Breaking the Silence: Boston Marathon bombings

Scores of others were not so lucky, however, and had to wait anxiously for hours or longer to find out if their loved ones were okay. One of those people is an emergency physician at Massachusetts General Hospital, Leana Wen, MD, who is also an author and essayist as skilled with words as she is with a scalpel.

Dr. Wen’s husband was at the Boston Marathon finish line. It took hours for Dr. Wen to receive confirmation that her husband was safe. All that time as she was treating victims of the bombing, she was terrified that her husband might be her next patient. When she finally spoke with her husband, she felt a mixture of relief and guilt – guilt because, as she put it “What kind of person was I to wish this horrible suffering on someone else’s family instead of mine.”

In several published articles, Wen vividly describes her experience in the ER that day. First, they transferred most of their patients to other parts of the hospital to make room for the wounded.

“Moments later, the doors flew open,” she writes. There were ambulances as far as I could see. The first patient: pulseless, not breathing, both legs blown to shreds. The second: covered with blood, no blood pressure. The third: covered in soot, one leg gone.”

Still waiting to hear from her husband, Dr. Wen describes her mounting anxiety.

“An hour passed. Friends called me to say they were OK, but nothing from my husband. I kept texting: Where are you? I love you.

“Two hours later, a cellphone rang. A nurse, a surgeon and I all reached for our pockets, but it wasn’t ours.

“The phone was in a pile of clothes in the corner, in the tan slacks of my patient who had gone to the operating room to complete his amputations. I picked it up and saw the message that had come through: ‘Where are you? I love you.’”

Dr. Wen admits that the experience has given her nightmares.

“At work, I feel numb to my patients’ suffering,” she writes. “At home, I break down and cry. Then I feel guilty. Who am I to have these emotions, when so many others suffered so much?”

Dr. Wen was brave to publicly address an issue that most healthcare professionals want to keep hidden: clinician grief. Many clinicians still feel there is an unwritten code that you must keep all feelings of sadness and grief to yourself.  That was my understanding as young physician.

One of the most searing emotional experiences I’ve had as a physician occurred early in my career when I was still a medical student. I was doing a pediatrics rotation at Hennepin County Medical Center when my call beeper went off and I ran to the Emergency Room. The resident was already there trying to revive a four year old child who had darted into the street and was run over by a car. The child was crushed by the car and we could not save him. After the child died, I went to the family room with the resident to deliver unfathomable news: their child was gone. Their wails of pain and sorrow pierced my soul. To this today, I still have occasional flashbacks of trying to resuscitate the child and I can still hear the anguished cries of his parents.

I have written about this topic previously. In my blog post from June 2012, “Clinician Grief,” I shared some other personal experiences and discussed a clinical study on grief among healthcare professionals. 

I commend Dr. Wen for her candor in sharing her personal feels about a public tragedy. If you would like to share your experience of dealing with grief in your professional life, please feel free to comment below.

End of Life

Tuesday was National Healthcare Decisions Day. The day serves as a reminder to answer the question of who will speak for you regarding important medical decisions if you cannot speak for yourself.  

Planning for end of life entails conversations with loved ones about your preferences and values that will help guide medical decisions at the end of life. You should also select a substitute decision-maker who knows your preferences and values and can make decisions in accordance with your wishes if you are unable to communicate.  These preferences and values are generally written into a document called “advanced directives”- directions to your loved ones in advance of needing them.

This day reminds me of John, a patient of mine who also became a teacher to me regarding how to be clear about preferences and face the end of life. I met John when I was an intern on the oncology service.  John had lymphoma that had progressed despite all treatment. He had large disfiguring nodules on his face and body and the nodules were filling his lungs. He knew he would not leave the hospital alive.  John was a few years older than me with a son about 5 years older than my newborn son. John and his wife were immensely likeable and during quiet on call evenings I found myself drawn to his bedside to talk.  

John knew that modern medicine could not halt the lymphoma that visibly grew on his face and invisibly inside his body. His wish was to have as much lucid and comfortable time as possible with his family. He did not want resuscitation and appeared at peace with his looming death. He and his wife spent their time together admiring their son and making arrangements for after John died.  At the time home hospice was not known but I am sure that he would have preferred to die at home if hospice was available.

John made me promise that when his “time was near” he would not be in pain. He feared being overwhelmed by a sense of anguish in his final days. I promised and dutifully wrote the orders for morphine which I knew to be the best pain killer.

