Michael Pistoria, DO

This is a nonmedical post – I hope you enjoy it nonetheless.

I recently took my middle daughter, Giana, to visit my oldest child, Maddie, in Florida. Maddie lives there with her mother, as she has for all but the first 7 months of her life. She turns 15 this year.

We went to see Maddie’s dance recital. For years, she has enjoyed dancing and I love experiencing the parental joy of watching one of my children pursue her passions. In the course of the weekend, we enjoyed each other’s company and conversation. We talked about dance, school, her friends, and boys. The sisters talked about sister things and I tried to provide space for those conversations. On Sunday, I took Maddie and Giana to Downtown Disney – one of Disney’s giant vacuums that literally suck money from parents’ pockets. The girls had a blast and I was in heaven – my own little heaven.

Through the day, we all knew the worst was approaching, though – the time when we needed to say goodbye. The inevitable came in Maddie’s driveway as we exchanged hugs, and she went into her house. As she went inside, I knew there were tears – there always are. I looked down at Giana and knew she needed a hug. I lifted her up and her tears started to flow. I whispered to her that it was okay to cry. She responded, "It is for everyone but you. You keep your tears inside." With that, I lifted her fingers to the corner of my eye where a tear had already formed and told her, "Not all the time, honey. Not all the time."

I wanted to tell her about the times when I’ve cried like there was no tomorrow as Maddie and I said goodbye. I wanted to tell her about how my heart breaks as I watch Maddie walk away. I wanted to tell her about the gaping hole in my heart that is only filled when we are ALL together – the now five of us. I didn’t tell her, though, because that is not her pain to bear. She knows that she has a big sister she loves and who loves her. She knows that they don’t spend nearly enough time together. That’s enough for her.

For me, the story is different. I keep most of it inside, where it hurts less. I worry about Maddie constantly, hoping that my physical absence from her daily life does not hurt her too much. I wish she were here with me – with us – but I know she is happy with her Florida family and friends. I work hard to make the most of our time together and our time apart. I have become quite adept at the language of text messaging – the preferred choice of communication of all teenagers.

We all have struggles in our lives – loss of loved ones, divorce, and depression. We all have a proverbial cross we bear. We can best deal with these struggles by reframing them. Instead of focusing on the pain of leaving Maddie, I choose to focus on the fact that we had a great time together and that we will see each other again soon. I’ve talked with my girls about making the same choice. These are conscious choices we make. It isn’t always easy, but for me it is better than the alternative.

As you deal with the struggles in your life, strive to find your little heaven.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

This is a nonmedical post – I hope you enjoy it nonetheless.

I recently took my middle daughter, Giana, to visit my oldest child, Maddie, in Florida. Maddie lives there with her mother, as she has for all but the first 7 months of her life. She turns 15 this year.

We went to see Maddie’s dance recital. For years, she has enjoyed dancing and I love experiencing the parental joy of watching one of my children pursue her passions. In the course of the weekend, we enjoyed each other’s company and conversation. We talked about dance, school, her friends, and boys. The sisters talked about sister things and I tried to provide space for those conversations. On Sunday, I took Maddie and Giana to Downtown Disney – one of Disney’s giant vacuums that literally suck money from parents’ pockets. The girls had a blast and I was in heaven – my own little heaven.

Through the day, we all knew the worst was approaching, though – the time when we needed to say goodbye. The inevitable came in Maddie’s driveway as we exchanged hugs, and she went into her house. As she went inside, I knew there were tears – there always are. I looked down at Giana and knew she needed a hug. I lifted her up and her tears started to flow. I whispered to her that it was okay to cry. She responded, "It is for everyone but you. You keep your tears inside." With that, I lifted her fingers to the corner of my eye where a tear had already formed and told her, "Not all the time, honey. Not all the time."

I wanted to tell her about the times when I’ve cried like there was no tomorrow as Maddie and I said goodbye. I wanted to tell her about how my heart breaks as I watch Maddie walk away. I wanted to tell her about the gaping hole in my heart that is only filled when we are ALL together – the now five of us. I didn’t tell her, though, because that is not her pain to bear. She knows that she has a big sister she loves and who loves her. She knows that they don’t spend nearly enough time together. That’s enough for her.

For me, the story is different. I keep most of it inside, where it hurts less. I worry about Maddie constantly, hoping that my physical absence from her daily life does not hurt her too much. I wish she were here with me – with us – but I know she is happy with her Florida family and friends. I work hard to make the most of our time together and our time apart. I have become quite adept at the language of text messaging – the preferred choice of communication of all teenagers.

We all have struggles in our lives – loss of loved ones, divorce, and depression. We all have a proverbial cross we bear. We can best deal with these struggles by reframing them. Instead of focusing on the pain of leaving Maddie, I choose to focus on the fact that we had a great time together and that we will see each other again soon. I’ve talked with my girls about making the same choice. These are conscious choices we make. It isn’t always easy, but for me it is better than the alternative.

As you deal with the struggles in your life, strive to find your little heaven.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

This is a nonmedical post – I hope you enjoy it nonetheless.

I recently took my middle daughter, Giana, to visit my oldest child, Maddie, in Florida. Maddie lives there with her mother, as she has for all but the first 7 months of her life. She turns 15 this year.

