“You don’t build a bond without being present.”
- James Earl Jones “Will you follow me even after my cancer surgery?”
the patient begs. I will continue to see you for as long as you are willing to return,
I respond. “Can we call you when we have questions?”
the daughter asks. Of course,
I answer. “Why did she get cancer? What can we expect?”
the husband wants to know. Soon, we are deep into a difficult discussion.
Tough questions keep physicians of every specialty busy. In order to evaluate and treat diseases, the demands of 21st century medicine require staying current with piles of journals and innumerable research studies. Office and hospital time is filled with performing procedures, prescribing medications, and administering treatments. The “softer” side of medicine — taking time to talk, provide explanations, and offer hope — takes a backseat whenever we view our main mission as providing intricate treatments for complex diseases. We all just get pulled along in the maelstrom.
In an earlier time, Lewis Thomas, MD
— gifted physician, researcher, administrator, and essayist — described
the primary tasks of a physician like this:
“First of all, the physician was expected to walk in and take over; he became responsible for the outcome whether he could affect it or not. Second, it was assumed that he would stand by, on call, until it was over. Third, and this was probably the most important of his duties, he would explain what had happened and what was likely to happen.”
How were physicians equipped to accomplish these tasks? Dr. Thomas amplified:
“The first two [taking over and standing by] needed a mixture of intense curiosity about people in general and an inborn capacity for affection, hard to come by but indispensible for a good doctor. The third, the art of prediction, needed education and was the sole contribution of the medical school.”
Thomas’s description comes from medicine at the time of his father’s medical school graduation — 1911. Thomas found medicine to be much the same when he started medical school in 1933.
Being accountable, being present, and making honest, informed predictions on behalf of our patients is never easy. Interestingly, despite the revolution in health care and explosion of information, these three tasks remain vital components of our profession. Things, it seems, haven’t changed all that much.
The following is feedback received for this blog:
Informed and to the point. Great post!
This article from NY Times adresses the value of emotional support from doctors:
Thanks for such an insightful post. I think the part about being there to explain and predict what happens is very critical to building trust with patients. In addition to this, knowing when to say, "I don't know" is a important way to build trust even though it somewhat violates the first rule, because then others know that despite seeming to have all the answers, you are smart enough to know when you don't have all the answers.
- Christian Sinclair