A Room With a View

Space is always at a premium in any bustling medical office, and my department is no exception.  In the four years that we’ve been open, the patient volume has nearly doubled.  We’ve added a second physician, a second nurse and several additional radiation therapists.  My office manager does financial counseling in her tiny office that is more like a closet, and my physicist has doubled up with his own physics resident. Now we have a rad onc resident rotating with us and we’ve had medical students nearly continuously since July, both welcome additions to our daily routine but our “zen” is being stretched a bit thin. The question has come up—where do we put everyone?  As we walk the hallways looking for walls to knock down and more closets to turn into offices, all eyes turn to me, and it is clear that the vultures are circling.  Everyone wants my consultation room!

Long ago my mentors taught me two important concepts.  First, that it is the very first meeting with the patient and the family that gives them the lasting impression of the department and the doctor—first impressions do count.  Second, that talk about cancer and radiation therapy is threatening and scary and is best served up when the patient is fully clothed, in a comfortable chair, preferably in a room with a window.  Not that anyone wants to jump out of course, but somehow the sunlight pouring in makes patients feel like there is an escape hatch from that claustrophobic feeling they have when they suddenly realize that their lives have been forever altered.  As a consequence, all of the departments that I have built or directed have had a room, simply and comfortably furnished, where the patient and his family or friends are taken for the initial part of the consultation.   My consultation room has a couch, a coffee table and two large armchairs .  Landscape photos line the walls and the picture books on the coffee table are mine.  The large window faces south, and the sun streams in all day.

By the time we move to the actual exam room, there is an ease, and a familiarity, like we’ve all just met some old friends over coffee and the undressing and gowning for the physical exam goes smoothly and quickly. From our “customer satisfaction surveys” I would venture to say that most patients leave a lot happier than they enter.  So as we walk the halls looking for more space for our growing department, I tell my vultures to back off—that the large sunny consultation room is sacred and it is not going to go away because it is a neutral space between the fear of the waiting room and the vulnerability of the exam room. It is the space that makes my patients feel like they are human beings, not specimens, not tumors, and not cattle waiting to be prodded down the chute to an uncertain fate.

Now all that being said, there are two little issues I’d like to raise.  First of all, whoever took my coffee table book containing lovely photographs of our local community, could you PLEASE bring it back?  And second, when I sank into that armchair on that warm summer afternoon, I did not, I repeat DID NOT fall asleep as I was explaining radiation therapy for prostate cancer to you.  You only imagined that I fell asleep.  And it was only for a minute.  Really.