I saw my primary care physician last month for an ear infection. While she listened to my heart, a look of concern crossed her face. She told me that she wanted to run an EKG in the office. After the EKG, she asked if I ever had chest pain or any other cardiac symptoms, particularly when running. She went on to tell me that my heart rate was extremely low and irregular, and she suspected that I had a heart block.
My usually calm and collected physician acted very alarmed. She advised me to see a cardiologist as soon as possible and to limit my running until then. As I heard the worry in her voice, as well as words like pacemaker and cardiac tissue ischemia, my own panic began to rise.
I cried all the way home from the doctor’s office and envisioned many worst-case scenarios. Thankfully, my very calm husband and some medical-professional friends talked me down, and I was able to see the cardiologist the very next day.
The cardiologist was wonderful and reassured me that my extreme bradycardia and heart block are actual very normal findings in a long-distance runner. He cleared me immediately to resume normal activities, unless I became symptomatic. Twenty-four hours of apprehension and angst melted away, and I felt like a new woman.
This made me start to question my approach with my own patients. When I discover an unusual finding or symptom, am I overreacting and causing my patients undue stress?
I usually try to reassure my patients by saying something like, “Well, this could be nothing or it could be something, but you won’t know unless you follow-up.” Now I wonder if after I’ve mentioned the breast lump or pelvic mass or other finding, are these patients even listening to me? Or are they already envisioning surgery, chemotherapy and other worst-case scenarios?
In my case, I believe my doctor’s concern stemmed from the need to emphasize how important it was for me to follow up. Seven years after she referred me to a specialist for another relatively minor problem, she knows that I still have not made that appointment. She also knows that I tend to put everyone else’s needs before my own.
In clinical situations, I pride myself on my ability to be reassuring and calm. But there are times when I feel that I need to show my patients just how concerned I am, so that they take me seriously and seek the appropriate follow-up treatment or testing. After my own recent experience, however, I will be mindful that there is a very fine line between conveying concern and eliciting panic when providing patient care.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.