” .. Since I knew you, I have been troubled by a remorse that I thought would never reproach me again, and have heard whispers from old voices impelling me upward, that I thought were silent forever. I have had unformed ideas of striving afresh, beginning anew, shaking off sloth and sensuality, and fighting out the abandoned fight. A dream, all a dream, that ends in nothing, and leaves the sleeper where he lay down, but I wish you to know that you inspired it.”- Charles Dickens
Every interaction we have matters. We may not see it, but it does
Here is a story of how one patient saw 2 different doctors. With the exact same problem. The reaction was completely different, and so was the result. You do not have to be a doctor or social worker or health care worker to have this impact. It is just this example. Every day we encounter people that as simple as it may seem, just a hello or a smile can make the difference. Sometimes, just knowing someone notices you are not doing well is a big deal.
Patient walks into Dr. D’s office. Patient is a 29 year old. He has depression, has a history of suicide, drug use, and addiction. He is in good physical health. He has not asked for help for a long time. He was in the psychiatric hospital as a teenager multiple times.
Dr. D comes into the office right at 8 am as the day starts. He gets his coffee, and asks for his first patient. He walks into the room and looks at the patient. He says “what can I do for you today?”
The patient says, “I am very sad, I have low energy, and I do not feel normal.” The patient is shaking and is embarrassed to be at this point in his life.
The patient says, “I have struggled with drinking and drugs and do not feel good about myself. I am scared to talk to anyone about anything, but especially this. I am at an end, I have to get help or I am going to die.”
Dr. D says, “Ok, well let’s draw some blood. Have you ever been checked for diabetes, low blood sugar, or thyroid problems?”
Patient says, in a trembling voice. “No. I don’t seem to have any of the other problems that would go with diabetes though. I work in the health care field.”
Dr. D says, “Well I am going to run some blood tests. I also see you once had a positive PPD test, so we will give you some INH.”
A ppd test is when you are tested for exposure to tuberculosis. If you are positive it usually means it is in your system but not active.
So Dr. D has the patients’ blood drawn and has given him the INH. The blood tests come back normal. No problems.
The clinic nurses call the patient and state everything is ok. Dr. D said to follow up if you have any concerns. They as a clinic have so many patients, they forgot why the patient came in the first place. They get a list of lab results, so when they see them come through, they never think of the patient. They see the results and make the call that they are ok. This is not their fault. They are completely overwhelmed with a huge volume of lab reports of patient’s to call.
This patient was anxious and depressed and afraid to ask for help to begin with. Now with this call and this response, the patient is basically pushed aside, IF the patient wants help, he will have to make the call again and go through the embarrassment and shame of asking for help again.
Now, the patient does not go for the INH. He is now feeling hopeless. He never even went for medical problems, then when the results came in, the clinic never even thought that it was to rule out anything. The patient got lost in the pile of papers. Basically became a number, not a person. This is normal these days. They want the Doctors to see as much patients as possible, as fast as possible. So give them a pill and get them out of here. It is our medical system, and it has become a business.
In this case, the patient now goes on another binge, and gets more depressed. If anyone has been through this they know any binge can result in death to self or someone else. Thinking again about suicide month later, the patient calls up the clinic. The patient has lost hope in Dr. D. However the patient is afraid to ask for another provider. Because he will be considered “difficult.”
The patient, using all the courage that they have, gets another appointment. This is months later. So at this next appointment, Dr. D walks in, and he does not recognize the patient. He treats him as if he is a new patient. He asks again if he has any medical problems.
This time. Dr. D says “Let me draw blood for some things” once again. Checks his heart. He does not know the patients name, or occupation, or any of what had happened before.
The patient is a number, he now feels worse and is upset that he even came back. He gets his blood drawn.
The patient gets a phone call back. He is to come see Dr D again, he must come in to go over the results. They cannot tell him over the phone the results. However, there is also some hope. He feels that maybe they found a reason he has felt like this his whole life.
The patient is scared, he knows if you have to come in to go over results it is not good. Saturday morning Dr. D walks in as he is the on call MD this weekend. His eyes are bloodshot and red, Dr. D did not sleep last night you can tell. He does not recognize the patient, his name, or anything. He feels he is just seeing all emergency patients as they are the Saturday clinic this month and he is on call. Dr. D has no idea he is talking to his own patient.
He then asks the patient, why he is here.
Then Dr. D still not knowing the patients name says “oh yeah, well, looks like you have chronic fatigue syndrome and there is really nothing we can do. Maybe go to groups, or exercise.”
Just what the patient wants to hear right? You are chronically tired and out of luck. You are not depressed or any of that. Sorry, go to groups.
The patient puts his head down, that’s it. You can see him, the thoughts are something like, “I guess I never was depressed, I’m just tired,” that is what he is feeling.
Any of us can tell these things in watching people if we just watch and are truly present with them. If we take time for one another it is easy.
Then Dr. D says well I can give you Provigil to keep you awake during the day and trazodone to help you sleep. SO let’s do that and check back in a few months. We are now giving a patient with severe anxiety a pill that they used to give to pilots to keep them awake during long flights.
