Always ask about the door.

As you’re leaving your patient’s room, always ask if they’d like the door opened or closed. Yesterday I discussed Marge Piercy’s poem “Doors opening, closing on us” with members of my palliative care section. It was a wonderfully insightful hour of reflection.

I was reminded of how scary an open hospital door may seem, not knowing who will walk in and when, not knowing if they’ll carry good news or bad. There’s very little comfort, and almost no control, in a hospital room door.

Always ask about the door on your way out. Deciding to close the door may be the one bit of control, and comfort, your patient squeezes out of that day. And deciding to keep it open may be a much needed reminder of what lies beyond that door.

Get the cookie.

When faced with a choice to get the cookie or not get the cookie, I highly recommend getting the cookie. Mercy Hospital does many things really, really well. One of the things it does amazingly well is Warm Cookie Wednesday, a magical baked Brigadoon experience when warm chocolate chip cookies the size of your hand appear in the cafeteria. They’re only there for a brief moment, and when they’re gone – they’re gone.

Get the cookie. Don’t be afraid to schedule your afternoon around the cookie: trust me, it’s worth it. Pace yourself, it’s a BIG cookie. If you have a pre-existing medical condition, maybe rethink the cookie – otherwise, get it.

Oh, and grab some milk while you’re at it. It goes REALLY, really well with that cookie in your hand.

Finish the song.

When you pull into the garage at work and your favorite song comes on the radio, finish the song. If you’re a minute late to that morning meeting, tell them you took the stairs. Or better yet, tell them your favorite song came on the radio, and you had to finish the song.

You know what I’ve learned from 20 years in medicine? There are few things in life that can’t wait for Superstition to finish.

Take a seat.

Whenever you’re chatting with your patients or their loved ones, remember to sit down. It may seem like such a simple thing to do, and guess what? It is! And yet, sitting down is one of the most powerful tools in your communication toolbox.

Sitting down closes the physical gap between you and your patient and sets you at, if not even slightly below, eye-level. You’re in their room on their time, joining in on an often terrifying and overwhelming moment in their life. It’s hard to honor your role in their story if you’re looming over them, casting a shadow on the bed.

Sitting lets you assume a comfortable body language, and allows you to more easily mirror your patient’s body language. The ability to mirror non-verbal communication is key in the empathetic engagement of someone’s narrative. By assuming a comfortable and non-threatening body posture, you can more easily diffuse tension and engage volatile emotions.

In addition to the above, sitting helps differentiate you from the other medical providers who come in and don’t sit. Sometimes this distinction, coupled with other communication skills and techniques (more to come!), can make all the difference in building trust and rapport in the short period of time between 4AM blood draws and that delicious hospital lunch.

Take a deep breath.

Before you go into any family meeting, before you enter any critical conversation: take a deep breath. Check in with yourself and take your own emotional temperature. Are you boiling over? Are you upset, or angry, or frustrated?

Just as overpowering emotions can cloud cognitive processing in your patients and their loved ones, so too can they cloud your ability to listen and respond with curiosity. Take a deep breath and name your emotions. Allow yourself to be human before going in.

Find the coffee.

This was one of the first things I did intern year, and the first thing I did after moving to Pittsburgh and starting at Mercy Hospital. I found the coffee. For me, there’s something special about a good cup of coffee. The smell, that first sip from your favorite mug. How it warms your hands and then your whole body. On a weekend, with the soundtrack of the kids playing in the background, there’s something magical about that morning brew.

And if you don’t drink coffee, then I hope you’ve found something just as wonderful to get you going at 6AM when your daughter says the birds are awake and so, therefore, am I…

Schedule moments that matter.

It’s easy to lose yourself in work. And while there’ll certainly be plenty of moments that matter at work, scheduling moments that matter outside of work can help keep you balanced, and sane.

Make time for exercising every day, or reading a good book. Make time to play with your kids, make time to catch up with your significant other. Meditate, listen to music, cook. Walk through the woods. Find whatever it is that brings you joy and adds meaning to your life, and schedule it.

Make it a priority. You won’t ever look back and wish you hadn’t.

Always take the stairs.

Not because it’s good for your health and helps tone your calves. Sure, those are good reasons, too. Take the stairs because it gives you a quiet place to pause for a minute before moving on with your day.

The stairs in my hospital have a bay of windows that overlook the city. In the summer months, the sunlight bounces off the buildings and the city glows like it’s made of gold. When it rains, the storm clouds float overhead, pulling the rain over the streets like jellyfish dragging their tendrils over the ocean floor.

Sometimes I’ll take the stairs and spend a few extra minutes gazing over the city, reminding myself how much of the world lies outside the hospital walls.

It’s OK to come back later.

Sometimes it’s even a better idea to come back later. Don’t feel like you have to get everything done in one sitting. Get a feel for the conversation, read the room. And if you don’t get as far as you hoped, then that’s fine.

The last thing you want to do in a conversation is force your own agenda. Patients and family members will notice that you’re not really listening – they’ll sense that you’re trying to check something off a list. Instead of pushing to get the code status and end-of-life wishes and medical decision maker and favorite childhood snack, pause. Check in. If they’ve had enough for now, then it’s OK to come back later.

They’ll appreciate that you listened, and treated them like a human who every-so-often gets tired of talking.

Always ask about the bear.

I mean, sometimes it’s a dog, or a bee, or literally an elephant in the room. But usually it’s a stuffed bear. Whatever it is, it’s there for a reason. So ask about it.

Asking about the bear gives you a glimpse into your patient’s life, into their priorities, the things that matter most. Maybe it’s a grandchild’s favorite stuffed animal given to inspire courage and strength, maybe it’s an anchor to a distant memory. Maybe it’s what happens when a son, exhausted and hungry, wanders to the gift shop when everything’s quiet.

Whatever it is, there’s a story behind it. And it’s a story that could help you understand your patient better than any lab test ordered that morning.