JAAPA

Figure“Though passion may have strained, it must not break our bonds of affection. The mystic chords of memory, stretching from every battlefield and patriot grave to every living heart and hearthstone all over this broad land, will yet swell the chorus of the Union, when again touched, as surely they will be, by the better angels of our nature.” —Abraham Lincoln, First Inaugural Address It's a tricky business to bring two strangers together these days, each bearing the weight of their own story. In a time when we seem increasingly at odds with our neighbor, it may be even more complex between clinician and patient. How soon after we enter an examination room does our patient know if we really see them, if we are there to care for them? How many seconds of eye contact, or speech, or quiet does it take? One study found that the average person can predict medical malpractice lawsuits after listening to 40 seconds of an initial encounter between patient and surgeon.1 What if we narrowed down the window to just the first 2 seconds: the knock on the door, our countenance, our first words to the patient? On a Thursday morning in January, I knocked and entered a procedure room to perform a lumbar puncture (LP) and administer intrathecal methotrexate to a woman I had never met. Two mornings a week, I am the “procedure guy” in the cancer center, running from room to room carrying a stack of consents and bone marrow biopsy and LP kits. On each consent is a sticky note with enough information to first do no harm. This one reads, “42 yo F, no AC, plts 147K, AML in CNS.” In my rush, I omit the long, deep breath outside the door, a pause I learned in PA school. I open the door as I knock and lead with an automatic, “Hi Ms. B, how are you?” Ms. B. is Black, slight of frame, seated in a typical examination room chair. Younger than I expected (for a fraction of a second, I remember I am middle-aged now). Her legs are crossed at the ankles, black tennis shoes tucked under the seat of the chair. Her hands grip the front edge of the...

The better angels of our nature