At this point in my career, however, I did not understand the difference between pain and anguish.  This was an important lesson that I learned from John. “Pain” was the intense physical symptoms caused by John’s illness. “Anguish” could range from breathing problems to the emotional and spiritual feelings related to dieing. Feeling anguish would interfere with John’s ability to spend time with his family as he approached the end of his life. During his last days of life John was comfortable. I kept my promise to him; morphine relieved the anguish and he died peacefully. 

John’s frank conversations with me and his family made a difficult time more bearable. As his physician, I knew his wishes and felt like a partner in helping him achieve his wishes. His loved ones could focus on the moment rather than worry about what he wanted when he could no longer express himself. John demonstrated care for his loved ones by being clear about his wishes.

Please use comments below to describe how conversations about end of life wishes and advanced directives represent caring for loved ones.

Terror

Monday started as a usual day. At 3:36 my daughter texted me the following message:

I don’t know if you heard about the Boston Marathon explosion, but Michael is fine. I think they might have shut down phones so if can’t call him that’s why, but he posted on face book.

My son Michael was at the finish line waiting for a friend to complete the race. Within minutes of my daughter’s text the phones of my immediate family began buzzing as we called and texted each other that Mike was not injured.

My first feeling was relief and gratitude. My relief was quickly displaced by the thoughts of friends and families across the world that would hear that their loved one was injured or dead. I felt the fragility of life and how in an instant lives change.

Working in healthcare we stand witness every day to this fragility. We are privileged to engage with patients, members and families as they courageously struggle when their lives are changed in an instant.

Please use comments below to describe your thoughts about the recent tragedy in Boston or how you deal with the possibility of life changing suddenly.​

Empathy

I’d like to share a fascinating video with you. In it, a camera tracks through the hallways and rooms of a hospital in real time, capturing the actions and interactions of 38 people (and one dog), in four and a half minutes. There are no spoken words – only written captions that appear over peoples’ shoulders indicating their private thoughts. Some of the captions express joy (“first vacation in years”), while others express fear (“too shocked to comprehend treatment options.”)

 In one scene, we watch a clinician taking his place beside two other people in an elevator. On the left, with his back flat against the wall, an elderly man with a furrowed brow twists his hands anxiously and looks straight down at his feet. The caption above his shoulder reads: “Wife had a stroke. Worried about how he will take care of her.” An arm’s length away, a middle aged woman in a white lab coat stares vacantly in a different direction; the caption above her shoulder reads “Recently divorced.” And in the opposite corner, a young, bearded clinician with a stethoscope draped around his neck looks bewildered and happy all at once as he looks straight ahead and smiles. His caption says “Just found out he’s going to be a dad.”

This poignant video is called “Empathy: The Human Connection to Patient Care.” It was produced by the Cleveland Clinic and opens with this quote from Henry David Thoreau:

“Could a greater miracle take place than for us to look through each other’s eyes for an instant?”

The video triggered in me a flood of thoughts and emotions that reflected my different roles as a physician, a health care executive, a concerned family member and a patient with several chronic illnesses.

I am blind in my left eye. As I watched the video with my sighted eye, I gratefully recalled the empathetic connections I feel when people supporting me understand my fear of going blind when I experience something unusual in my lone good eye. As a husband and a father, I thought about the physicians and nurses who interact with my wife and how they understand that every time she experiences a symptom she is concerned that her cancer has returned.

I also recalled my own times as a practicing physician and the satisfaction I felt when I tried to see the world through the eyes of my patients. And I remembered times when I was less than perfect in empathizing with my patients and instead thought about other tasks, rather than being present for the person in front of me. And, ironically, after feeling those memories, I had to be empathetic with myself and forgive my lapses that occur in a busy, multi-tasking environment and remind myself that maintaining empathy is a practice requiring constant vigilance. 

The video also reminded me of something said at a recent Schwartz Rounds, a forum for discussion of the ethical and personal issues surrounding healthcare. Shannon Cooksley, a Methodist Hospital Cardiovascular RN said “I try to be the nurse that my patients need me to be.” In other words, Shannon does not use a “one size fits all” approach as she interacts with patients and families. She uses empathy to sense the inner stories of her patients and shapes her interactions with them to best meet their needs.   

Opportunities to show empathy go beyond the patient bedside and extend throughout our organization, from explaining insurance benefits to an anxious family member, to giving directions to someone in a hallway, to smiling when we stand in line next to a stranger. Every interaction in healthcare creates an opportunity to benefit our patients, families and our co-workers.

