Thank you Dr Adam for your wonderful words. As a young doctor from Uganda I read your words and find them to be true. The connection you make with the patient , being proud and keeping tabs of your achievements and knowing your staff.
Thank you for these words and thank you for the symptoms to diagnose podcast which I have listened to repeatedly during commutes to work.
Great advice. Every patient gift I receive I hang up if it fits in my exam rooms. Even when a patient “quilled” my diploma as a gift to me. There is 10 lbs of hot glue on that thing. One word of advice is if a patient asks to do something nice with your diploma give them a copy.
Thanks for this reminder! It also illustrates that much of the therapeutic interaction between physician and patient is the actual (and ongoing) human interaction and caring shared. It seems reassuring that in this age of the dawn of AI, chatbots and algorithms will only accomplish so much. A big part of "healing" is in this ongoing human connection.
But nothing about health systems transformation? Systems thinking? Systems stewardship? Systems advocacy?
We are in an era when systems change is needed just as much as outstanding patient care and patient physician relationships. And we’re all part of the system.
Regarding "know your stuff", I've always maintained that one needs to know as much as one can, but have the wisdom to recognize when one doesn't know enough, and the humility to ask for help when needed. Some of the worst mistakes I've seen happened when someone should have asked for help.
Thanks for the beautiful post, Adam, and a timely reminder of what is at stake for physicians. i obviously loved this: "Someone once said that as we get older, more of our patients become friends and more of our friends become patients." As someone who has spent substantial time on both sides of the story, I see this to be such an insightful comment. Keep on inspiring!
I also have a Me File Too. 28 years in the ED with a locker full. One day in retirement I plan to look at it all. I have received far more blessings than I deserve. ❤️
My career was forged in the blast furnace of AIDS when it was actually called GRIDS.
I cared for numerous patients who initially walked into my office appearing healthy and concerned knowing that their CD4 of 26 meant that, in 18-24 months they would be dead, or wishing they were.
I also was told it was unethical to accept gifts but couldn’t turn them down because although I knew they could represent a psychological bargain for them, they really were showing their appreciation, and my worth to them. I still have 4x6 embroidered mural of Calabria given to me by a paisano.
42 years ago at the very start of my practice, when I actually had an office and a desk, I began a Me File too. It swelled to about 8 inches thick but I never looked in it until one grey cold Saturday afternoon 4 years or so after I retired from clinical IM/ID/Critical Care practice. Reading through it I could recall the people and the faces. It was a very moving experience.
When young people ask me why I went into Medicine I say truthfully it was an idea I had when I was very young and I just stuck with it.
No Resident, Fellow or Attending ever told me that the most satisfying and profound part of my practice would not be in the diagnoses, and successful therapies but, instead would be seeing patients as human beings who provided me the honor and privilege of being part of their lives.
Dr. Cifu, You and I are about the same age. I have been in residency education for 30 years, now as a Program Director in Family Medicine for the last 5 years in a semi-rural location in the SE US. Culturally, we are a far cry from Boston, but people are the same everywhere. Everything you wrote resonated with me as I have had the same experiences over these many years.
Despite being told not to accept the gifts of patients, I frequently wear a bracelet made for me by a patient who I have cared for with our residents since moving to this new location. Twenty years ago, an elderly lady whom I diagnosed with hyperthyroidism as the cause of her atrial fibrillation, which had disabled her knitting ability, brought me a hand-made blanket for my new home. She had asked me once ( I had not remembered) about the colors of my decor, creating a beautiful masterpiece which took her a year to complete. She and her daughter came to the clinic to present it to me near the end of her life (she died a few months later). I accepted it through tears and heartfelt thanks that any patient had cared enough for me to be so meticulous and thoughtful. Can anyone imagine turning down such a gift? Never. I would rather have gone to jail than perpetuate such an uncaring act.
We have far too many stupid and thoughtless "rules" to follow in medicine which have, in many ways, destroyed the doctor-patient relationship. I find myself frequently telling my residents to consider Direct Primary Care as a mechanism to take back control of patient care and those relationships rather than bow to insurance and other external forces that care little about outcomes other than profit margin.
Thank you for such a thoughtful piece of writing and exceptional advice.
Thank you for sharing this (again)! I've had so many bad experiences with doctors; what drew me to Sensible Medicine in the first place-and keeps me reading-was my search for some light in the dark. Pieces like this go in *my* sunshine folder.
What a beautiful essay. I am a psychologist, and in my class yesterday I reviewed an article about things that people who had lost a loved one find helpful or harmful. Your post reinforces the idea that being caring and thoughtful and skilled is an essential skill in medicine and in other helping professions. Well done.
Thank you Dr Adam for your wonderful words. As a young doctor from Uganda I read your words and find them to be true. The connection you make with the patient , being proud and keeping tabs of your achievements and knowing your staff.
Thank you for these words and thank you for the symptoms to diagnose podcast which I have listened to repeatedly during commutes to work.
I just started medical school. Will keep these in mind. Thanks much
Great advice. Every patient gift I receive I hang up if it fits in my exam rooms. Even when a patient “quilled” my diploma as a gift to me. There is 10 lbs of hot glue on that thing. One word of advice is if a patient asks to do something nice with your diploma give them a copy.
