now that you wish you had known as a practitioner?

I wish I had recognized the bind that many of my patients were in — how to afford their medicine, how to manage getting to appointments and missing work to do it. I wish I had recognized that the health crisis forces difficult decisions on some patients who are not able to do what is best for themselves because of the demands of their everyday lives. They have a life that they would like to continue as much as possible. It is not always possible.

How can ophthalmologists adjust their interactions to enhance their patients’ experience?

One way is to start with an open-ended question. If a patient comes in for a routine glaucoma follow-up visit, I know what they need that day, but I don’t really know what they want that day. If you are only doing what the patient needs, they may leave feeling like you did not even hear them or like you did not give them what they really wanted.

Another thing, when there is time, is to ask an unnecessary question. What did you have for breakfast today? Did you read anything good lately? Something like that. In almost all ophthalmology subspecialties, especially glaucoma, we have ongoing relationships with patients. It helps us to know who they are, and it helps them to know that we care. They can open up and trust us.

How have your interactions with the ophthalmology community changed?

First, I am not doing surgery anymore, so those discussions about techniques and complications and case management, they are off the table. But I am doing primary eye care volunteer work at our local Lions Club, so I am still engaged in that way. I still read the journals, and I try to go to local eye continuing education meetings. I am also not participating in conversations about insurance reimbursement — that I love.

Do you find the volunteer work satisfying ?

The Lions Club is a wonderful organization. Our local club runs a sheltered workshop where several hundred visually impaired people have jobs. There is an eye clinic where we do exams for these workers, as well as for others who may have limited means to afford care or who have no insurance. We are referred patients through social service agencies like battered women’s shelters, homeless shelters, Goodwill, Salvation Army, AIDS clinics, that sort of thing. We do see cases of undiagnosed glaucoma or untreated diabetic eye disease because these patients sometimes have no other access to care.

I will also say that it has been wonderful that my malpractice carrier, the one that I had when I was working, has a special rate for volunteer ophthalmologists. So, if I promise to do uncompensated nonsurgical primary eye care, I get the same coverage as I had in practice for $100 a year, which makes this work possible.

What motivated you to write a book?

I was in the unusual and privileged position of having experience and expertise on both sides of a medical encounter: the provider side and the patient side. Everybody, at some point in their life, is going to be a patient. But not many people are doctors and not many doctors have, I think, tried to learn the patient’s perspective. Having become a patient, I have learned things that have helped make me a better doctor. Being a doctor has probably made me a better patient, too.

Is there anything else that you would like to add?

Three of the patient stories in the book were impossible to disguise. So, I contacted the patients or their surviving families for their permission to use the stories. I was nervous about it. Would they think I was violating their confidence? Would they take exception to the way I portrayed them? But all of them were thrilled that I remembered them.

It reminded me that we do not realize how important we are to our patients and what an honored place we occupy in their lives. We need to repay that honor, with our minds and our work and also with our hearts and devotion, our honesty and most of all with kindness. – by Scott Buzby

Editor’s note: Michael H. Rotberg, MD, passed away June 14, 2019, of complications related to cancer. He was 64 years old.

Reference:

Rotberg M. Practice: Becoming a Better Doctor, Patient, and Person. 2018.

For more information:

Michael H. Rotberg, MD, can be reached at email: mhrotberg@gmail.com.

Disclosure: Rotberg reports he is the author of Practice: Becoming a Better Doctor, Patient, and Person.