Data-Driven Empathy

By: Dougan Mcgrath

The daily battle of the bottomless primary care inbox can be exhausting: some cross professional lines, treat it as if it were a casual text, or even ask questions more suited for office visits. While I have countless examples of each scenario, there was a particular patient who was especially memorable.

Beginning of my intern year, I received a message from them stating “The Mychart messages create a character limit, so I figured I would send attachments to provide more information.” This message was both frustrating and astounding how they found a way to circumvent the character limit of the MyChart messages by attaching documents to the message itself. Initially this patient’s creativity frustrated me, though unbeknownst to me at the time, there was b a deeper lesson lurking.

I was their PCP managing their blood pressure. They would send me ambulatory vital sign reports that collected information approximately every fifteen minutes and would then send me multi-paged, color-coded excel sheets complete with both bar and line graphs. At a subsequent visit, I gently tried to broach the subject of these documents being too much information, but the reports persisted.

During one virtual visit, we were discussing their blood pressure readings and how they were correspondingly self-titrating home antihypertensives. I urged them away from all the data and to minimize unsafe medication adjustments without provider supervision, acknowledging sometimes a more objective and peripheral insight might be helpful. They stated, “but in the future there is no way this information will not be readily available and common practice.” To which I simply replied, “you may be correct, but today this may be causing more stress.” The patient then mentioned something that felt like a light switch turned on for me: “but when people are stressed about their health it can be helpful for them.”

This seems like a no-brainer but internally I thought “oh my gosh this is why they do it.” The messages my patient sent were not intended to upset me or increase my workload. They were a signal of his blood pressure readings but more importantly, a signal of them not only attempting to engage in their care but an alarm uncovering their healthcare fear and anxiety. This realization changed the course of the encounter and subsequent encounters.

I shifted gears immediately and asked, “how has your stress been?” and this opened an entirely different conversation. They shared the fears of their health but also the fear of their spouse’s health conditions – specifically how their spouse was having a lot of difficulty with their amiodarone dosing and side effects from their atrial fibrillation and recent hospitalization from their ablation. They spoke about drinking less, willingness to start talk therapy, and their unrelenting support for their spouse. This moment radically shaped our patient-provider relationship as I felt I was able to both sympathize and empathize.

When I first received these messages with the excel attachments, I was frustrated and spent a lot of time questioning why someone would send all this information via MyChart message. However, now when I see these messages, I realize that it is testament of a deeper message and in this instance, their stress levels as well as coping mechanisms. It took this specific visit to realize that taking a step back to examine the patient in front of me as a someone inundated with stress was the key to successfully lowering his blood pressure and ultimately treating him holistically.

Dr. Mcgrath is a third-year internal medicine resident at Oregon Health & Science University.