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Mirena for Crying Babies and Stickers for Older Siblings: An Image of a Biopsychosocial Physician

Posted By Scott Michaels, Tuesday, August 14, 2012
A biopsychosocial physician is one who can attend to systemic issues and mobilize patient resources. As it happens, I have had the privilege of working with such a physician. And I have taken creative liberty in recounting a peculiar patient encounter I witnessed. Some of the connections I make may also seem a bit creative.

As I was walking back to my office, I heard a large commotion in the next hallway. It turned out to be a mother and two young sons being entertained by a physician.

At first glance, a baby was crawling up his mother while crying and pining for the book the physician just stripped from his hands. I wasn't quite ready for what I saw next. In what seemed like a scene out of Monty Python, the doctor somehow harmoniously quelled the crying baby, went through an entire supply of stickers, and exhausted the reading material in the pamphlet ridden hallway.
Scott Michaels
Too often, we get so caught up in our pursuit of education, competence, and mastery of little techniques that we forget to connect with our patients.
 The physician somehow pulled off a pirouette and somersaulted behind the nurse’s station to grab what seemed like every sticker left in the clinic for the baby’s older brother. And with lightning speed he darted across the room to find seemingly nonsensical reading material for a baby. It became clear to me that this wasn’t just any old intervention; this was a master at work.

This isn't a story about when doctors lose their minds; maybe it's not a story about anything. But to me, this is a story about health literacy, a story about expanding the patient system, and a story about customer service.

You may think it is strange for a doctor to steal a book from a baby, but is it really? You may think it is strange for a doctor to replace that book with a Mirena pamphlet, but is it really? You may think what this doctor was doing may seem like nonsense, but I don't. What was really happening was a doctor planting the seeds of change.

Lesson one: what this doctor was doing was ingenious; this was a systemic intervention for health behavior change starting with health literacy. With this young brainchild knowing all there is about Mirena, and who knows, maybe next time it will be Byetta, this family will surely be healthy, knowledgeable about their health, and could teach others how to do the same.

It took me a while to understand why the older child got so many stickers. But as it so happens in primary care, patients are seen from the cradle to the grave. So this older child must've been seen by this doctor many times. And I can only imagine that the older child had already studied Mirena, Byetta, and even Abilify. Obviously, the stickers were a reward for each pamphlet the older child read.

Lesson two: expand the system! The mother of these children may not have needed Mirena, Byetta, Abilify, or really any other medication. But, this doctor expanded the system to include family members. The family is always more influential in changing and maintaining health behaviors than healthcare providers. These children can hold that young mother accountable for her health behaviors now that they’ve learned about disease processes.

The pirouette, the dash across the hallway, and what seemed like countless somersaults were not just for show. This doctor exhibited a different kind of showmanship, that is, showmanship you would see in a good salesman. These patients came for a service and who better to provide that service than a dancing, tumbling, and profusely sweating doctor?

Lesson three: your patients are customers. And as providers of a service, you have a responsibility to your customers. Sure, there are many ethical opinions, obligations, and so on. Regardless, provide service with care and enthusiasm.

Too often we forget that our patients need a little laughter; and let me tell you, this was something to laugh about.

Lesson three and a half: don't forget to laugh! This was one of the funniest things I've seen in primary care, maybe because this doctor is hysterical, but mostly because his intervention worked. This family left the clinic feeling cared for, jovial, and ready to come back.

You may realize by now, this anecdote was written in jest. However, there are some very real points here: promote health literacy, expand the patient system, provide good customer service, and use humor. Too often, we get so caught up in our pursuit of education, competence, and mastery of little techniques that we forget to connect with our patients.

I'm not encouraging all healthcare providers to abandon our quests for competency just to pirouette, somersault, and run around hallways. But I would like to encourage that we remember aspects of our practice like customer service and humor to establish meaningful patient-provider relationships.

My last pearl: this doctor was only successful because he was being himself. So when you treat your patients, remember that you don't have to be perfect. No one is; but the moment was perfect because this provider embraced who he was and the patients accepted him because he genuinely cared.


Scott Michaels is a Medical Family Therapy doctoral candidate at East Carolina University. He completed his Master’s degree at the University of Rochester (MFT) in 2010. He is currently the Applied Psychosocial Medicine Resident in the Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. His academic interests include MedFT competency development and family medicine residency education.

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