We went to see Maddie’s dance recital. For years, she has enjoyed dancing and I love experiencing the parental joy of watching one of my children pursue her passions. In the course of the weekend, we enjoyed each other’s company and conversation. We talked about dance, school, her friends, and boys. The sisters talked about sister things and I tried to provide space for those conversations. On Sunday, I took Maddie and Giana to Downtown Disney – one of Disney’s giant vacuums that literally suck money from parents’ pockets. The girls had a blast and I was in heaven – my own little heaven.

Through the day, we all knew the worst was approaching, though – the time when we needed to say goodbye. The inevitable came in Maddie’s driveway as we exchanged hugs, and she went into her house. As she went inside, I knew there were tears – there always are. I looked down at Giana and knew she needed a hug. I lifted her up and her tears started to flow. I whispered to her that it was okay to cry. She responded, "It is for everyone but you. You keep your tears inside." With that, I lifted her fingers to the corner of my eye where a tear had already formed and told her, "Not all the time, honey. Not all the time."

I wanted to tell her about the times when I’ve cried like there was no tomorrow as Maddie and I said goodbye. I wanted to tell her about how my heart breaks as I watch Maddie walk away. I wanted to tell her about the gaping hole in my heart that is only filled when we are ALL together – the now five of us. I didn’t tell her, though, because that is not her pain to bear. She knows that she has a big sister she loves and who loves her. She knows that they don’t spend nearly enough time together. That’s enough for her.

For me, the story is different. I keep most of it inside, where it hurts less. I worry about Maddie constantly, hoping that my physical absence from her daily life does not hurt her too much. I wish she were here with me – with us – but I know she is happy with her Florida family and friends. I work hard to make the most of our time together and our time apart. I have become quite adept at the language of text messaging – the preferred choice of communication of all teenagers.

We all have struggles in our lives – loss of loved ones, divorce, and depression. We all have a proverbial cross we bear. We can best deal with these struggles by reframing them. Instead of focusing on the pain of leaving Maddie, I choose to focus on the fact that we had a great time together and that we will see each other again soon. I’ve talked with my girls about making the same choice. These are conscious choices we make. It isn’t always easy, but for me it is better than the alternative.

As you deal with the struggles in your life, strive to find your little heaven.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

My wife texted, "Tigger is having problems. Call me."

Tigger is our beloved (and bouncy) 9½-year-old boxer. My wife had just finished putting our 16-month-old son down for his nap when she heard a commotion in the foyer. She looked downstairs and saw Tigger struggling to get up. She ran down the steps and sat down beside him. It was clear that his hind legs were not working. Wide-eyed, he looked terrified to her. As she stroked his back, he eventually settled down and rested for several minutes. After about 10 minutes, he was able to get up and slowly walk around the house.

I came home from work, followed shortly thereafter by one of our friends and two of his young boys. While my wife and I had drinks and pizza with our friend, and the boys and our daughter played in the yard. Tigger, normally in the center of the action, lay off to the side of the patio. When I brought out a bowl of food for him, he did not budge. This was a first – he has never passed up a meal. Instead, he usually looks to supplement his food with anything he can steal from unsuspecting members of our family.

That evening, my wife and I had a long conversation about Tigger. We were going to take him to the vet and have him evaluated, but we were very realistic about what we might find. On average, boxers live just shy of 10 years. We’ve noticed that he had been slowing down, and the events of that evening – keeping to himself and passing up dinner – made us concerned that the end was close. We agreed that our primary goal is to keep him comfortable. He is a valued member of our family, and we do not want him to suffer.

Thankfully, Tigger rebounded from that initial episode, although he had a similar episode in the weeks that followed. We know the end is coming for him and we are working to maximize our time with him. We are retelling stories from his younger days and enjoying some of his behavioral quirks (read: stealing food) more than we had in the past. Again, our focus remains on his comfort. When he appears to be struggling too much – when his pain and discomfort exceeds – we will make that difficult decision that most every pet owner has to eventually make.

These discussions made me think of the patients I have cared for over the years who were never encouraged to think in such terms about their own lives. Many were being treated for underlying malignancies, yet had no conversations with their physicians about goals of care or end-of-life decisions.

I have written in the past about the need for these discussions and how we, as physicians, often die differently from our patients. Allow this to be a reminder to everyone to discuss goals of care with your patients. The conversations are an important investment in your relationship with that patient and are vital to providing the best possible care for them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

My wife texted, "Tigger is having problems. Call me."

Tigger is our beloved (and bouncy) 9½-year-old boxer. My wife had just finished putting our 16-month-old son down for his nap when she heard a commotion in the foyer. She looked downstairs and saw Tigger struggling to get up. She ran down the steps and sat down beside him. It was clear that his hind legs were not working. Wide-eyed, he looked terrified to her. As she stroked his back, he eventually settled down and rested for several minutes. After about 10 minutes, he was able to get up and slowly walk around the house.

I came home from work, followed shortly thereafter by one of our friends and two of his young boys. While my wife and I had drinks and pizza with our friend, and the boys and our daughter played in the yard. Tigger, normally in the center of the action, lay off to the side of the patio. When I brought out a bowl of food for him, he did not budge. This was a first – he has never passed up a meal. Instead, he usually looks to supplement his food with anything he can steal from unsuspecting members of our family.