As the video concludes, the following question appears on the screen: 

“If you could stand in some else’s shoes…Hear what they hear. See what they see. Feel what they feel. Would you treat them differently?” 

Would you?

Please use comments below for your thoughts about the importance of empathy.

Being “present” saves lives

The simple act of one human being “present” for another saves lives. According to a fascinating New York Times column, simple listening could contribute to solving the Medicare cost problem. In this time of spiraling health care technology costs, we overlook simple but profoundly effective activities.

These radical statements echoed in my mind as I attended an event to recognize volunteers in the Hospital Elder Living Program (HELP) at Methodist. Approximately 25 volunteers attended, ranging from young adults to retired seniors. The event also included team members led by Paula Duncan.

HELP is an approach to prevent delirium in hospitalized patients. Delirium describes acute confusion and attention problems occurring most frequently in elderly patients hospitalized for other problems. It may complicate elective procedures like a joint replacement or may occur in patients admitted for acute problems. Delirium is life threatening. Patients with delirium have a 25% to 70% higher chance of dying during the hospital stay compared to similar individuals without delirium. For those who survive, up to 63% will die in the next 12 months compared to 17.4% for a similar group without delirium. After an episode of delirium, functional dependence triples and institutionalization doubles. An episode of delirium expands length of stay and may increase the costs of a hospital stay by tens of thousands of dollars. (Many of these statistics are highlighted in a second New York Times column on hospital delirium linked here.)

HELP prevents delirium in many at risk patients. The approach is simple. Once a patient is identified as at risk, a volunteer sits at their bedside, listens and sometimes talks. The simple act of one human being who happens to be a volunteer connecting with another human being who happens to be a patient prevents the chance of a patient developing delirium by 30-40%.

The highlight of the HELP event was hearing the responses to the request to “tell me about a special moment you have had as a volunteer.” One volunteer after another talked about what it meant to simply be present and listen. John described how rare it is to really listen to another person. He said that more often than not “listening” really means being conscious of time and when it is your turn to tell your story rather than simply being present for the other person’s story. John also painted a profound image about how we are constantly changing roles in our lives — sometimes we are at the bedside of a patient and other times we are the patient in the hospital bed. He described how, as he sits volunteering at the bedside of a patient, he often sees himself as a patient.

As I listened to the “special moments” of the volunteers, I glimpsed how important the experiences were to them. Could it be that the volunteers were enhancing their own longevity by being present at the bedside of patients and listening? Daniel Buettner describes the characteristics of “Blue Zone” communities — geographic pockets marked by unusual longevity. The features include a sense of purpose (why I wake up in the morning) and belonging. In Wellbeing, the authors describe five categories of wellbeing based on years of Gallup Poll surveys. One category is “community wellbeing” including volunteer activities.

We learn from HELP about the power of healing relationships. Everyday miracles occur when one human being is fully present and connects with another.  Delirium is averted, lives are saved, healthcare costs are reduced and the connection enhances the wellbeing and perhaps even the longevity of the volunteers.

Please use comments below to describe how the power of “being present” and simply listening helps you at work and/or in your personal life.

Team work and a culture of safety

Katie Goehner, RN has been part of the Methodist Hospital team since she was born 30 years ago. Her father, Dick Barrett, worked in the Methodist Safety and Security office when Katie was delivered more than a month prematurely by emergency C-section with very immature lungs and weighing just 2 pounds, 11 ounces. Katie’s Dad used to go upstairs to help feed her during his work breaks as she slowly gained weight and strength.

Katie went home a few months later and soon began to thrive. In her first week of kindergarten, she drew a stick drawing of herself standing in front of a nursery incubator and told her teacher she wanted to be a nurse.

Katie went through the St. Anthony school system, where she was on the Student Council and the marching band in high school. Katie received her nursing degree from Winona State. Methodist hired her in 2004 and she was trained in her new job by some of the nurses who helped deliver her two decades earlier.

Sharing her story to help others

A mother of two children herself (three and five year old girls, also born at Methodist), Katie loves her work at the Family Birth Center. When she helps care for premature newborns, she sometimes shares her own personal story with anxious parents. If it looks like they need encouragement, she flips over her employee ID badge and shows them her kindergarten drawing that she laminated to the back of her badge when she started at Methodist.

“They usually smile when they see the drawing and it helps lighten the mood,” she says. “It helps give them perspective. I try to give them reassurance and stay positive. I tell them I hope their baby will come back and take my job when I’m ready to retire, just like I did with the nurses who delivered me.”

