“Trevor, I need you to come talk to this mom, she’s very angry and has a lot of questions and doesn’t want to talk to me. I tried to explain everything but she is just arguing with me now.” – One of the most experienced nurse practitioners I’ve ever met, in the middle of the night.

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With the evolution of medical practice and care from a patriarchal system to one more appropriately focused on patient autonomy and shared decision-making in the era of technological explosion and access to endless information of various validity, it has become more and more common to have disagreements in medical recommendations from what a patient views as the right steps for them. While a majority of the time a middle-ground that takes into account the medical expertise of a healthcare professional and the holistic needs of a patient is easily reached, sometimes this is not always the case. Sometimes a simple misunderstanding can lead to a rift in discussion and in the more extreme cases, can lead to a patient requesting to “fire” their provider and seek an alternative or “second opinion.”

I will never forget my first year of being considered a Doctor when I wandered the halls of our cancer center as a Pediatric Intern covering the unit in the night time on my Oncology rotation. A mother had become concerned about her son’s lack of improvement, although he was exceptionally stable, and had requested in the middle of the night to talk to someone. Of course, that someone was Me. I entered the room quietly to a distraught mother requesting extensive imaging and testing that I knew was unnecessary at that time; although, I acknowledged that a discussion was worthy in the morning when the primary team was rounding. However, she wasn’t happy with my advice and angrily asked for another person to come talk to her saying she didn’t want to talk to me anymore. I will never forget that night calling my Attending to wake her up to quell her consternation in the early hours after midnight. Ultimately, the mother had thought I had rolled my eyes at her, when really it had been just my motor tic in exhaustion that had come out. My Attending came to the room barely awake, spent a while in the room with the mother, and then left a mom in a happier position feeling she had been more heard by someone other than me, despite my best try.

As a locum tenens provider, one of the most challenging jobs is being the first, second and third opinion – most of the time you’re alone and there really is nobody else to speak to. As I have grown in my medical career, I have continued to deepen my understanding and discussions with families, realizing this is possibly the true Heart of medicine. My main goals have always been cautious confidence, honest transparency and empathetic support in non-medical vernacular, understandable, hopefully, to listeners of any educational level. More than once in the last few years as a locum tenens provider I have come across families that have been frustrated or angered by situations that are often uncontrollable or unclear in the medical course of their loved one. But when they’ve wanted a second opinion, there’s no one to give it, so compromise and trust becomes even more paramount.

Sometimes I have been tasked with ameliorating the concerns, confusion and frustration of families of the sick. The concept that “the customer is always right” holds even greater long-term implications when it pertains to one’s health, especially the health of one’s child. I will never forget the hours spent trying to mold or remold situations that have had unintentional differences in perception or opinion leading to dissent in small towns where a shared-decision was crucial to providing adequate care or to cure illness. Frankly, we are all human, and an expectation for more should be taken lightly.

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Ten years after the night I woke my Attending, I found myself walking across the bridge from our main hospital to the smaller hospital that night for a similar situation, now in a different role. I walked into the room as a second set of ears echoing in professional courtesy and solidarity the same thoughts of the nurse practitioner. I spoke slowly and softly as i listened to confusion and questions thrown at me, I provided transparency for what I knew and the unknowns of our job and I left hopefully with them in a happier position. The fire had been put out, the ashes smoldering, but just as my Attending had done for me so long ago, I provided ears to listen and words to clarify, and our team was re-hired in the end, with myself in a position strengthened by my time as a Locum Tenens.

Image Credit: https://www.healthecareers.com/career-resources/on-the-job/how-to-fire-a-patient