That evening, my wife and I had a long conversation about Tigger. We were going to take him to the vet and have him evaluated, but we were very realistic about what we might find. On average, boxers live just shy of 10 years. We’ve noticed that he had been slowing down, and the events of that evening – keeping to himself and passing up dinner – made us concerned that the end was close. We agreed that our primary goal is to keep him comfortable. He is a valued member of our family, and we do not want him to suffer.

Thankfully, Tigger rebounded from that initial episode, although he had a similar episode in the weeks that followed. We know the end is coming for him and we are working to maximize our time with him. We are retelling stories from his younger days and enjoying some of his behavioral quirks (read: stealing food) more than we had in the past. Again, our focus remains on his comfort. When he appears to be struggling too much – when his pain and discomfort exceeds – we will make that difficult decision that most every pet owner has to eventually make.

These discussions made me think of the patients I have cared for over the years who were never encouraged to think in such terms about their own lives. Many were being treated for underlying malignancies, yet had no conversations with their physicians about goals of care or end-of-life decisions.

I have written in the past about the need for these discussions and how we, as physicians, often die differently from our patients. Allow this to be a reminder to everyone to discuss goals of care with your patients. The conversations are an important investment in your relationship with that patient and are vital to providing the best possible care for them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

My wife texted, "Tigger is having problems. Call me."

Tigger is our beloved (and bouncy) 9½-year-old boxer. My wife had just finished putting our 16-month-old son down for his nap when she heard a commotion in the foyer. She looked downstairs and saw Tigger struggling to get up. She ran down the steps and sat down beside him. It was clear that his hind legs were not working. Wide-eyed, he looked terrified to her. As she stroked his back, he eventually settled down and rested for several minutes. After about 10 minutes, he was able to get up and slowly walk around the house.

I came home from work, followed shortly thereafter by one of our friends and two of his young boys. While my wife and I had drinks and pizza with our friend, and the boys and our daughter played in the yard. Tigger, normally in the center of the action, lay off to the side of the patio. When I brought out a bowl of food for him, he did not budge. This was a first – he has never passed up a meal. Instead, he usually looks to supplement his food with anything he can steal from unsuspecting members of our family.

That evening, my wife and I had a long conversation about Tigger. We were going to take him to the vet and have him evaluated, but we were very realistic about what we might find. On average, boxers live just shy of 10 years. We’ve noticed that he had been slowing down, and the events of that evening – keeping to himself and passing up dinner – made us concerned that the end was close. We agreed that our primary goal is to keep him comfortable. He is a valued member of our family, and we do not want him to suffer.

Thankfully, Tigger rebounded from that initial episode, although he had a similar episode in the weeks that followed. We know the end is coming for him and we are working to maximize our time with him. We are retelling stories from his younger days and enjoying some of his behavioral quirks (read: stealing food) more than we had in the past. Again, our focus remains on his comfort. When he appears to be struggling too much – when his pain and discomfort exceeds – we will make that difficult decision that most every pet owner has to eventually make.

These discussions made me think of the patients I have cared for over the years who were never encouraged to think in such terms about their own lives. Many were being treated for underlying malignancies, yet had no conversations with their physicians about goals of care or end-of-life decisions.

I have written in the past about the need for these discussions and how we, as physicians, often die differently from our patients. Allow this to be a reminder to everyone to discuss goals of care with your patients. The conversations are an important investment in your relationship with that patient and are vital to providing the best possible care for them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.

We need to speak a language our patients understand. I’m not talking about cultural competence, although that is incredibly important. Rather, I’m talking about speaking in plain language to our patients about their diseases and treatments. We also need to ensure those in our care understand the information we’ve shared with them.

Several years ago, my family was on vacation and I found myself watching (at the behest of my then 13-year-old) "So You Think You Can Dance," or, as I learned, SYTYCD. Ordinarily, it would take a four-point restraint that would make The Joint Commission blush to get me to watch the show. I have nothing against dancing – I simply prefer sports or history for my viewing options. However, my daughter loves dancing and so we watched SYTYCD.

While watching the show, my wife and older daughter began talking about the various piercings and tattoos of some of the contestants.

On one level, the conversation completely freaked me out because, you know, my then 13-year-old daughter was discussing this stuff! On another level, though, I simply listened. I quickly realized their knowledge of this stuff was way beyond mine. They were basically talking another language and I was just along for the ride.

That moment made me think about some of the conversations we have with our patients and their families. Too often, we use language and terms familiar to us but completely foreign to those in our care. We talk at patients rather than with them and then wonder why our patients do not adhere to the plans we outlined.

At my former hospital, I was involved in a project to change this dynamic. Working with a talented multidisciplinary team, we started to change how we talked with our patients. We began having our patients "teach back" to us the information we needed them to know.

Using simple questions, teach back allows a provider to ensure the patient (or family member) truly understands the disease process, treatments, and follow-up plans. The lead-in is simple, but the questions are powerful – "To be sure I did a good job of explaining your medications to you, it will be very helpful to have you describe to me why you take your Lasix – your water pill." In framing the question this way, we change the dynamic, giving patients’ permission to say they do not understand what we tell them. We subtly increase the likelihood that the patient will view the relationship as a partnership where we are all working toward the same goal – the patient’s continued health.

