Holding Space

by Lisa Weaver, MD

As a family medicine physician, I have the privilege of getting to know my patients across different moments in their lives. Sometimes these patients are establishing care with a primary care physician for the first time in their adult lives and have multiple concerns. I have found that in many of these cases, the patient has been estranged from the medical system because they have significant trauma histories or even negative experiences directly related to the healthcare system. There is often distrust surrounding doctors and the medical system as a whole that has been present long before they walked through our clinic doors. Primary care doctors are in the unique position to gain these patient’s trust long enough to start chipping away at their concerns and have a positive impact on their health.

As I am over halfway through my residency training, I have begun to establish a panel of such patients, and I have had the opportunity to deepen my relationships with them in this process. Often this includes listening to their story and validating their concerns for the first few visits. Sometimes I will try to bring up my concern about their high blood pressure or suggest a diabetes or cholesterol screen, and this will be met with varying degrees of receptivity. I remember in my first year of residency, I would often leave these initial visits feeling frustrated that I did not accomplish anything “medical” during the visit as I attempted to (not always very) patiently mostly just listen to their concerns. Each time I saw these patients, I would ask myself why they kept coming back to me when it felt like we did not make headway on any of their “real” medical issues.

I have found that if I continue to stick with these patients and see them regularly, this will start to pay off as we slowly develop a relationship. For example, I have a patient that was very hesitant to start a hypertension medication because they were concerned about the side effects of starting any medication and didn’t believe it was necessary. After several visits with this patient where I learned more about their history of deep trauma from sexual abuse and family abandonment, they trusted that I was invested in their wellbeing and were ready to start a medication. After this, we slowly started chipping away at all of my own medical concerns such as getting a colonoscopy, catching up on vaccines, and initiating a statin. It took several months of seeing this patient, but I truly believe that the vast majority of the healing that took place in that clinic room started with simply holding space for that patient to share their story and express their doubts and concerns.

Of course there are times that my patients will not be able to establish a relationship with me, either because they are looking for something else or because of other barriers beyond their control. I have a patient who has been in the hospital multiple times this year for alcohol withdrawal and frequently has not shown up to appointments. On the times that he has shown up, he has shared that he hasn’t made it to his appointments because he was recently evicted from his home and has been unable to get access to a cell phone. In “The Hot Spotter” from the New York Journal which discusses focusing on patients that are high utilizers of healthcare, Dr. Brenner states that “ The ones you build a relationship with, you can change behavior. Half we can build a relationship. Half we can’t.” While it can be frustrating to feel like we can’t make progress in some situations, it is important to continue to be present for these patients when they do show up.

As I build my practice in residency and beyond, it is important to keep reminding myself that the best I can do a lot of the time is listen to my patient’s story, validate their experiences and past traumas, and continue to show up and be present. Historically, the medical field has done a poor job of doing this – particularly in BIPOC, LGBTQIA+, and economically disadvantaged individuals. We as healthcare providers are working against centuries of oppression, trauma, and discrimination, but we are also working in a system that continues to be flawed. Unfortunately, we still often fail at building trust with at-risk populations, but it is our job as family medicine physicians to be persistent and hold space for the individuals that do grace our clinic rooms.

Dr. Weaver is from Ephrata, PA. Her medical interests include women’s health, obstetrics, pediatrics, mental health, and LGBTQ medicine. She chose the University of Utah because of the unique mix and community and academic learning opportunities and the wonderful faculty and residents that she met during her interview. During her free time, she enjoys running, camping, weight training, playing violin, reading, and baking bread.

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