Vital Signs: What’s Missing?

I read an article from the vital signsBritish Medical Journal this week that brought up what I think is a keystone for health. Dr. Christina Mangurian, a practicing psychiatrist in San Francisco, wrote about her family’s personal journey through the healthcare system as her 10-month-old son received a bone marrow transplant for a life-threatening illness. Having already been through a three-week hospital stay when her son was only one month old, she and her family made plans to care for themselves and their 4-year-old daughter physically and emotionally during the marathon hospitalization for the transplant.

She described difficulty in asking for help, something that I identify with, and witness often in our region full of stoic, Scandinavian roots. But she knew that the well-being of her children would be positively impacted if she and her husband took some time to care for themselves. They lined up friends, colleaugues and family to help with chores, childcare and meals through “Lotsa Helping Hands” website. They exercised and alternated sleeping in the hospital with a peaceful night at home. 

Yet despite all the planning and support and knowledge from her medical background, she was brought to her knees by being on the other side of the patient-provider relationship. Despite mostly excellent care, she felt full of fear and vulnerability. She blames logistics and the emotional divide.

One of her logistical concerns was the disregard for sleep in the hospital, despite so much research on its importance in and out of the hospital. She described late-night visits by the residents, and numerous checks by the well-meaning nurses that made rest almost impossible. She felt that sleep was one missing vital sign, and that protecting sleep time would improve clinical outcomes and reduce emotional stress for patients and their families.

Gauging and addressing the emotional toll of illness was the other glaring failure in the system for Mangurain. As a psychiatrist, in a life or death situation, she knew it was normal to feel angry, fearful and out of control, but she had to fend for herself for emotional support. She worried that most families don’t have the backup that she had.

She shared, “It struck me again and again that, because of the increasing complexity of medical care, doctors do not seem to have the time to take the ‘emotional temperature’ of patients or their careers during prolonged hospitalizations, nor are providers thinking critically about essential, patient centered concerns to facilitate wellness.” She suggests that taking the “emotional temperature” of the patient and family is a necessary vital sign. Care and concern must be expressed through words and actions, otherwise the impression left is cold and technical. She describes a hug from her son’s main doctor as a major source of healing for her personally.

I see this in the clinic setting too. There is an emotional side to illness. Even in the cosmetic part of our practice, there is an emotional side to beauty.

Missing even more glaringly is the query into the role that our emotional well-being has on the development of illness. We know that stress has a major impact on our bodies, but understanding and addressing it during a patient visit can be daunting. Even in our daily lives, we joke about “feelings” and being tough enough to withstand the ups and downs of life. But relationships, money woes, and work issues play a big role in our health.

In the healthcare world, as we take blood pressure, pulse and temperature readings, maybe we need to ask, “What else is going on in your world? How are you feeling?” It might take a while for our stoic patients to share, but if we don’t ask, we miss vital signs that may put the healing back into health care. We might not have the answers, and some patients might need professional therapy or intensive self-reflection. But the questions open doors that patients might not have considered otherwise in their quest for health and well-being.