Book

In Shock by Rana Awdish: A Five-Star Book Review.

In Shock by physician author Rana Awdish was just published in October 2017, and already this remarkable memoir has garnered widespread praise from patients and providers alike. It’s being incorporated into the curricula at several medical schools, and is used in healthcare provider communication courses all over the world. This 5-Star review is long overdue.

The short version: This is a must-read for all healthcare providers, and the best book on patient-provider communication that exists to date. If you take care of people, go get this book and read it now.

The long (and personal) version: I have been an attending physician and instructor for a decade now. This year, I began questioning my role and purpose in medicine.

Specifically, I had been increasingly bogged down and frustrated with clinical care. A lot of this is due to our admittedly clunky and buggy system. Endless patients have complained–some in tears– about how difficult it is to reach anyone in our clinic. By reach, they mean connect with someone who is interested and able to help them with whatever problem or request they have. Then there’s delays in reporting results, errors in prescriptions, endless difficulty with tests and studies… It feels like there is way more of this crap then there ever used to be. Part of it is the admittedly clunky and buggy system, the glitches in what is still pretty new technology. But part of it is also human, errors due to confusion or complication or even sloppiness and laziness.

I had found myself uncomfortably annoyed, even infuriated! by all of this. After all, I’m not the problem, right? It’s the system, it’s the technology, it’s other people, it’s insurance companies, it’s pharmacies. But every time I placed blame elsewhere, it just made me feel worse. It just doesn’t help, placing blame.

Yes, the system is clunky and buggy. Yes, it’s unreasonably difficult for patients to reach anyone who is interested and able to help them. Yes, glitches and miscommunications happen. Yes, profit-minded insurance companies suck. Yes, sometimes people make mistakes, for whatever reason.

These are all problems, big problems across all modern medical systems, and they need to be addressed, objectively and effectively.

But meantime, these negative emotions: annoyance, frustration, blaming, judgment, anger, fury, are harmful. These negative emotions create an Us vs Them dynamic. Us vs Them contributes to provider dissatisfaction, a malignant work environment, and poor patient care. Us vs Them means that the promise of the healthcare provider to the patient has been broken.

The first step in healing these harmful emotions is to align with the patient, while at the same time taking actions, no matter how small, to address systems issues as a team. This turns frustration into motivation, annoyance into problem-solving. These messages: Align with the patient, and We are all on the same team are the main messages of Awdish’ book.

There are endless examples of how aligning with the patient and taking a team approach can play out in clinical life. The result is: It feels so much better. This is the premise for her award-winning communications course, CLEAR Communications. As she herself describes in an NPR interview:

What I most wish people knew is that while the system is broken, the people are good. The system actually obstructs things like communication and access. So it’s up to us to figure out the best way to communicate on a one-on-one basis and create that sacred space between ourselves.

It took six months of percolating and three weeks of vacation for Awdish’ message to fully sink in for me, but it did, and I am trying. As negative emotions bubble up, I acknowledge them and then apply the positive attitude and meaningful action to dispel them. This usually involves talking to people, like, picking up the phone and having a conversation. This is a work in progress, but I feel good about it.

I have also submitted a strong recommendation for this book as required reading for our incoming students at Harvard Medical School, and it appears to have at least made the cut as recommended reading.

If you take care of patients, and especially if you ever feel annoyed or frustrated in your work, then read this book.

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