From the Department of Health and Human Services -
In 2024, Black/African Americans were more than three times as likely as the U.S. population overall to be diagnosed with HIV.
In 2024, Black/African American teens and young adults ages 13–24 were nearly four times as likely to have HIV as others their age nationwide.
In 2024, Black/African American children under age 12 were diagnosed with HIV five times as often as children nationwide.
In 2024, Black/African Americans ages 13 and older were more than three times as likely as the U.S. population to have AIDS.
In 2024, Black/African Americans ages 13 and older who had AIDS were more than three times as likely to die as people with AIDS nationwide.
This story reminds me that HIV/AIDS is an area where the racial disparities in US healthcare really stand out in the worst way. Not only has there been no meaningful progress in narrowing the gap in caring for HIV risk and HIV/AIDS in the black community, but we are actually losing ground.
This post was truly beautiful! As someone who is on the other side, pondering for hours what possibly to ask a physician that would resonate with me, this was said in such a perfect manner. But what advice would you give someone who has no idea if medicine is what they want to do? For most people its "this is what i've wanted to do since i was young" but was it really? How do you distinguish between genuinely wanting to pursue medicine and simply being drawn to the idea of it?
Thanks for this reflection. Wanting to pursue.....for the knowledge? being drawn to it.....for the position, the station in life? Neither are bad. Motivations can be different. I started out wanting and appreciating the knowledge. Then came the part about giving a damn, caring for and about the patient. The caring is vastly better when the knowledge is there.
I am now four years retired from an academic medical career. I would recommend two books for a college student considering a career in medicine. Anatomy of an Illness by Norman Cousins discusses his illness from a radically patient perspective. The Patient as Person by Paul Ramsey is another gem making some of the same points that Adam has so humanistically described.
One lesson from the Covid pandemic is that physicians have a responsibility to their patients and their profession to be prepared to challenge experts in new unprecedented events like a pandemic and then speak up!
Adam, I really enjoyed this. Thoughtful, personal, and full of wisdom that becomes more meaningful the longer one practices medicine.
After more than 30 years in medicine, a few things particularly resonated with me. One is the humility of recognizing that what we believe to be right today may eventually prove to be wrong. Another is that sometimes the most important thing we give a patient isn’t a diagnosis or treatment, but trust, time, and the sense that someone is genuinely there for them.
I would probably add two lessons of my own.
First, *primum non nocere*. Never lose sight of the fact that what we do has the potential to harm as well as help. Knowing when not to investigate, prescribe, intervene, or simply do more can require as much judgment as knowing when to act.
Second, medicine is as much an art as it is a science, and at times it is mostly an art. Evidence can guide us, but patients rarely arrive looking exactly like the populations in our studies or the cases in our textbooks. Listening, judgment, uncertainty, context, and knowing the person in front of you still matter enormously.
And I love the sunshine folder. It may sound a little sentimental early in one’s career. A few decades later, it makes perfect sense.
Wonderful piece. I hope medical students read it, but I suspect those of us who have been doing this for a while may appreciate it just as much.
So many small but emotionally generous gifts have left me a humbler physician. Sometimes it’s just, ‘thank you for listening to me’. I too am a believer in the sunshine folder.
I would absolutely argue we need to get as close as professionally possible to our patients. Yes, it’s extremely trying when things go bad (with or without fault), but nothing inspires me to pick apart a study or consider all treatment alternatives like putting a face (and a life) to a disease process.
I have some patients who are so poor, they pay me in vegetables and muscadine wine. And yet, I find myself as their last bastion of hope when their health is compromised. Those are the cases that remind me of the reason I got into this field.
BT was a pt admitted to the urology service for hematuria. He had Terminal / metastatic prostate cancer diagnosis, and he was a subject in a research protocol. On being called for internal medicine issues, I discovered that he and the family were more interested in qol and comfort and had never been properly instructed on palliative or hospice care options. We discussed the topic at length and to their satisfaction. He decided he wanted to be a DNR and go with comfort measures and be sent home on Hospice. This didn’t please the ones doing research and caused a problem for me, but to this day, I don’t regret it. The pt and family were very relieved and appreciative. We are the pts advocates first.
I had an EJ. He had taken an HIV test and had a CD4 count under 50 but refused ART. I met with him month after month, as he worked at a clinic on my schedule. Every month I tried a new approach but he was insistent. Finally he presented to hospital with cryptococcal meningitis and survived to start ART. As far as I know he is alive and well 15 years later.
From the Department of Health and Human Services -
In 2024, Black/African Americans were more than three times as likely as the U.S. population overall to be diagnosed with HIV.
In 2024, Black/African American teens and young adults ages 13–24 were nearly four times as likely to have HIV as others their age nationwide.
In 2024, Black/African American children under age 12 were diagnosed with HIV five times as often as children nationwide.
In 2024, Black/African Americans ages 13 and older were more than three times as likely as the U.S. population to have AIDS.
In 2024, Black/African Americans ages 13 and older who had AIDS were more than three times as likely to die as people with AIDS nationwide.
