Jill Muhrer is a family nurse practitioner who retired after providing primary care to patients in Camden, New Jersey through a federally-qualified healthcare center.
A seasoned clinician told me that determining the correct diagnosis and treatment is essential but not sufficient for establishing a successful plan. According to my mentor, the ability to engage an individual in treatment decisions is critical to its success. When decision making is collaborative, based on the medical knowledge of the clinician and the values of the patient, patient satisfaction and health care outcomes are improved.
In Divya Manikandan’s story “Say Om” (Intima, Fall 2022) she is warned to be careful with Jay due to his severe anxiety. In reviewing his chart, she discovers that he is a child with high functioning autism who loves math and science. She quickly realizes that children his age are “old enough to be reasoned with, but still children, not responsible for their own bodies and governed by strong emotions and phobias that deserved acknowledgment.”
Based on this understanding, she develops several strategies—and then, “brimming with plans A through D, I walked into the room, believing that once I saw Jay and spoke to him I would somehow know what to do.” Her openness to seeing Jay as an individual is key to building rapport with him. Using nonverbal cues such as lowering herself to his eye level and talking directly to him deepens this connection. When she presents the options to him and asks him to decide, she engages him as a partner.
Their relationship is strengthened when they discover that they are both from India and that they have a shared cultural heritage. When it’s time to administer the vaccine, Jay, his mother, and Manikandan recite the Gayatri Mantra, a sacred Hindu hymn, deepening their connection and reducing the stress of the injection.
Having a person from a similar background creates a greater capacity for understanding, shared perspectives, and a strong therapeutic alliance. Furthermore, when Manikandan tailors her approach to Jay’s values, she engages him in the plan, increases his sense of control, and encourages his trust in their relationship. This type of bond is the foundation for meaningful health care decisions that will improve outcomes.
Jill Muhrer is a family nurse practitioner who retired after providing primary care to patients in Camden, New Jersey through a federally-qualified healthcare center. After completing a writing workshop at Westport Writers and a medical narrative program at Columbia University, she is focusing on story writing. Muhrer received her BSN from the University of Pennsylvania and her MSN and DNP through Yale University. She has published stories in Pulse: Voices from the Heart of Medicine and the American Journal for Nurse Practitioners as well as clinically focused articles in the Journal for Nurse Practitioners and The Nurse Practitioner and haiku in Modern HAIKU. Her Field Notes essay “Pocketbook” appears in the Fall 2022 issue of Intima.