Thanks for this reminder! It also illustrates that much of the therapeutic interaction between physician and patient is the actual (and ongoing) human interaction and caring shared. It seems reassuring that in this age of the dawn of AI, chatbots and algorithms will only accomplish so much. A big part of "healing" is in this ongoing human connection.
Excellent essay. Thank you.
But nothing about health systems transformation? Systems thinking? Systems stewardship? Systems advocacy?
We are in an era when systems change is needed just as much as outstanding patient care and patient physician relationships. And we’re all part of the system.
Regarding "know your stuff", I've always maintained that one needs to know as much as one can, but have the wisdom to recognize when one doesn't know enough, and the humility to ask for help when needed. Some of the worst mistakes I've seen happened when someone should have asked for help.
Thanks for the beautiful post, Adam, and a timely reminder of what is at stake for physicians. i obviously loved this: "Someone once said that as we get older, more of our patients become friends and more of our friends become patients." As someone who has spent substantial time on both sides of the story, I see this to be such an insightful comment. Keep on inspiring!
That therapeutic alliance you mention, so much there and so much goes into it. Thank you for the inspiring thoughts.
I also have a Me File Too. 28 years in the ED with a locker full. One day in retirement I plan to look at it all. I have received far more blessings than I deserve. ❤️
These thoughts are just as valuable to those of us in physical sciences. Thank you, Adam.
Well done.
My career was forged in the blast furnace of AIDS when it was actually called GRIDS.
I cared for numerous patients who initially walked into my office appearing healthy and concerned knowing that their CD4 of 26 meant that, in 18-24 months they would be dead, or wishing they were.
I also was told it was unethical to accept gifts but couldn’t turn them down because although I knew they could represent a psychological bargain for them, they really were showing their appreciation, and my worth to them. I still have 4x6 embroidered mural of Calabria given to me by a paisano.
42 years ago at the very start of my practice, when I actually had an office and a desk, I began a Me File too. It swelled to about 8 inches thick but I never looked in it until one grey cold Saturday afternoon 4 years or so after I retired from clinical IM/ID/Critical Care practice. Reading through it I could recall the people and the faces. It was a very moving experience.
When young people ask me why I went into Medicine I say truthfully it was an idea I had when I was very young and I just stuck with it.
No Resident, Fellow or Attending ever told me that the most satisfying and profound part of my practice would not be in the diagnoses, and successful therapies but, instead would be seeing patients as human beings who provided me the honor and privilege of being part of their lives.
Thanks so much.
Love this post and especially advice #1. From the patient's perspective, there is true healing power in a physician showing they care.
As to number 3, I had an elderly colleague who used to say that the smiting shall continue, so take what solace you can when you can. Sound advice.
Dr. Cifu, You and I are about the same age. I have been in residency education for 30 years, now as a Program Director in Family Medicine for the last 5 years in a semi-rural location in the SE US. Culturally, we are a far cry from Boston, but people are the same everywhere. Everything you wrote resonated with me as I have had the same experiences over these many years.
Despite being told not to accept the gifts of patients, I frequently wear a bracelet made for me by a patient who I have cared for with our residents since moving to this new location. Twenty years ago, an elderly lady whom I diagnosed with hyperthyroidism as the cause of her atrial fibrillation, which had disabled her knitting ability, brought me a hand-made blanket for my new home. She had asked me once ( I had not remembered) about the colors of my decor, creating a beautiful masterpiece which took her a year to complete. She and her daughter came to the clinic to present it to me near the end of her life (she died a few months later). I accepted it through tears and heartfelt thanks that any patient had cared enough for me to be so meticulous and thoughtful. Can anyone imagine turning down such a gift? Never. I would rather have gone to jail than perpetuate such an uncaring act.
We have far too many stupid and thoughtless "rules" to follow in medicine which have, in many ways, destroyed the doctor-patient relationship. I find myself frequently telling my residents to consider Direct Primary Care as a mechanism to take back control of patient care and those relationships rather than bow to insurance and other external forces that care little about outcomes other than profit margin.
Thank you for such a thoughtful piece of writing and exceptional advice.
M. Shawn Morehead MD
Thank you so much for the note and for all you do.
Adam
Thank you for sharing this (again)! I've had so many bad experiences with doctors; what drew me to Sensible Medicine in the first place-and keeps me reading-was my search for some light in the dark. Pieces like this go in *my* sunshine folder.
What a beautiful essay. I am a psychologist, and in my class yesterday I reviewed an article about things that people who had lost a loved one find helpful or harmful. Your post reinforces the idea that being caring and thoughtful and skilled is an essential skill in medicine and in other helping professions. Well done.
Here is the article in case you or others are interested. https://www.researchgate.net/profile/Holly-Prigerson/publication/15397323_Complicated_grief_and_bereavement-related_depression_as_distinct_disorders_Preliminary_empirical_validation_in_elderly_bereaved_spouses/links/582cb9bd08ae102f072a134c/Complicated-grief-and-bereavement-related-depression-as-distinct-disorders-Preliminary-empirical-validation-in-elderly-bereaved-spouses.pdf
Thanks so much.
Adam