Calling the team to action

Fortunately, retirement is a long way off for this very active nurse, who recently received the Good Catch Award from the Minnesota Hospital Association for recognizing a serious situation with a newborn baby. Katie’s concern and quick action triggered the Family Birth Center team to save the life of the newborn.  The incident is an important reminder of the essential relationship of teamwork, culture and patient safety in providing care, which Katie describes in her own words:

When I came across that baby in the nursery I first noticed how pale he was and instinctively decided to do an assessment on him, just because he did not look “right.”  My assessment revealed a lethargic, pale infant with a swollen head that extended to his ears.  Basic vital signs were stable, and I was assured that the doctor had ordered a morning hemoglobin, but that was to be done 6 hours later and I knew he couldn’t wait that long.  My basic thought was that I knew someone had to see him, even if he had been seen an hour before I knew his condition had likely worsened and would likely continue to do so.  I announced that I was going to take him to the special care nursery to have him looked over, and that if all  was well he would come right back.  I figured I had nothing to lose, and that more importantly this baby had everything to gain.  Most importantly, I knew that the culture here is so team centered, that I wasn’t afraid to ask for a second look, even if I had been wrong.  It was the team that worked together, quickly, that was able to get him transferred in just under an hour, and it was a team that I feel honored to be a part of, every shift, every day.

Thank you for promoting that team mentality, I think it meant all the difference that day.

Speak up for safety

A culture of teamwork prevents harm and saves lives.  After listening to recordings of crashes in which co‑pilots or others sensed danger before accidents but did not clearly communicate their concerns, the airline industry changed its culture by creating the expectation that everyone speaks up if they have a concern. The deck of an aircraft carrier resembles healthcare in that there is life threatening danger with unpredictable and constantly changing factors such as weather or waves. Safety depends on everyone on deck having “situational awareness” moment by moment and clearly communicating with each other.

The Minnesota Alliance for Patient Safety (M.A.P.S.) cites evidence that workplaces with high scores on surveys assessing a culture of safety are safer organizations. In other words, maintaining a culture of safety enhances patient safety. Our culture of Head+Heart, Together encourages a safety culture by promoting team work and by creating an environment in which everyone feels comfortable speaking up. That said, we must always look for ways to improve.

Looking Backward, Looking Forward

On January 1, 2013, Park Nicollet and HealthPartners officially combined. How appropriate this event occurred in the month of January. The ancient Romans named January after Janus, the god of beginnings, transitions, gates, doors, endings and time. In Roman mythology Janus has two faces, one looking back at the past and one looking ahead to the future. The image of Janus simultaneously peering back while gazing at the future continues to describe our behavior despite the thousands of years which separates us from the ancient Romans. During January, the media summarizes the “year in review” while we look ahead and make New Year’s resolutions.

In Janus, the Romans captured human beings as narrators. With one face looking backward, we weave stories about the past using a common thread of meaning. With the other face looking ahead, we tell stories about the future. Fearing an unknown and uncertain future, these stories may be full of anticipatory dread about all the unfortunate things that may befall us. In contrast, we can use stories to create and shape the future by describing a vision.

What story line do I select looking back at Park Nicollet? Park Nicollet developed over the years from multiple combinations of entities which were dissatisfied with the health care status quo and subsequently found ways to improve upon the standard. St Louis Park Medical Center and Nicollet Clinic were created by individuals who knew that a group practice could provide better care than solo practice. As a result, they were shunned by their colleagues in private practice. Methodist Hospital, wanting to be close to the community it served, was the first Twin Cities hospital to move to the suburbs. Park Nicollet Clinic and Methodist Hospital merged and demonstrated that care integrated across the clinic and hospital was superior to the usual fragmented version. In order to support this vision of integration, Park Nicollet became one of the first healthcare systems in the country to implement an Electronic Medical Record that spanned clinic, hospital and home-care. The excellent reputation of Park Nicollet attracted talented and dedicated people who furthered the outstanding care to patients and families.

What story do I want to choose in order to create the future? Patients, families and members will be better supported in what they live for because we can do it better together. Together, we will support health by working with patients, families and members so the quality of our care and the experience and affordability of that care is exemplary. Despite a harsh and unpredictable healthcare environment, we will thrive and become a national model of how healthcare should be implemented.

Combinations create uncertainty. The healthcare environment is uncertain. We have a choice through the stories we tell to ourselves about how we deal with uncertainty. We can tell stories that dwell on uncertainty and amplify anxiety or we can use stories to shape our future.