Focus on speaking at the patient’s level of understanding – change your language as the situation warrants. I would describe heart failure very differently to a patient who worked as a nurse for 20 years than I would to my parents. It is not difficult – it simply takes practice and making a mental note to do it. It works. Look into the concept of teach back, and find situations to incorporate it into your care.

Let us speak a common language. Let us communicate with our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

We need to speak a language our patients understand. I’m not talking about cultural competence, although that is incredibly important. Rather, I’m talking about speaking in plain language to our patients about their diseases and treatments. We also need to ensure those in our care understand the information we’ve shared with them.

Several years ago, my family was on vacation and I found myself watching (at the behest of my then 13-year-old) "So You Think You Can Dance," or, as I learned, SYTYCD. Ordinarily, it would take a four-point restraint that would make The Joint Commission blush to get me to watch the show. I have nothing against dancing – I simply prefer sports or history for my viewing options. However, my daughter loves dancing and so we watched SYTYCD.

While watching the show, my wife and older daughter began talking about the various piercings and tattoos of some of the contestants.

On one level, the conversation completely freaked me out because, you know, my then 13-year-old daughter was discussing this stuff! On another level, though, I simply listened. I quickly realized their knowledge of this stuff was way beyond mine. They were basically talking another language and I was just along for the ride.

That moment made me think about some of the conversations we have with our patients and their families. Too often, we use language and terms familiar to us but completely foreign to those in our care. We talk at patients rather than with them and then wonder why our patients do not adhere to the plans we outlined.

At my former hospital, I was involved in a project to change this dynamic. Working with a talented multidisciplinary team, we started to change how we talked with our patients. We began having our patients "teach back" to us the information we needed them to know.

Using simple questions, teach back allows a provider to ensure the patient (or family member) truly understands the disease process, treatments, and follow-up plans. The lead-in is simple, but the questions are powerful – "To be sure I did a good job of explaining your medications to you, it will be very helpful to have you describe to me why you take your Lasix – your water pill." In framing the question this way, we change the dynamic, giving patients’ permission to say they do not understand what we tell them. We subtly increase the likelihood that the patient will view the relationship as a partnership where we are all working toward the same goal – the patient’s continued health.

Focus on speaking at the patient’s level of understanding – change your language as the situation warrants. I would describe heart failure very differently to a patient who worked as a nurse for 20 years than I would to my parents. It is not difficult – it simply takes practice and making a mental note to do it. It works. Look into the concept of teach back, and find situations to incorporate it into your care.

Let us speak a common language. Let us communicate with our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

We need to speak a language our patients understand. I’m not talking about cultural competence, although that is incredibly important. Rather, I’m talking about speaking in plain language to our patients about their diseases and treatments. We also need to ensure those in our care understand the information we’ve shared with them.

Several years ago, my family was on vacation and I found myself watching (at the behest of my then 13-year-old) "So You Think You Can Dance," or, as I learned, SYTYCD. Ordinarily, it would take a four-point restraint that would make The Joint Commission blush to get me to watch the show. I have nothing against dancing – I simply prefer sports or history for my viewing options. However, my daughter loves dancing and so we watched SYTYCD.

While watching the show, my wife and older daughter began talking about the various piercings and tattoos of some of the contestants.

On one level, the conversation completely freaked me out because, you know, my then 13-year-old daughter was discussing this stuff! On another level, though, I simply listened. I quickly realized their knowledge of this stuff was way beyond mine. They were basically talking another language and I was just along for the ride.

That moment made me think about some of the conversations we have with our patients and their families. Too often, we use language and terms familiar to us but completely foreign to those in our care. We talk at patients rather than with them and then wonder why our patients do not adhere to the plans we outlined.

At my former hospital, I was involved in a project to change this dynamic. Working with a talented multidisciplinary team, we started to change how we talked with our patients. We began having our patients "teach back" to us the information we needed them to know.

Using simple questions, teach back allows a provider to ensure the patient (or family member) truly understands the disease process, treatments, and follow-up plans. The lead-in is simple, but the questions are powerful – "To be sure I did a good job of explaining your medications to you, it will be very helpful to have you describe to me why you take your Lasix – your water pill." In framing the question this way, we change the dynamic, giving patients’ permission to say they do not understand what we tell them. We subtly increase the likelihood that the patient will view the relationship as a partnership where we are all working toward the same goal – the patient’s continued health.

Focus on speaking at the patient’s level of understanding – change your language as the situation warrants. I would describe heart failure very differently to a patient who worked as a nurse for 20 years than I would to my parents. It is not difficult – it simply takes practice and making a mental note to do it. It works. Look into the concept of teach back, and find situations to incorporate it into your care.

Let us speak a common language. Let us communicate with our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Dr. Pistoria, they need you over in the preop holding area."

There was no urgency in the request, no indication that I was needed immediately. Nonetheless, I went right over. Once there, I was briefed on the situation – a patient, scheduled to go to the OR for joint replacement had coughed up some blood. The surgery was cancelled and now she was angry. I was being asked to see the patient for the possible hemoptysis and determine whether she could be safely sent home or if we should admit her.

The anesthesiologist and the nursing staff concurred: This patient was mad and rude and, everyone’s favorite word, "difficult." I took a deep breath and wandered back into the bay where she lay on the litter. I introduced myself and explained that I was a hospital medicine physician there to help evaluate her. She stared at me with a look that bordered on disdain and launched into her story.

