Office details that put patients at ease
I played my violin today. It’s an old but not a rare or expensive instrument that I keep in my office. I don’t have to play it; my violin plays itself. Just the sight of the violin brings the music to my mind.
Mrs. Goldstein heard it. She sat wide-eyed across my desk, her daughter at her side, glancing constantly at the surroundings. She was 101 and frail, but refused to allow any gray hair on her head to date her -- and she loved my office. She told me that she had seen a lot of doctors but had never seen an office “like this one.”
She had been sent to me by her geriatrician for an evaluation of shortness of breath. She stopped as she entered my consultation room and saw the violin resting against the wall, then asked if I played. I told her that I did not, but that I loved to listen, that just looking at the violin made me feel as if I were attending a concert of my favorite concerto.
She told me that she loved classical music. “I’ll try to imagine I am listening to Mozart,” she said as the consultation began.
In my office, I also have a mandolin, several pieces of American folk art and a number of prints on the walls. I keep bestselling books that I have read and enjoyed on my shelves, instead of the huge medical tomes you find in most doctors’ offices.
These things are there for a reason. The doctor’s office is a stressful place. Patients often approach a medical appointment fearing the worst and believing that they have cancer or another terminal illness. This high level of stress preoccupies the individual so that information and instructions that are given are often not retained.
If I can get my patients to relax, they will hear and learn more about their health.
One time, a book editor with emphysema and lung cancer who had been sent to me by his internist had one eye on my bookshelf the whole time we talked. I had several works there by Philip Roth, one of my favorite authors, including “Everyman,” which had just been released.
In the middle of the interview, my patient stopped and asked me if I recommended the books I displayed. We spent the next few minutes talking about Roth and whether he would win the Nobel Prize. I had the sense, when we finished, that the editor now approved his physician’s choice of consultant, and that he felt more relaxed about finding out more about his condition.
After my interview with Mrs. Goldstein, I took her into my examination room and told her I was going to start by checking her blood pressure. She told me that her pressure would be high because she had “white coat syndrome.”
This form of anxiety reaction is quite common in physician offices, but Mrs. Goldstein’s pressure was normal for her age. We speculated that the reduction in blood pressure from her usual doctor’s office reading was due to relaxation brought on by the sight of the violin and her thoughts of Mozart’s concerto.
A number of my patients tell me that I always get a lower blood pressure reading than their other physicians.
These stress relievers aren’t just for patients: Physicians also experience stress. I needed to tell the book editor with lung cancer that his emphysema was so severe that it prevented him from undergoing surgery to remove the tumors and that it also made him a poor candidate for radiation or chemotherapy. There would be no treatment, in other words. He asked me how long he had to live.
This is not an uncommon question in my office, and I tried to answer honestly. Each time I do, I worry that I will give incorrect information and falsely raise or lower hope. My patient seemed to accept what I told him calmly.
Not long ago I came across his obituary and realized that my projection of the time he had left had been correct. As I read, I also learned that he had been the editor of a favorite book of mine, one that had provided me with enjoyment as well as an escape from the pressures of medicine.
Back in my office, Mrs. Goldstein had spied photographs of my dogs and my family and asked me about them. I spent a few minutes telling her about the individuals in the photos -- my wife, stepchildren and my two playful Havanese -- before discussing her medical condition.
Her shortness of breath turned out to be due to emphysema, essentially an aging process that had occurred within her lungs. I told her that I could not reverse the damage done but that I would prescribe a medication to relieve her symptoms.
I asked her to let me know in a month if it was helpful. As she was leaving, she quickly glanced around the office and told me that she was happy that she had come.
“This is very unusual,” she said. “I don’t want to leave.”
I walked her to the receptionist’s desk and as I did, I am sure I heard my violin playing.
Adams is a pulmonologist in New York City and the author of “The Asthma Sourcebook” and “Healing Through Empathy.”