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Dr. MacDiarmid and Dr. Londoño on the patient-physician relationship


"Sometimes, when you just look at people in the eye, you sort of can forget about everything else; you can just focus on that person in front of you," says Diana Londoño, MD.

In this installment of “Begin Your Journey,” urologist Diana Londoño, MD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about the importance of focusing on the patient-physician relationship. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.


MacDiarmid: Do you have a bailout strategy? Like when you're losing it, do you just go for a time-out and close your door?

Londoño: I have a fantastic nurse; she always knows when something is off. I will just express my frustrations that I'm having that I know I'm getting triggered. I literally will shake my body, my hands, whatever it is, to really get rid of that energy I'm starting to absorb. Just like when dogs get in a fight, and they are fighting, they really shake that energy, and then they go about their day. Humans are the same. We just don't think about it. But we sometimes have to shake that off, whether it's literally by movement, by just breathing, relaxing, saying, "What do I need right now?" Because like I said, at that moment, I'm thinking, "What do I need right now?" And it's like, "I need a vacation." And I know it's not about them; it's really about me being depleted, and really taking care of your needs, going home and doing something to take care of that need. Maybe you can't have a vacation for another week and a half, but go home, turn off the phone, get in the bath tub and just do something for you that is going to de-stress you. Read that book that you enjoy, so you can just take your mind off of that stress, that trigger that happened for you. So yes, you do have to have a little bit of a back-up plan of what to do, and slow down that movie again. Because otherwise, you're going to bring that energy that is not great, that frustration, to the next patient and the next patient, and the whole day is gonna go down the toilet. Let go of whatever happened, start fresh when you go in and say, "Okay, now I'm here for you, present." Whatever happened, let it go, stop worrying about what's going to happen at the next patient; just focus on the person right in front of you. Just look at people in the eye. I mean, sometimes, when you just look at people in the eye, you sort of can forget about everything else; you can just focus on that person in front of you.

MacDiarmid: That's actually my next question. So when my partner the pod over closes my door because my voice went up too high, he's giving me grace. I haven't learned my bail-out well enough yet. But my partners are good to me. Now, the patient-physician relationship, I think, for myself, that is it. In the burnout I went through, when that sort of becomes devalued, in a sense, or commoditized, that really adds to our burnout struggle. I also think it's the answer that if we can focus on that, and bring your patients grace and love and excellence of care, I found myself concentrating, it was almost robotic-like, on excellence. But I found that looking over the past few years, you need to be more compassionate one on one. And I've heard you talk about that. What do you do at a patient level, that brings you a lot of joy and peace?

Londoño: Maybe you're on call and I really do not like call, but I sort of enter the mindset of, I have skills that are going to help somebody that is scared, hurting, or in pain, and I am grateful I have those skills, and I can help somebody in need instead of going, "Oh, my God, another call." That's not going to help anything, because I have to take the call anyway; it doesn't change the circumstances. So I just really try to really focus on the fact that somebody out there that I'm going to get called about really needs my expertise. But when I'm with a patient, I really think it is all about that. For everybody, it is different, because maybe your reason for going into medicine is very different. But for me, it's really about that connection with the person in front of me, by really, really listening and being a team member and trying to help give them more information. The definition of a physician is a healer and a teacher. Teach them, explain to them what's going on so they are more empowered to make decisions about their body, about what they want to do or not do. And I have assumptions of what I want to do and what's best because sometimes that doesn't work with what they want to do. We want to keep them safe. I'm not advocating for things that are not safe, but we have to work with people, because they have their own things that we may not be aware of: child care or financial struggles or a recent death. So maybe it's not a perfect time to do surgery right now when you want it to be done. So we have to give them grace and give them time and space to make those decisions together and allow them to have some control of their own choices, guiding them. It really is about being present, really understanding a little bit more of the big picture, what is driving them, what is scaring them. Because everybody's scared when they're at the physician. They're not saying it, but you can see it if you pay attention: a look in their eye, they're kind of wincing, their hand is clenching, they're breathing a little shallow. You can notice those things or maybe you don't, but maybe you ask them straight up, "What is your fear about this medicine? What is this fear about the surgery?" And they're going to then tell you, and then you can start working with that. Because when people are afraid, their decisions would be very different than when they're doing it from a different emotion, from love or things like that. So we have to know what is their fear—it can be very simple or it can be really big—and then work with that and just really help them like a physician. Heal and teach them and work with them, so that you can have the best outcomes for you and for them.

This transcript was edited for clarity.

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