I let her talk, maintaining eye contact the whole time. I nodded and made appropriately empathetic facial expressions as she spoke. She told me how the surgery was initially set up for 2 weeks prior but was cancelled for reasons beyond her control. She explained how much her shoulder was bothering her and limiting her ability to function in the way she once did. She talked about the fact that she had an upper respiratory infection that had left her with a nagging cough. She expressed her anger that her surgery was cancelled again.

When she was done, I told her that I was sorry she had two surgeries cancelled within the span of several weeks. I said I could not imagine how frustrating it must be to have constant pain and limitations in ability, and that I would be angry as well if my surgery – the surgery I was hoping would ease my pain – were cancelled yet again. I also explained that her surgeon felt she was at too much risk to operate safely today given the blood she had coughed up. I said that my role was to determine whether this incident was something we needed to worry about, and I walked her through how I would do that.

I could see the anger slowly dissipate as I spoke. This was an individual who wanted to feel better and wanted someone to acknowledge that the situation stank.

I took a full history and examined her. I reviewed her chest x-ray and went over my findings and thoughts with her. I was not concerned about the blood – it was likely due to irritation to her throat from her persistent and occasionally violent coughing. When she said she could not get a ride home, I put her on my service for observation and to allow her nerve block to wear off. In the end, the angry and suspicious patient who had greeted me was kind and appreciative.

A key part of health care reform is the concept of shared decision making. We need to work with our patients and find mutually agreeable treatment plans, based upon the best available evidence. In order to get there, we need to develop better relationships with our patients. Sometimes patients just need to vent, and they need to have an affirmation that, yes, their situation stinks. Those needs often run counter to our collective need and desire to have things run smoothly and without complication – particularly a complication that will require our time to listen. However, that time and listening can make all the difference in the world for that patient.

A little bit of empathy and a caring ear can show exactly how important that patient is to us. As we move toward a model of shared decision making, listening is a skill we must acquire and hone. A little bit can go a long way.

Michael Pistoria, D.O., is chief of hospital medicine at Coordinated Health in Bethlehem, Pa.

"Dr. Pistoria, they need you over in the preop holding area."

There was no urgency in the request, no indication that I was needed immediately. Nonetheless, I went right over. Once there, I was briefed on the situation – a patient, scheduled to go to the OR for joint replacement had coughed up some blood. The surgery was cancelled and now she was angry. I was being asked to see the patient for the possible hemoptysis and determine whether she could be safely sent home or if we should admit her.

The anesthesiologist and the nursing staff concurred: This patient was mad and rude and, everyone’s favorite word, "difficult." I took a deep breath and wandered back into the bay where she lay on the litter. I introduced myself and explained that I was a hospital medicine physician there to help evaluate her. She stared at me with a look that bordered on disdain and launched into her story.

I let her talk, maintaining eye contact the whole time. I nodded and made appropriately empathetic facial expressions as she spoke. She told me how the surgery was initially set up for 2 weeks prior but was cancelled for reasons beyond her control. She explained how much her shoulder was bothering her and limiting her ability to function in the way she once did. She talked about the fact that she had an upper respiratory infection that had left her with a nagging cough. She expressed her anger that her surgery was cancelled again.

When she was done, I told her that I was sorry she had two surgeries cancelled within the span of several weeks. I said I could not imagine how frustrating it must be to have constant pain and limitations in ability, and that I would be angry as well if my surgery – the surgery I was hoping would ease my pain – were cancelled yet again. I also explained that her surgeon felt she was at too much risk to operate safely today given the blood she had coughed up. I said that my role was to determine whether this incident was something we needed to worry about, and I walked her through how I would do that.

I could see the anger slowly dissipate as I spoke. This was an individual who wanted to feel better and wanted someone to acknowledge that the situation stank.

I took a full history and examined her. I reviewed her chest x-ray and went over my findings and thoughts with her. I was not concerned about the blood – it was likely due to irritation to her throat from her persistent and occasionally violent coughing. When she said she could not get a ride home, I put her on my service for observation and to allow her nerve block to wear off. In the end, the angry and suspicious patient who had greeted me was kind and appreciative.

A key part of health care reform is the concept of shared decision making. We need to work with our patients and find mutually agreeable treatment plans, based upon the best available evidence. In order to get there, we need to develop better relationships with our patients. Sometimes patients just need to vent, and they need to have an affirmation that, yes, their situation stinks. Those needs often run counter to our collective need and desire to have things run smoothly and without complication – particularly a complication that will require our time to listen. However, that time and listening can make all the difference in the world for that patient.

A little bit of empathy and a caring ear can show exactly how important that patient is to us. As we move toward a model of shared decision making, listening is a skill we must acquire and hone. A little bit can go a long way.

Michael Pistoria, D.O., is chief of hospital medicine at Coordinated Health in Bethlehem, Pa.

"Dr. Pistoria, they need you over in the preop holding area."

There was no urgency in the request, no indication that I was needed immediately. Nonetheless, I went right over. Once there, I was briefed on the situation – a patient, scheduled to go to the OR for joint replacement had coughed up some blood. The surgery was cancelled and now she was angry. I was being asked to see the patient for the possible hemoptysis and determine whether she could be safely sent home or if we should admit her.