This story reminds me that HIV/AIDS is an area where the racial disparities in US healthcare really stand out in the worst way. Not only has there been no meaningful progress in narrowing the gap in caring for HIV risk and HIV/AIDS in the black community, but we are actually losing ground.
Thanks for your article. I, too, have kept letters and cards that I have been sent from patients and families. They are truly treasured.
This post was truly beautiful! As someone who is on the other side, pondering for hours what possibly to ask a physician that would resonate with me, this was said in such a perfect manner. But what advice would you give someone who has no idea if medicine is what they want to do? For most people its "this is what i've wanted to do since i was young" but was it really? How do you distinguish between genuinely wanting to pursue medicine and simply being drawn to the idea of it?
Thanks for this reflection. Wanting to pursue.....for the knowledge? being drawn to it.....for the position, the station in life? Neither are bad. Motivations can be different. I started out wanting and appreciating the knowledge. Then came the part about giving a damn, caring for and about the patient. The caring is vastly better when the knowledge is there.
Set aside your own agenda to meet a patient’s needs. Words of wisdom that few are able to hear.
As to #2-So much of medicine is presented as fact, when it started as opinion and sounded right and gained a life of its own.
Thank you for a thoughtful piece.
I am now four years retired from an academic medical career. I would recommend two books for a college student considering a career in medicine. Anatomy of an Illness by Norman Cousins discusses his illness from a radically patient perspective. The Patient as Person by Paul Ramsey is another gem making some of the same points that Adam has so humanistically described.
One lesson from the Covid pandemic is that physicians have a responsibility to their patients and their profession to be prepared to challenge experts in new unprecedented events like a pandemic and then speak up!
Excellent! So much here that resonates. Should be required reading for all medical school graduates. (And current doctors as well.)
Thanks, Paul!
Adam, I really enjoyed this. Thoughtful, personal, and full of wisdom that becomes more meaningful the longer one practices medicine.
After more than 30 years in medicine, a few things particularly resonated with me. One is the humility of recognizing that what we believe to be right today may eventually prove to be wrong. Another is that sometimes the most important thing we give a patient isn’t a diagnosis or treatment, but trust, time, and the sense that someone is genuinely there for them.
I would probably add two lessons of my own.
First, *primum non nocere*. Never lose sight of the fact that what we do has the potential to harm as well as help. Knowing when not to investigate, prescribe, intervene, or simply do more can require as much judgment as knowing when to act.
Second, medicine is as much an art as it is a science, and at times it is mostly an art. Evidence can guide us, but patients rarely arrive looking exactly like the populations in our studies or the cases in our textbooks. Listening, judgment, uncertainty, context, and knowing the person in front of you still matter enormously.
And I love the sunshine folder. It may sound a little sentimental early in one’s career. A few decades later, it makes perfect sense.
Wonderful piece. I hope medical students read it, but I suspect those of us who have been doing this for a while may appreciate it just as much.
Thanks so much, Vad.
Adam
I’ve been doing critical care for 20 years, and this was still a great advice for me. Thanks for a great column.
Excellent.
Loved it. I also made the mistake of not accepting "trivial' gifts. Never again.
Rookie mistake.
So many small but emotionally generous gifts have left me a humbler physician. Sometimes it’s just, ‘thank you for listening to me’. I too am a believer in the sunshine folder.
As a new intern, this is a very timely and great read, thank you Dr. Cifu. Would love to see a picture of the drawing if you can post it
Thanks Brock. I keep the picture private. Stop by next time you're in town!
Adam
Excellent - forwarded to my daughter who started medical school this week!
Amazing. Please wish her all the best from me.
I would absolutely argue we need to get as close as professionally possible to our patients. Yes, it’s extremely trying when things go bad (with or without fault), but nothing inspires me to pick apart a study or consider all treatment alternatives like putting a face (and a life) to a disease process.
I have some patients who are so poor, they pay me in vegetables and muscadine wine. And yet, I find myself as their last bastion of hope when their health is compromised. Those are the cases that remind me of the reason I got into this field.
Another way of saying footnote #6- “What do you call the person who graduates last in the medical school class?” Answer- “Doctor”
BT was a pt admitted to the urology service for hematuria. He had Terminal / metastatic prostate cancer diagnosis, and he was a subject in a research protocol. On being called for internal medicine issues, I discovered that he and the family were more interested in qol and comfort and had never been properly instructed on palliative or hospice care options. We discussed the topic at length and to their satisfaction. He decided he wanted to be a DNR and go with comfort measures and be sent home on Hospice. This didn’t please the ones doing research and caused a problem for me, but to this day, I don’t regret it. The pt and family were very relieved and appreciative. We are the pts advocates first.
I had an EJ. He had taken an HIV test and had a CD4 count under 50 but refused ART. I met with him month after month, as he worked at a clinic on my schedule. Every month I tried a new approach but he was insistent. Finally he presented to hospital with cryptococcal meningitis and survived to start ART. As far as I know he is alive and well 15 years later.