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Nov 21, 2022

What do you say to the parents of a recent high school graduate who was just killed when the car she was riding in collided with a truck? Or to a son who asks you to do everything possible to save his cancer-ridden mother even though she has opted for hospice? Or to a patient when she informs you, with complete sincerity, that she can’t change into a hospital gown…because she’s a zebra? While finding the right words is a crucial part of every doctor’s job, according to Dr. Jay Baruch it’s often less about what you say and more about what you hear. As he explains, “To be an emergency physician, any clinician really, is to be a professional listener of stories.” Each patient presents a story; finding the heart of that story is the doctor’s most critical task. More technology, more tests, and more data won’t work if the doctor gets the story wrong. Dr. Baruch tells of patients who sometimes come to the hospital with lives troubled by scales of misfortune that have little to do with disease or injury. When a patient comes into the hospital with cardiac arrest or a compound fracture, doctors know what to do. The problem is evident, and the solution is practically algorithmic. Dr. Baruch contends that the biggest challenge and the biggest part of an ER doctor’s work is often caring for people who come in with not just problems with their body, but also social issues, emotional issues, and substance use issues—and oftentimes all of them at once. He explains that that the toughest part of an emergency physician’s work isn’t the high-wattage drama, the mayhem and the blood, that is portrayed on television, but rather the actual getting to the heart of the patient’s story—and figuring out how to address it.