The anesthesiologist and the nursing staff concurred: This patient was mad and rude and, everyone’s favorite word, "difficult." I took a deep breath and wandered back into the bay where she lay on the litter. I introduced myself and explained that I was a hospital medicine physician there to help evaluate her. She stared at me with a look that bordered on disdain and launched into her story.

I let her talk, maintaining eye contact the whole time. I nodded and made appropriately empathetic facial expressions as she spoke. She told me how the surgery was initially set up for 2 weeks prior but was cancelled for reasons beyond her control. She explained how much her shoulder was bothering her and limiting her ability to function in the way she once did. She talked about the fact that she had an upper respiratory infection that had left her with a nagging cough. She expressed her anger that her surgery was cancelled again.

When she was done, I told her that I was sorry she had two surgeries cancelled within the span of several weeks. I said I could not imagine how frustrating it must be to have constant pain and limitations in ability, and that I would be angry as well if my surgery – the surgery I was hoping would ease my pain – were cancelled yet again. I also explained that her surgeon felt she was at too much risk to operate safely today given the blood she had coughed up. I said that my role was to determine whether this incident was something we needed to worry about, and I walked her through how I would do that.

I could see the anger slowly dissipate as I spoke. This was an individual who wanted to feel better and wanted someone to acknowledge that the situation stank.

I took a full history and examined her. I reviewed her chest x-ray and went over my findings and thoughts with her. I was not concerned about the blood – it was likely due to irritation to her throat from her persistent and occasionally violent coughing. When she said she could not get a ride home, I put her on my service for observation and to allow her nerve block to wear off. In the end, the angry and suspicious patient who had greeted me was kind and appreciative.

A key part of health care reform is the concept of shared decision making. We need to work with our patients and find mutually agreeable treatment plans, based upon the best available evidence. In order to get there, we need to develop better relationships with our patients. Sometimes patients just need to vent, and they need to have an affirmation that, yes, their situation stinks. Those needs often run counter to our collective need and desire to have things run smoothly and without complication – particularly a complication that will require our time to listen. However, that time and listening can make all the difference in the world for that patient.

A little bit of empathy and a caring ear can show exactly how important that patient is to us. As we move toward a model of shared decision making, listening is a skill we must acquire and hone. A little bit can go a long way.

Michael Pistoria, D.O., is chief of hospital medicine at Coordinated Health in Bethlehem, Pa.

It is the holiday season – Christmas, in my house. I look forward to this month with such childlike zeal that it drives my family crazy.

The house can never be decorated too soon and those decorations can never remain up too long. I love the sense of anticipation and watching the expressions on children’s faces (especially my own children). I love the lights and the smells and the tastes (perhaps a little too much, given I always spend January and February wondering why my clothes do not fit as well.) More than anything, I love the simple kindness we allow ourselves to share with each other. We forget our differences and see everything through the prism of the holidays. We shift our perspective for 1 month before reverting back to our usual way of looking at each other and the world around us.

thinkstockphotos.com

With that in mind, I want to give each of you a gift. This gift is always the right size, and it will not expire. It is highly portable and can be used any time and any day of the year. It is the gift of reframing.

Approximately 1 year ago, I saw Dewitt Jones’ "Celebrate What's Right With the World" video. Mr. Jones is a well-known freelance photographer, made famous by his work with National Geographic. In this video, he speaks of one’s ability to reshape the story they are presented with and tell it in a new way – a way of their choosing. In other words: reframing.

We see people reframe every day and often fail to recognize it. It happens as we watch family members grieve for a loved one. Inevitably, the family takes time to celebrate the wonderful experiences they shared with their loved one and the positive impact of those times on family and friends. We see it in those who, as they detail the struggles they are working through in their daily lives, say, "Well, at least I have my health."

You may have to work hard to reframe, but the opportunity is always there. Even in our darkest moments, we can find a sliver of light that helps us get through the day. Like most things in life, though, you will get out of reframing what you put into it. If you choose not to look for the positives in life, you will not see them. If you opt not to see the beauty that surrounds us, you will miss it.

This holiday season, take a moment to remember the joy of giving when you get overwhelmed because you are behind on your holiday shopping. When you are tired and wrapping presents at midnight, picture the expression on your child’s face and remember how excited you were as a child during the holidays.

If you think medicine is in trouble because of health care reform, view it as an opportunity to create a system that provides seamless, value-driven care for our patients. Regardless of your situation, take a moment to reframe it and make it positive. You will be happy that you did.

I wish you and your families a safe, happy, and healthy holiday season.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.

It is the holiday season – Christmas, in my house. I look forward to this month with such childlike zeal that it drives my family crazy.

The house can never be decorated too soon and those decorations can never remain up too long. I love the sense of anticipation and watching the expressions on children’s faces (especially my own children). I love the lights and the smells and the tastes (perhaps a little too much, given I always spend January and February wondering why my clothes do not fit as well.) More than anything, I love the simple kindness we allow ourselves to share with each other. We forget our differences and see everything through the prism of the holidays. We shift our perspective for 1 month before reverting back to our usual way of looking at each other and the world around us.

thinkstockphotos.com

With that in mind, I want to give each of you a gift. This gift is always the right size, and it will not expire. It is highly portable and can be used any time and any day of the year. It is the gift of reframing.

