Such a Little Thing

October 5, 2010

What I’ve learned over time is that I build trust with my patients, not so much with the big things as with the small things. Even when I’m not concerned, it is necessary to address the symptom, ask appropriate questions, sometimes directly ask what they are concerned is really going on. After they are reassured, then we can move on to my agenda.

This morning my son was in tears because a plastic slinky had become inadvertently tangled up. While wiping tears from his eyes with the back of his sleeve, he tried to twist the slinky coils this way and that in a futile effort to restore it to its original springy splendor.

After a little coaxing, he agreed to hand it over to me for a try. I twisted and turned the cheap plastic toy, inwardly groaning that I was spending precious morning minutes on an item that probably would cost less than a dollar to replace. After a few minutes, and much to the surprise of both myself and my son, I had freed the coils from each other and the slinky looked like new.

He was thrilled. “I didn’t think you could do it, Mom,” he said, followed by, “Where’d you learn how to do that?”

My reply: “They taught me at mom school.” He seemed to accept this and went off to play.

Such a little thing - to spend a few moments on something I considered unimportant, but which, at that moment was the most important thing in my little boy’s world. I know other mornings, more hectic mornings, would have found me urging my son to just put the slinky aside, promising to replace the broken toy the next time we were at Target or Walmart. Somehow, fixing the slinky felt a lot better than just buying a replacement at the store. For a moment, at least, I was his hero. That feels good.

I often am trying to do grand and great things for my patients - help them quit smoking, get their hemoglobin A1C less than 7 percent, prevent a second heart attack. Sometimes, my patient and I frustrate each other during these visits. I know what the highest yield health behavior change would be. They don’t care. They are concerned about something I consider to be a little thing - the cough present for the last 36 hours, a bruise on their thigh, or an episode of vomiting they had two weeks ago and which has not recurred.

In my youthful inexperience (and sometimes still during difficult days), I tried to redirect their concern. “The cough is not anything to worry about. However, it may be a good reminder to quit smoking.” Not surprisingly, this approach is rarely successful.

What I’ve learned over time is that I build trust with my patients, not so much with the big things as with the small things. Even when I’m not concerned, it is necessary to address the symptom, ask appropriate questions, sometimes directly ask what they are concerned is really going on. After they are reassured, then we can move on to my agenda. It really is the little things that matter.