You Might Also Like: The Blind Spot with Dr. Aditi Nerurkar

**Dr. Aditi Nerurkar** (0:13)
Welcome back to The Blind Spot. I'm Dr. Aditi Nerurkar, your host. This episode is sponsored by Pfizer.
I want to tell you about a doctor's appointment I had many decades ago.
One that I have thought about so many times since. I was in my medical residency working 80 hours a week in the cardiac ICU taking care of the sickest cardiac patients. After one particularly brutal overnight call, I was finishing up rounding on my patients before I went home, and I felt a stampede of wild horses across my chest. It knocked the wind out of me quite literally. That sensation in my chest, the stampede of wild horses, never happened again at work. But it followed me night after frustrating night for weeks until I finally saw a doctor. I was taught in medical training, pressure makes diamonds. So when I would go through a difficult experience, as extreme as feeling a stampede of wild horses across my chest, I would say to myself, I'm a diamond in the making, but my diamond cracked. Eventually, I did see a doctor and I had every possible test run.
All the lab tests, testing for thyroid, anemia, electrolytes, an EKG, an echocardiogram, you name it, I got it. And everything came back fine. My doctor said to me in the most reassuring tone, it's just stress, just try to relax. And that was it.
And here is a thing that I have thought about so often since. I did not push back. I didn't say, I need more than that. I didn't say, I'm working 80 hours a week. I haven't slept properly in months. I can't go home and just relax. That's not an actionable plan for me. So why did I not say anything in the appointment? I was a doctor. I understood the system I was inside. I wasn't intimidated by the white coat or the clinical language. I knew how to read the data. That's what this episode is about. It's about the patient who knows plenty, who maybe even walked in prepared, who sat in the exam room, and for reasons that have more to do with the dynamics of the encounter than with the knowledge or education or access, didn't ask about the thing they really wanted to know. Because it turns out, I was not unusual. Research shows that fear of finding out bad news, which is so relatable or appearing difficult, demanding, or uneducated are commonly cited reasons patients give for not asking follow up questions. On the other side of that encounter, a physician who covered the information asked if there were any questions, heard no further questions, and not unreasonably moved on. Both of us doing exactly what the setting has trained us to do. Both of us assuming the other would surface what needed to be surfaced. My guest today has spent her career inside that exact dynamic. Dr. Lucy McBride literally wrote the book on this topic. It's called Beyond the Prescription, A Doctor's Guide to Taking Charge of Your Health.
Together, we're going to get into what we can unlock with our patients when we help them quell their fears, even the unspoken ones. Let's take a look.
Dr. Lucy McBride, welcome to The Blind Spot. We are so thrilled you could join us today.

**Dr. Lucy McBride** (3:42)
Aditi, thank you so much for having me.

**Dr. Aditi Nerurkar** (3:44)
Before we get into the heart of this, I want our listeners to get to know you a little bit. Tell us about your path. What led you to this kind of work, and when did this communication piece, specifically, what happens between a patient and a physician in the exam room become central to how you think about clinical practice?

**Dr. Lucy McBride** (4:03)
I've been in primary care for over 20 years, and I realized over time that the most therapeutic thing I do in my exam room usually isn't when I write the prescription. It's the moment when the patient realizes I'm actually listening, that I'm paying attention to them talk about their grief, their wobbly relationship with food, their toxic boss, and how it's informing their gravitational pull towards the wine at night or to the sugar during the day.
Patients want to be heard. They hold so much information in their stories, their narratives, and medicine is wonderful at treating the disease and is not always so good at treating the person who has the disease. So I became the doctor that I wish I had had when I was in my 20s and 30s, bouncing from specialist to specialist, treating body parts, taking medicines for different symptoms, and no one had asked me what's going on in your life. Medicine makes it so difficult for doctors to do that.