Approximately 1 year ago, I saw Dewitt Jones’ "Celebrate What's Right With the World" video. Mr. Jones is a well-known freelance photographer, made famous by his work with National Geographic. In this video, he speaks of one’s ability to reshape the story they are presented with and tell it in a new way – a way of their choosing. In other words: reframing.

We see people reframe every day and often fail to recognize it. It happens as we watch family members grieve for a loved one. Inevitably, the family takes time to celebrate the wonderful experiences they shared with their loved one and the positive impact of those times on family and friends. We see it in those who, as they detail the struggles they are working through in their daily lives, say, "Well, at least I have my health."

You may have to work hard to reframe, but the opportunity is always there. Even in our darkest moments, we can find a sliver of light that helps us get through the day. Like most things in life, though, you will get out of reframing what you put into it. If you choose not to look for the positives in life, you will not see them. If you opt not to see the beauty that surrounds us, you will miss it.

This holiday season, take a moment to remember the joy of giving when you get overwhelmed because you are behind on your holiday shopping. When you are tired and wrapping presents at midnight, picture the expression on your child’s face and remember how excited you were as a child during the holidays.

If you think medicine is in trouble because of health care reform, view it as an opportunity to create a system that provides seamless, value-driven care for our patients. Regardless of your situation, take a moment to reframe it and make it positive. You will be happy that you did.

I wish you and your families a safe, happy, and healthy holiday season.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.

It is the holiday season – Christmas, in my house. I look forward to this month with such childlike zeal that it drives my family crazy.

The house can never be decorated too soon and those decorations can never remain up too long. I love the sense of anticipation and watching the expressions on children’s faces (especially my own children). I love the lights and the smells and the tastes (perhaps a little too much, given I always spend January and February wondering why my clothes do not fit as well.) More than anything, I love the simple kindness we allow ourselves to share with each other. We forget our differences and see everything through the prism of the holidays. We shift our perspective for 1 month before reverting back to our usual way of looking at each other and the world around us.

thinkstockphotos.com

With that in mind, I want to give each of you a gift. This gift is always the right size, and it will not expire. It is highly portable and can be used any time and any day of the year. It is the gift of reframing.

Approximately 1 year ago, I saw Dewitt Jones’ "Celebrate What's Right With the World" video. Mr. Jones is a well-known freelance photographer, made famous by his work with National Geographic. In this video, he speaks of one’s ability to reshape the story they are presented with and tell it in a new way – a way of their choosing. In other words: reframing.

We see people reframe every day and often fail to recognize it. It happens as we watch family members grieve for a loved one. Inevitably, the family takes time to celebrate the wonderful experiences they shared with their loved one and the positive impact of those times on family and friends. We see it in those who, as they detail the struggles they are working through in their daily lives, say, "Well, at least I have my health."

You may have to work hard to reframe, but the opportunity is always there. Even in our darkest moments, we can find a sliver of light that helps us get through the day. Like most things in life, though, you will get out of reframing what you put into it. If you choose not to look for the positives in life, you will not see them. If you opt not to see the beauty that surrounds us, you will miss it.

This holiday season, take a moment to remember the joy of giving when you get overwhelmed because you are behind on your holiday shopping. When you are tired and wrapping presents at midnight, picture the expression on your child’s face and remember how excited you were as a child during the holidays.

If you think medicine is in trouble because of health care reform, view it as an opportunity to create a system that provides seamless, value-driven care for our patients. Regardless of your situation, take a moment to reframe it and make it positive. You will be happy that you did.

I wish you and your families a safe, happy, and healthy holiday season.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.

I met Darlene during my internship. She scheduled my continuity clinic patients, and we became fast friends. I loved her sense of humor and fierce protectiveness of those with whom she worked. Our roles changed through the years, but our relationship remained a constant. She was one of my favorite people to see in the hallways and always put a smile on my face.

Two summers ago, Darlene was admitted to my service. I reviewed her data with my resident team and pulled up her CT scan. What I saw made me want to cry – a large pancreatic mass. I had to give her the news. We talked and listened, and we both shed some tears. We formulated a plan to confirm the diagnosis of pancreatic cancer and move forward. I saw Darlene periodically over the next several months. We chatted and I listened for clues to help us guide her care.

In mid-October of that year, I visited Darlene during one of her inpatient stays and recognized she was nearing the end. We talked, probably for about an hour. She finally asked me if she was dying. I took a long breath and told her she was. Darlene was silent for a while, and I forced myself to allow that silence to breathe. When she began talking again, we discussed her next steps – essentially, how she wanted to die. I did my best to listen and remember. She passed the next day, comfortable and surrounded by work colleagues and family. She joined her beloved husband Jim, who also had recently passed away.

I share this story to illustrate the importance of listening. Had we not listened, Darlene’s passing may have been very different. Those who loved her would have very different memories of her final hours.

We have all heard of the 1984 study demonstrating that patients were interrupted by their physician within the first 18 seconds of beginning their story (Ann. Intern. Med. 1984;101:692-6). Each of us has likely made a mental note to listen more – to our patients, our partners, and our friends. Sadly, we have all probably struggled to make that a consistent reality.