The patient gets the pill to stay awake. His depression and anxiety have still not been addressed. He has learned that this is what happens when you ask for help. The patient now feels hopeless, sad, anxious, and like a fool for asking for help. There is nothing they can do for him.
First they tell him he has tuberculosis, then its chronic fatigue. They spend 15 minutes with him each time because management wants doctors to see 4 patient per hour so they can bill for that. Then they make more money. Dr. D is considered more productive if he sees more patients in a day because he makes the clinic money then.
The patient then with this depression history, drug abuse history, has made his last ditch efforts to get help. It took everything he had to even ask for help. He was pushed aside, they didn’t know his name. He got lost as a number. Then he was told different things by the same doctor each time he went in.
Why would someone go seek help after this? Dr. D never even asked him about his depression or anxiety or his history. He was a number, and he pushed it off like it was not depression. Just give him a pill and get him out. I don’t blame Dr. D, this is our system. I have seen Doctors get scolded for taking too much time with their patients.
This patient would then go into severe depression and his drinking and self-destructive behaviors would intensify over the next few years. He had many near death experiences, he got a DUI and spent more time in jail. He got to a point in which he almost died and his family had given up on him completely. He was basically going to fade away to the world. You could tell, he had given up on himself and everyone else had given up on him.
About 3 years later after Dr. D. This patient called the clinic. They said “So you see Dr. D, would you like to see him again.”
The patient has an opening and says, “No anyone is fine.” Simple stroke of luck.
The patient is set up with Dr Broeker. This is his real name he still practices for Allina. It is at the end of May. The patient has made up an excuse to go in he says he is having urinary problems.
He is in the clinic office in the room waiting. Dr. Broeker knocks on the door, he says, “hey XXX, I just want you to know I am running a little bit late but I will be in as soon as I can.”
The patient is shocked, Dr Broeker knew his name and just knocked on the door to tell him that he was running late.
Then during their meeting, the patient is comfortable, and feels at ease. Dr Broeker comes in and says his name, what his experience is and does not have a clipboard. IS not looking at the computer. He asks “what are you here] for?”
Dr Broeker then says “what else can I do for you?”
The patient starts to cry and says “I am anxious, nervous and afraid to ask anyone for anything. I hate myself, I cannot stop drinking and I want to get help for feeling depressed.”
Dr Broeker spent the next hour talking with this patient. It was amazing. He talked to the patient about life. Dr Broeker talked about his time as an MD and how he wants to get this right. He explains the depression scale, the anxiety scale and fills it out with the patient.
It was like this patient had been waiting years for someone to say, “It’s ok to be sad, let’s talk about it.” Finally after, years and years of internal torture. Dr. Broeker had released this man from his own internal prison. It was amazing. Words will never do it justice what Dr Broeker was doing for this patient.
It was supposed to be a 15 minute appointment. Dr Broeker knows the patient has been seen by Dr D because he read the chart, he says “why were you tested for all of this?”
The patient says,” I don’t know that’s what he thought.”
Dr. Broeker says “well, ok, let’s start you on celexa and come back in 2 weeks to make sure you are not having any side effects.” Dr. Broeker did not judge the other physician and was respectful and kind about what the other MD had done. When someone is truly great like this, they do not need to question anyone else. He is pure, there is no competition for people like Dr. Broker, he practices out of love, and he is a doctor for the right reasons.
The patient was so much at ease with Dr. Broeker that he was able to tell him everything and open up about the drinking, drug use and all other issues that he was facing.
Dr Broeker wanted him back in 2 weeks just to check on side effects. The patient felt he had a new lease on life.
Then in 2 weeks Dr Broeker pops in and knows the patients name. He talks to him for a while like they are old buddies and shakes his hand and is friendly with him.
This patient has had a history of no shows throughout his life, but never with Dr Broeker. Usually if we have a patient with no shows, we label the as non-compliant or as not really wanting to get help. But, could it be that the problem is in the provider and how we treat patients? Or at least say it is 50/50? In a few months the patient was in rehab, and able to look at people. Dr Broeker then eventually recommended therapy to this patient.
This patient was willing to listen because he trusted Dr Broeker. He believed in him. The same recommendation could have come from another Doctor and it would have gotten a different reaction. The difference is in the relationship, not in the knowledge. Dr Broeker took time, he did not care about the 4 patients an hour.
Dr. Broker is special, he is in it for the right reasons. He takes time. That is true productivity.
He saves lives, He saved this patients life.
I know this, I watched it. The patient was me.
The Doctor is Dr Michael Broeker.
He saved my life. He is one of the “fab 5” that I refer to that changed my life. That is number 1. The magical Michael Broeker.
If it was not for him, I would not be alive today. The patients that tell me I saved their lives and changed them forever, my friends and family and everyone that I have touched, it is all not possible without him.
I almost died and did not want to ask for help ever again. He sat down and listened. And talked. He didn’t follow the 15 minute rule. In my moment, lost in the woods, he gave me the light and pointed me in the right direction. All because he took time to get to know me and did not judge me.
I am alive today because of him.
Thank you Dr Broeker.