I choose the latter.

Please use comments below to relate the stories you tell yourself looking back at Park Nicollet and looking ahead at a combined future.

Pay it Forward

DrAbelsonConnects is on vacation during the holidays. We hope you’ll enjoy this post originally published in October 2010.

The film, “Pay it Forward, depicts young Trevor McKinney, engaged in an intriguing assignment from his new social studies teacher, Mr. Simonet. Trevor must create an opportunity to make a positive difference in the world. Trevor conjures the notion of not “paying back” a favor, but “paying it forward.” He intends to repay one good deed, by generating several new ones on behalf of three new people. Trevor’s efforts reverberate, not only in the close circles of his life which include his mother, and physically and emotionally scarred teacher, but in widening ripples of people completely unknown to him

Recently, Methodist experienced “pay it forward.” The following story is true with the exception of altered details to protect confidentiality. This summer, a 90 year old retired accountant working at a local store, sustained 6 hours of chest pain before taking a bus to the Methodist Emergency Room. Arriving early in the morning at 6:45 a.m., he remained resolute in desiring a rapid evaluation enabling him to return to his work shift. The Emergency/Observation Center team scrambled to honor his wishes. Discharged by 12:50 p.m. he completed a full evaluation including a stress test. Appreciative of the team’s assistance in helping him meet his work obligations, the professor, sent a check for $1,000 allocated to aiding less fortunate individuals unable to afford emergency care.

His generosity paralleled attempts by the Emergency Center and the Pharmacy at Park Nicollet Methodist Hospital to identify ways to fund low cost or free prescriptions for patients unable to afford discharge medications.  Emergency Center team members, inspired by the generosity, donated $7,000 through matching gifts.

The Emergency Center team “paid forward” a good deed to the patient by honoring his desire to return to work in the afternoon. The patient “paid forward” with a donation for those unable to purchase prescriptions. His gift prompted a cascade of others “paying forward” with matching donations.

Please use comments below to reflect on the relationship between “paying it forward” and our work

Dealing with Tragedy: Remember What You Live For

“What do you live for?” is an important question at Park Nicollet. The question embodies the “noble cause” of health care. Living for something is an essential part of wellbeing. Our role at Park Nicollet is to support wellbeing by enhancing the ability of people to participate in life as fully as possible. We’ve made the question the theme of Park Nicollet’s marketing campaign with billboards that feature patients and families saying what they live for.

It is on days like Friday when we are powerfully reminded of the important things we live for.

Tragedy in Connecticut

I am sure that all of you share in my deep sadness and sorrow following Friday’s shootings at Sandy Hook Elementary School in Newtown, Connecticut.

At this writing we know that 28 people were killed, 20 of them children between the ages of 5 and 10. The 20 year old gunman also shot and killed his mother and killed himself.

Like many of you, one of my first reactions was to think of my own family and loved ones and to be grateful they are healthy and safe. President Obama, in addressing the nation about the shooting, had a similar response.

“I react not as a President,” he said, brushing away tears, “but as anyone else would, as a parent. I know there’s not a parent in America who doesn’t feel the same overwhelming grief that I do…our hearts are broken today…Our hearts are [also] broken for the parents of the survivors as well. As blessed as they are to have their children home tonight, they know that their children’s innocence has been torn away from them too early and there are no words that will ease their pain.”

Emotional costs of responding to tragedy

We all pay a cost when we confront tragedy. Something or someone we value has been taken from us and we must find a way to move forward.

This circumstance confronted my own family and community last September when a friend of mine was killed along with four others in an act of workplace violence. (I wrote about this in a previous blog entry.) My friend left behind his grieving wife, children and grandchildren who must find a way to carry on with their lives. I was moved by the strength of my friend’s wife, who visited with the families of the wounded at a hospital less than two days after the death of her husband. This terrible event hit close to home and was a reminder to all of us to be grateful for the things we live for.

We also confront these issues in our professional lives. First responders, police officers, firefighters, emergency response personnel and those of us privileged to practice medicine know what it is like when you have to set aside your personal feelings and treat the victims of tragedy.

On Friday, as police officers were still searching the school, victims were transported to Danbury Hospital, just eleven miles away. The hospital was forced to go on lockdown and activate their emergency response team to quickly react to this unforeseen and unimaginable tragedy. As victims were brought into their emergency room on stretchers, I am sure they had to suppress their own emotions to treat these children under challenging and stressful circumstances.