Listening is not easy. It is hard work and it takes time, but it is essential in developing relationships. Physicians and providers are constantly pressured to move quickly and efficiently. Being asked to take the time to listen can be annoying, because we feel listening will slow us down. Taking that extra time, though, gets us to our destination more quickly. It provides us with the information we need to make the proper diagnosis and confirm the correct treatment choice for a patient’s desires and beliefs. It facilitates understanding and solving problems with our colleagues. It shows us a different point of view. Listening benefits everyone.

I challenge each of us to take an extra moment to listen – it is time.

"One friend, one person who is truly understanding, who takes the trouble to listen to us as we consider a problem, can change our whole outlook on the world." –Dr. E.H. Mayo

Dr. Michael Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.

I met Darlene during my internship. She scheduled my continuity clinic patients, and we became fast friends. I loved her sense of humor and fierce protectiveness of those with whom she worked. Our roles changed through the years, but our relationship remained a constant. She was one of my favorite people to see in the hallways and always put a smile on my face.

Two summers ago, Darlene was admitted to my service. I reviewed her data with my resident team and pulled up her CT scan. What I saw made me want to cry – a large pancreatic mass. I had to give her the news. We talked and listened, and we both shed some tears. We formulated a plan to confirm the diagnosis of pancreatic cancer and move forward. I saw Darlene periodically over the next several months. We chatted and I listened for clues to help us guide her care.

In mid-October of that year, I visited Darlene during one of her inpatient stays and recognized she was nearing the end. We talked, probably for about an hour. She finally asked me if she was dying. I took a long breath and told her she was. Darlene was silent for a while, and I forced myself to allow that silence to breathe. When she began talking again, we discussed her next steps – essentially, how she wanted to die. I did my best to listen and remember. She passed the next day, comfortable and surrounded by work colleagues and family. She joined her beloved husband Jim, who also had recently passed away.

I share this story to illustrate the importance of listening. Had we not listened, Darlene’s passing may have been very different. Those who loved her would have very different memories of her final hours.

We have all heard of the 1984 study demonstrating that patients were interrupted by their physician within the first 18 seconds of beginning their story (Ann. Intern. Med. 1984;101:692-6). Each of us has likely made a mental note to listen more – to our patients, our partners, and our friends. Sadly, we have all probably struggled to make that a consistent reality.

Listening is not easy. It is hard work and it takes time, but it is essential in developing relationships. Physicians and providers are constantly pressured to move quickly and efficiently. Being asked to take the time to listen can be annoying, because we feel listening will slow us down. Taking that extra time, though, gets us to our destination more quickly. It provides us with the information we need to make the proper diagnosis and confirm the correct treatment choice for a patient’s desires and beliefs. It facilitates understanding and solving problems with our colleagues. It shows us a different point of view. Listening benefits everyone.

I challenge each of us to take an extra moment to listen – it is time.

"One friend, one person who is truly understanding, who takes the trouble to listen to us as we consider a problem, can change our whole outlook on the world." –Dr. E.H. Mayo

Dr. Michael Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.

I met Darlene during my internship. She scheduled my continuity clinic patients, and we became fast friends. I loved her sense of humor and fierce protectiveness of those with whom she worked. Our roles changed through the years, but our relationship remained a constant. She was one of my favorite people to see in the hallways and always put a smile on my face.

Two summers ago, Darlene was admitted to my service. I reviewed her data with my resident team and pulled up her CT scan. What I saw made me want to cry – a large pancreatic mass. I had to give her the news. We talked and listened, and we both shed some tears. We formulated a plan to confirm the diagnosis of pancreatic cancer and move forward. I saw Darlene periodically over the next several months. We chatted and I listened for clues to help us guide her care.

In mid-October of that year, I visited Darlene during one of her inpatient stays and recognized she was nearing the end. We talked, probably for about an hour. She finally asked me if she was dying. I took a long breath and told her she was. Darlene was silent for a while, and I forced myself to allow that silence to breathe. When she began talking again, we discussed her next steps – essentially, how she wanted to die. I did my best to listen and remember. She passed the next day, comfortable and surrounded by work colleagues and family. She joined her beloved husband Jim, who also had recently passed away.

I share this story to illustrate the importance of listening. Had we not listened, Darlene’s passing may have been very different. Those who loved her would have very different memories of her final hours.

We have all heard of the 1984 study demonstrating that patients were interrupted by their physician within the first 18 seconds of beginning their story (Ann. Intern. Med. 1984;101:692-6). Each of us has likely made a mental note to listen more – to our patients, our partners, and our friends. Sadly, we have all probably struggled to make that a consistent reality.

Listening is not easy. It is hard work and it takes time, but it is essential in developing relationships. Physicians and providers are constantly pressured to move quickly and efficiently. Being asked to take the time to listen can be annoying, because we feel listening will slow us down. Taking that extra time, though, gets us to our destination more quickly. It provides us with the information we need to make the proper diagnosis and confirm the correct treatment choice for a patient’s desires and beliefs. It facilitates understanding and solving problems with our colleagues. It shows us a different point of view. Listening benefits everyone.

I challenge each of us to take an extra moment to listen – it is time.

"One friend, one person who is truly understanding, who takes the trouble to listen to us as we consider a problem, can change our whole outlook on the world." –Dr. E.H. Mayo

Dr. Michael Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that best care is always personal.