I have had ample experience with negotiation during the past three years of medical school. Through the Herbert Wertheim College of Medicine community outreach program, I had the opportunity to meet my patient at his household with an interdisciplinary team. At our initial visit, I met a friendly, elderly Haitian man, who loved having company and chatting. It was extremely overwhelming to gather an initial history and physical, as he had a lifetime of stories for each question. From explaining his housing situation to roaring about his four ex-wives, my patient seemed as if he would never stop talking.
Initially, I did not feel comfortable redirecting the conversation, but I realized that building rapport is a part of the art of medicine. In subsequent visits, I emphasized setting an agenda and developing goals before each meeting, which in turn helped me to address his needs. I learned about the nuances of negotiation and the importance of giving room for flexibility in our conversations, as my patient is a traditional man, who has lived many years with a certain routine. It was my responsibility to respect his way of life, while providing suggestions for improving his quality of life.
As a part of the social determinants of health care, I emphasized diet and exercise at each visit, as my patient eats a sandwich, coffee, and toast for each meal and does not exercise due to joint pain from osteoarthritis. We have had our differences regarding these topics, and I have tried tactics such as pamphlets, food inventories, and assessing grocery store accessibility, but I realized the most important part of negotiating is consistency. During every visit, I encouraged my patient to drink water and to eat despite a decreased appetite. The physician assistant and nurses on the team helped me to communicate the importance of health, encouraging him to cook meals at home and to exercise by means of physical therapy or short walks. Our nurse was also Haitian and related to our patient regarding diet, language, and culture. She helped to communicate the importance of flavor and spices in Haitian food, while recommending that he supplement meals with vegetables and fruits. I suggested adding small habits to his daily routine rather than big changes that seem formidable.
Further, my patient and I have had multiple discussions regarding safety. He lives in an annex connected to a house with fall hazards and no fire security alarm. Despite discussions regarding these hazards and offering a free smoke alarm installation, he is not interested in installing an alarm because he believes he is moving soon. Social work has helped him to apply for low-income housing, an experience that has opened my eyes to the number of individuals, who apply for these services and how difficult it is to obtain assistance without the internet. I advised him to minimize purchasing items until he has the approval to move to a new location. I explained that the items are a fall hazard, and he has agreed to hold off on the purchases. I encouraged him to use his cane when ambulating, but I realized that he may be resistant to this idea due to social stigma. I communicated the fear of a fall and informed him about morbidity associated with a fracture at his age, and he agreed to purchase a cane with more legs for stability.
As elderly patients are vulnerable to diseases, discrimination, and social inequality, I realized that it is my responsibility to advocate for my patient. He shared information that he heard by word-of-mouth about medications and his health, which I encouraged him to share, as I realize that verifying misinformation is crucial. While I am grateful for the opportunity to meet him face-to-face every few months, I am most thankful that he attends church every Sunday and is a part of the church choir, facilitating his social connection with the community. He has many church friends and has a healthy lunch every Sunday. I encouraged him to continue to maintain social connections, as he loves to chat with others. He agreed to have Meals on Wheels come to the house to provide a healthy meal on weekdays, which will also provide a service through which someone can check on him at his home.
This valuable experience has helped me to understand that patients rely on doctors not only for health needs but also for guidance on topics such as hurricane preparation, COVID-19 prevention, and assistance with housing. Since my patient does not have access to the internet, it is imperative that I provide him with current and reliable information. As he has lived his life in a certain way for over 80 years, I understand that change is difficult, but I am pleased with the changes that we have made so far. Our interactions have led me to understand the importance of actively listening to our patients, the art of negotiation, and the importance of patient care that extends beyond the walls of the clinic.