Keeping families connected

Here at Park Nicollet Methodist Hospital, we have our own emergency preparedness plan that is ready to be activated in the event of an emergency. In fact, our team has spent the past two months working with regional hospitals, Minneapolis Police, Minneapolis Public Schools and the American Red Cross to create plans and procedures for how to reunite parents and school children after a mass casualty event, such as happened Friday. 

Park Nicollet and other health systems do this because we know what our patients, families and communities live for: the health and well being of each other.

I am glad we prepare for such emergencies, but I pray that we never have to respond to something as tragic as the school shootings in Connecticut.

What do you live for?

I live for the well being of my family and friends. I live for making an impact in how healthcare contributes to well being —including affordability.

We all live for things that are important to us. Please use comments below to share your feelings and tell us what you live for.

Touch and Technology in Patient Care

At one clinic, an experienced physician uses the tips of his fingers to probe a patient’s neck and feel for any abnormalities. At another clinic, a young physician uses the tips of his fingers to launch a smart phone app that details the symptoms of thyroid disease.

Which physician is practicing the most effective kind of medicine?

The tension between touch and technology in healthcare is a familiar problem that has become more acute with the ability of app designers to make sophisticated diagnostic resources available to clinicians at the tap of a finger on portable mobile devices. Does the use of smart phones and tablets by clinicians improve the care they provide, or does it put a barrier between them and their patients?  Does it create a generational divide between colleagues? Does it take us farther away from one of the first things we learn in medicine, the laying on of hands?

I experienced a similar generational divide 40 years ago during my medical training. My cardiology mentors received their training before the advent of echocardiograms. They spent many minutes bent over patients, carefully listening to subtle heart sounds to find evidence of valvular heart disease, congestive heart failure and pulmonary hypertension. I could never hear what they heard and instead relied on the results of phonocardiograms and echocardiograms. My endocrine mentors diagnosed thryroid disorders from the speed of ankle reflexes; I used blood tests. Other mentors, trained before the advent of C-T scans used palpation (touching the patient) and plane XR’s to diagnose- I relied on C-T scans. At the time, I did not understand how listening and touch contributed to healing- I only focused on how much more efficiently I could diagnose by using new tools. Only later in my practice did I come to appreciate the importance of touch (as I described in my earlier blog post, “Rituals”)

A recent New York Times story took this issue a step further and looked at the generational divide that some feel is developing over the use of mobile technology in patient care. In her article “Redefining Medicine with Apps and iPads,” reporter Katie Hafner creates a fascinating juxtaposition of two physicians at the University of California, San Francisco Medical Center who share the same goal of providing outstanding patient care but with from different perspectives. I encourage you to read it.

The story follows a third year resident in Internal Medicine, Alvin Rajkomar, as he uses his iPhone and an app called “MedCalc” to help him provide patient care. The story also focuses on a 66 year old physician at the same hospital, Paul A. Heineken, who worries that younger physicians may be losing the ability to rely on human touch to treat and comfort patients.

For Dr. Rajkomar, according to the reporter, mobile technology is “a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information, to think about what it means to be both a doctor and a patient.”

But Dr. Heineken says “’I tell [residents] that their first reflex should be to look at the patient, not the computer…’ And he tells the team to return to each patient’s bedside at day’s end. ‘I say, don’t go to a computer; go back to the room, sit down and listen to them. And don’t look like you’re in a hurry.”

My feeling is the best approach lies somewhere in between. Personal contact and human empathy are essential to patient care and must not be overlooked – nor should we overlook the value of medical and mobile technology to aid in care and to give us more time to be with our patients.

Personally, I like what another physician quoted in the article says: “Just adding an app won’t necessarily make people better doctors or more caring clinicians…What we need to learn is how to use technology to be better, more humane professionals.”

In other words, we should use technology not just to find answers, but to help us become more humane to our patients and to ourselves.

In other words, we must use Head + Heart, Together.

This article and the issues it raises are perfect examples of why we need our internal culture of Head + Heart Together. We must use the evidence-based medicine and technological resources that are in our Heads and combine them with the healing relationships and compassionate care that come from our Hearts, and bring it all Together to create experiences that benefit our patients, families, teams and communities.

Be it technology, experience or generational divides, we can bridge any gaps when we all share the values of Head + Heart, Together.

Please use comments below to share your experiences with using technology to improve patient care and to improve the quality of time that you spend with patients or supporting patient care.