Dr. Gottlieb:
I recently read your article, “Medicine’s malady: Too much of the caring is for money.” I am a senior medical student. I agree with many of the points you wrote about, and your diagnosis (“The people who care about money have too much power… . The people who care about people don’t have enough.”) What kinds of changes can be directly initiated by physicians? With an opportunity to truly influence the medical care of my future patients, I am anxious to make the best difference I can.
-Wayne
I’ll bet most of the people who just read your letter are thinking: “Boy, I wish my doctor thought like that.” Most people want a doctor who cares. You care.
The majority of medical training is devoted to teaching state-of-the-science diagnostic and therapeutic techniques. And although many medical schools are now teaching the value of compassion, very few teach you to honor your ignorance. Instead, most students are acculturated to hide their ignorance.
If you can respect and honor what you don’t know, you will approach your patients with a sense of humility and respect. You will be able to think beyond the technical skills you have learned. You will listen differently. When you approach someone from a position of ignorance or awe, you will hear his story rather than his “chief complaint” or “history of present illness.” Ignorance is not shameful. It opens the door to learning and may well open the door to healing.
When you take the Hippocratic oath, you will say the words: “In purity and holiness I will guard my life and my art.”
What you practice is an art as much as a science. You must not allow what you do to turn into dispassionate science. Guard the art – the caring and compassion, the holiness of one human offering care to another, of being invited into the life of another who is vulnerable and frightened. Understand these things when you walk into a patient’s room. Experience the honor and the humility. And please don’t forget that the doctor is ultimately a servant.
Which gets us to the rest of the oath: You are also responsible to guard your life with purity and holiness. Don’t sell your soul to the great forces out there. There are lawyers who will make you frightened, government regulations that will threaten you, offers that will entice you. But you owe it to yourself, your practice, and anyone who loves you to guard your life and your integrity.
As part of the process, you must take care of yourself. Eat well, sleep enough, take time off, find time to sit and breathe. Care for your body and mind as though you were your most vulnerable patient.
If I am your patient, before you enter my room, take a few seconds and look inside. Try to switch gears from what you were just doing and be aware of how you feel in this moment. It almost doesn’t matter what you feel; what matters is that you are aware of it. Otherwise, you are burying feelings, which is unhealthy, and I am at risk of getting some of the fallout.
When you approach me, touch me in a nonclinical way. Put your hand on my shoulder and look in my eyes. While you are taking my history, don’t just ask about my illness, ask about my life. Let me tell you about who I am, what I have left on the outside, and what it is like to be on the inside. Then I will know that you care about me, not just my symptoms.
As far as treating me is concerned, look at some of the literature on nontechnical treatments and you will see what eye contact, physical touch and genuine compassion do to the immune system. Also, if you can recognize and respect how much you don’t know, you can be open to things like meditation, massage, acupuncture and prayer.
If I am your patient, it is critical that I have access to you. My calls must be returned, and if I need to speak with you personally, then good doctoring means speaking with me. I recently went through a severe medical crisis, and I spoke with my doctor on the telephone every day. Simply having access to someone who cares was the single factor that protected me from despair.
Finally, think about why you are doing what you are doing. Are you about preserving life or postponing death? If you are preserving life, understand what life means for the person you are treating. If you are postponing death, please understand why. If I am your patient and you are postponing my death, is it for your sake or mine? I once heard a resident say: “The patient will not die on my watch.” Clearly, he was postponing death for his sake.
If I am your patient as my life trickles away, I don’t want you to fight for my life, nor do I want you to avoid your anxiety and “refer” me to the palliative care department. What I want is for you to become death’s midwife. Don’t worry if you are afraid of death. If you sit with me as I die, I will teach you. That would be a great parting gift to both of us.
Then in purity and holiness, you will be guiding your life and your art.
I realize I did not address your concern about changing medicine and society. You can change medicine and society by teaching. Teaching through role modeling. Gandhi once said: “You must be the change you want to see in the world.”
drdangottlieb1946@gmail.com