What Patients Are Really Saying: A Conversation with Dr. Dave Moen

Dr. Dave Moen, President of Prospero Health Partners, received his first lessons in good healthcare practice when he picked up the phone in his family home as a kid. Growing up in a tiny town just south of Lake Superior in Wisconsin, Moen and his five siblings served as an ad hoc answering service for their father, who was one of the few family doctors in the area. The elder Dr. Moen was not always in the house when his services were needed, so he told his children to “use their ears” when his patients called, and they took the message to heart.

“From a very young age, I was beginning to understand what kinds of problems people face and what kind of role my dad as a physician played,” Moen said.

“And I was very intrigued by the relational aspects of the work. I watched him build trust with people, I watched him help them navigate difficult challenges, and I saw that it was meaningful to him and meaningful to his patients.”

Though Moen had some doubts about his ability to endure the arduous journey to a medical degree, he turned out to have a real knack for the sciences as an undergraduate and excelled as a student at the University of Wisconsin-Madison School of Medicine. As he neared the end of medical school, he was well-positioned to pursue a career in one of the more prestigious and lucrative specialties, like cardiology or orthopedics. Reflecting on the comfort and guidance his father provided to people back home, he chose family medicine. Still, even with his unique childhood experiences, Moen quickly realized during his residency that he had a lot to learn about meeting patients’ needs in a holistic way.

“I was actually under-equipped for the degree of social skill that I’ve had to use to both manage teams in care environments and relate with different kinds of patients,” he said.

As Moen explained, the field of medicine was in the midst of an “awakening” during the early years of his career. Technical expertise was as valued as ever, but a growing number of clinicians were acknowledging the critical emotional component of their work. While training in an emergency department, Moen homed in on one particular emotion — fear. When patients called him late at night, they were often afraid. He decided that one part of his job was to dig a little deeper to understand what they were afraid of.

Moen recalled a woman who brought her two-year-old into the emergency department late one night. The child was complaining of ear pain. Doctor and mother spoke about the toddler’s symptoms. Then, Moen tried to get to the heart of the matter.

“By then, I had gotten really good at discerning what people were afraid of,” he said. “We talked for a bit about the pain, and then I said, ‘It’s four o’clock in the morning. There must be something you’re really worried about to be here.’”

The mother revealed that her sister’s child had had ear pain and died of meningitis within 24 hours; she was afraid her child would suffer the same fate. While Moen could not guarantee that this woman’s child would never develop meningitis, he could calm her fears in that moment by asking the right question. Had Moen simply made a diagnosis and written a prescription without asking further questions, her anxieties would most likely have persisted.

Moen’s time in emergency rooms repeatedly forced him to confront patients’ and doctors’ overarching fear: mortality. People wanted to believe he could prevent death. He knew that he couldn’t, and the lack of certainty was agonizing. Rather than attempting to ward off what was often inevitable, he chose to accept ambiguity.

“I found it was more important to just be present and empathize with their fear, and then determine what needed to be done, as opposed to feeling an urgency to fix it,” he said.

Of course, no physician is alone in communicating with patients about the realities of life and death. As an emergency services doctor and in his role at Prospero, Moen recognizes and relies on the strengths of nurses, social workers, and other providers. The people under Prospero’s care are mostly older adults with serious illness. Before the start of the COVID-19 pandemic, the Prospero team began their relationship with a patient by sending a nurse practitioner (NP) to their home. The home visit allows NPs both to develop a rapport with patients and to pick up clues on their ability to take care of themselves, the safety of the home environment, and any potential family (or caregiver) dynamics at play.

Some patients know exactly what their care goals are. They’ve had the opportunity to speak with their loved ones about the progress of their illness and have an idea of what they want the last chapters of life to look like. Other families need time — and help — to get on the same page.

Moen and his team recently worked with a mother and two daughters who were coming to terms with the mother’s late-stage cancer. While one daughter thought her mom should go to a specialist in a different state to get more treatment, her sister saw their mom withering under the toll of chemotherapy and wondered if palliative treatment would be a better approach. The NP immediately recognized this tension in the family and decided to bring in a social worker to mediate the situation. After several meetings with the social worker, during which each family member’s emotional pain was acknowledged, they chose to move forward with hospice care.

“The mom’s primary goal was not to be a burden,” Moen said. “The difficult thing is when the children have different definitions of what’s a burden. Once the daughter’s fears were addressed and she understood what services the hospice could actually offer, they were all happy with that outcome.”

To Moen, this anecdote illustrates how the Prospero team facilitates difficult but necessary conversations.

“Families who are traumatized during the dying process suffer a much higher incidence of serious grief and depression following the death,” he said. “Our job as clinicians is to take care of the whole family. And what that means is that people feel heard, their fears are addressed, and the patients don’t feel like a burden.”