Commentary: Always the Right Time for the Right Words

When a physician finds himself on the other side of the doctor-patient equation, it serves as a reminder that saying the proper things matter at every moment. Good intentions sometimes miss the mark.

As a seasoned family physician, I have been fortunate enough to provide care to thousands of patients over the years. Just like other physicians, I have been there for patients during their times of wellness and times of infirmity. Their maladies can be as benign as a sinus infection or as devastating as metastatic colon cancer. No matter the condition, I have always made it a point to be empathetic, sympathetic and as uplifting as possible.

Martin E. Klein

Sometimes, patients need nothing more from us than the feeling of being “heard” as we provide reassurance and validate their concerns. I know there is a prevailing sentiment that we’re not afforded the respect and reverence we enjoyed in the past, but, whether we realize it or not, most patients hang on our words and take to heart what we say to them. With that in mind, I always have lived by a simple tenet: “Be impeccable with your word.”

Not that long ago, I was on the other side of the doctor-patient equation, and I have experienced quite a few people who clearly are not impeccable with their word. It compelled me to share my story with other physician leaders, hoping it will encourage them to help their people be more impeccable with their word. Sometimes, when we are just “trying to be nice” or trying to “be positive,” we can really miss the mark.

After a couple of months of conservative treatment for chronic Achilles tendinitis and a subsequent partial tear, I had a minor trauma that sent me into “routine” surgery to repair the tendon in September 2016. I was enjoying an uneventful rehabilitation — with progressing physical therapy, transition to a walking boot, part-time use of a brace, seeing patients full time and so forth — until the weekend before Thanksgiving, when I began to have a lot of pain and suffered from systemic symptoms, including chills.

I didn’t start to worry — in denial, perhaps? — until that Monday, when my leg got edematous, red and warm. I conferred with my surgeon and I was admitted for intravenous antibiotics, which didn’t do too much overnight. On Tuesday, an MRI confirmed a massive infection, with the entire tendon repair turned into liquefied pus. We went to the OR that night for extensive debridement and further IV antibiotics.

I was fortunate to go home on Thanksgiving with a PICC line in my arm so that I could get IV antibiotics at home for six weeks. After two weeks of wearing a splint, I went into a walking boot and went back to work to see patients on a reduced schedule. In retrospect, that was too aggressive, as my surgical site wasn’t healing well and there was one area that wasn’t approximating. My surgeon was diligent in the wound care and was there for me at every call and text.

After my PICC line was removed in January 2017, I was put on oral antibiotics to cover the staph aureus that was the culprit in the infection. However, that antibiotic didn’t treat Aeromonas bacteria harboring in my poor-healing nidus of an opening. Two days after the line was removed, my heel started to hurt, and the next morning it was red and warm around the heel and the open site. I again had chills and arranged to meet my surgeon at the hospital, where an MRI confirmed that it was a localized infection.

My surgeon and infectious disease doctor agreed that the area needed to be debrided and cleaned further. I went back to the OR the next day and was put on more antibiotics. I was able to go home two days later, followed by daily visits to the wound care center and an extended period of not bearing weight.

I had to learn to be more patient in advancing my activity as fantastic wound care nurses took care of me in a formal manner as a registered patient. Down the road, I needed another surgery to reconstruct my Achilles tendon, but that was the least of my concerns during the days following treatment.

“All doctors should suffer from the afflictions that they treat.”

I heard this statement from an orthopedic surgeon after my second surgery while I had a splint on my leg, a PICC line in my arm and a pump around my waist. This gentleman is fond of speaking philosophically and delivering platitudes, but I was taken aback at the timing of this statement. This sounds like a noble and grand idea, but I am sure he wouldn’t sign up voluntarily for the same.

Some would argue there are many physicians with big egos who aren’t compassionate with patients, and that they should be “taken down a notch” or “given some perspective.” I’d argue that this affliction will not make me a better physician or change my character. My character is ingrained at this point, and one could argue afflictions might make zero impact on an insensitive doctor — or might even make them more insensitive.

“I don’t feel sorry for you.”

This statement came from a patient who asked me what happened to my leg. Mind you, I didn’t say anything until asked, trying to be as covert as one can be while hobbling into the room with a walking boot on. I relayed my rote, abbreviated version of the story, and he then delivered that line.

Turns out, he was there to see me in follow-up after an overnight hospital stay for cellulitis of the finger because of a cut he didn’t take care of. His finger already looked to be at baseline, with no sign of redness or swelling.

Mind you, this gentleman is probably not a Mensa member, but he is a long-time patient of mine, as are his two sons. Did he think he was being funny? Pithy? Nevertheless, I said to him, “I didn’t ask for your sympathy. You asked me what happened, and I told you the story. I am your doctor and you are here for my medical care.” Believe me, a lot of other comments raced through my mind. Still, it got to the point of another of my core beliefs, “Don’t take things personally.”

“We all need to be humbled once in a while.”

This was uttered by a receptionist at my office as I introduced her to my surgeon while he was checking in. It was refreshing to hear my surgeon reply, “I can think of better ways to be humbled.” Amen to that. When you think of being humbled, you don’t think of people suffering from physical ailments. When I think of people who need to be humbled, I think of narcissists. But even for them, this sort of affliction would have no relevance to changing their character. An infected leg requiring urgent surgery and six weeks of IV antibiotics is more than humbling.

“This will make you a better doctor.”

This came from a renowned and brilliant surgeon, to whom I went for consultation, as I lay on his exam table in fear of needing him to perform further surgery beyond the scope of my surgeon’s expertise. I looked at my wife first, and she squeezed my hand. Mind you, I wouldn’t have been so sensitive had I not heard similar such sentiments previously.

I looked over at him and I said, “Are you being sarcastic?” I wasn’t sure at first, as this was my first encounter with him, and he seemed to have a dry sense of humor. He said that he wasn’t, so I offered that my patients would relay to him that I am a compassionate doctor and that they would not want me to endure this so that they could have a “better” doctor. It was the only negative moment of my experience with him, as he saw me the day that I called, was reassuring and said that he will be there for me if I need him. I have full and unreserved confidence in him.

“That which does not kill you makes you stronger.”

I had chosen this quote from German philosopher Friedrich Nietzsche as the opener to my closing, but on the day I wrote this, the aforementioned orthopedic surgeon said this to me. Looking at my atrophied calf, I hardly could say it was any stronger. But I knew what was stronger: my resolve, my steadfastness, my faith in my friends and family, the bond with my wife and children, and, yes, my perspective.

These situations certainly make you realize who truly cares about you and your family. The outpouring of offers of help from sincere people, whom I know would deliver if asked, was incredibly touching. I could write an extensive essay about the amazing outpouring of support and concern that I received. (Let me just say that I thank everyone wholeheartedly for all of their support.)

Has this experience made me a better doctor? I don’t think so. If anything, it was a detriment as it prevented me from being there every day for my patients, who are loyal to me in the most touching of ways. I’ve always tried to be empathetic, sympathetic, understanding, respectful, uplifting and cognizant of the big picture. If someone polled my patients to ask if my demeanor or character has changed since this series of events, I am certain they would all say that I am the same relatable guy that they were coming to see in the first place.

Martin E. Klein, MD, MS-HQSM, FAAFP, is chairman of family medicine at Hunterdon Medical Center and a physician leader at Hunterdon Family Medicine at Bridgewater, in New Jersey.