Just before the holidays, I was treating a woman with severe pneumonia. As I examined her, day after day, she told me about her family, their plans for Thanksgiving, and how much she missed her children. I liked her. I cared about her. I even used the promise of free Wi-Fi to convince her teenage daughter to come see her.
The day before she went home, as I had done every day, we talked about her treatment plan. A couple of hours later, I got a page — this patient was angry because she said she hadn’t been seen by a doctor that day. In those days of caring for her, I introduced myself as her doctor, I mentioned being part of her team of doctors, and I was prescribing her different medicines. All of these indicators that I was a physician, and she had no idea who I was.
At that moment, I felt so defeated. I’m often mistaken for something other than a doctor because I am female, young, and black, but it was more than that. I was disappointed because I had committed a lot of time and energy to her care. I had assumed that this would lead to some interpersonal connection — that we’d stand together in her journey to get well. I wasn’t prepared for the hurt of being abandoned on that journey.
I became a doctor because I saw something beautiful in helping patients overcome the agony and isolation of illness. I spent years training to build bridges with my patients, to listen, and to be empathetic. Medical schools are increasingly recognizing the importance of being “humanistic” practitioners. And patients tell us they want these healing relationships with us. They don’t want unfeeling caregivers.
It’s National Physicians Week, a time when doctors around the country reflect on the art of medicine. I’m wondering how to cope with these feelings and not get burned out. The more I open my heart only to be rejected, the less I want to risk opening it up again. How do you not become uncaring? I expect this rejection to happen many times over the course of my career, but if I become self-protective, am I setting myself up for failure?
Doctors are supposed to be selfless. “Selfless acts lie at the center of the caregiver’s soul,” says Dr. Rajesh Panjabi, a Harvard Medical School instructor at Brigham and Women’s Hospital. But caregiving is emotionally complex and draining work. It’s becoming harder to ignore the entangled mix of anger, dismay, and purposelessness that takes me by surprise.
I asked a social work colleague how she dealt with this. “I do my best, but I always have to tell myself not to want it more than they want it,” she said about forming that bond with the patient. “When you want it more, you set yourself up for disappointment.”
But is fair for me to expect more from my patients when, in the doctor-patient dynamic, the balance of power usually tips in my favor? I know it’s not, because my patient comes first. That’s part of what Panjabi is talking about when he says we need to be selfless. So, I struggle with the idea of practicing humanistic, patient-centered medicine that requires me to stifle my humanity and to make myself small or even invisible.
While my patient with pneumonia was successfully treated, I couldn’t help but feel something between us had failed. I’m always looking to learn how to replicate the more positive, healing relationships I’ve had with patients, but its easier said than done. There’s no guidebook.
After his young wife, Laura, suddenly died, Peter DeMarco penned an open letter in the New York Times to the staff at my hospital who cared for her. I was on the neurological team that examined Peter’s wife in the ICU.
“Every single one of you treated Laura with such professionalism, and kindness, and dignity as she lay unconscious,” he said.
He described the heavy moments when we “deliver[ed] bad news with compassionate words, and sadness in [our] eyes.”
A resident recently told me that it was nice to be recognized, but Peter’s kind words just reminded her of all the other times patient’s families had screamed at her.
“I don’t really understand,” she said. “We always deliver the same care.”
I’m forming my identity as a physician, and I still have a lot to learn. Perhaps the art of medicine lies in this tortured ambiguity. And maybe with time and experience we stop struggling against it, and grow into its embrace. In the meantime, I’m still striving to be a humanistic doctor, and I’ll hope for the best — for both of us.
About the Author Reprints
Dr. Gruner; I understand the issue. For those physicians out there who truly care about the person they are attending to, and focus entirely on what they are doing AT THAT MOMENT, I have profound empathy for the pressure they are under and the accompanying stress comes with it. However, I have spent the last fifteen months researching the medical profession, the people who are engaged in every facet of that profession and the outcomes that are prevalent. Clearly a lot of good comes from people like yourself and others in your profession; but the fact is that there are an extraordinary number of your colleagues who do not hold the same values that you seem to embody. Because an enormous number of them have their minds on other cases, their private practice, their problems at home, the golf course, etc. They make — taken individually — tiny mistakes that don’t make sense and don’t have to happen; they do not report or acknowledge that mistake, so the result of the mistake grows and is exacerbated by another mistake by themselves or others caring for the human being who is the patient. Soon, a SERIES of errors has happened, without anyone saying anything, and the result is someone suffering serious harm or death. Then, to cap it off, some physician puts false information into the medical record of an affected patient, trying to ameliorate liability. I found this phenomenon initially because it happened to my wife and she died needlessly. That is what promulgated my investigations. I have now spoken with physicians, researchers, journalists and hundreds of ordinary human beings to which this same phenomenon has happened. If you think that no one acknowledges the many people who are helped by your profession, you should compare those percentages with the percentages of reported medical errors that are never reported. I have also researched my wife’s particular illness, lymphoma. Her case was botched from the start to the finish. Inappropriate biopsy for lymphoma, misdiagnosis, ineffective treatment, undiagnosed and untreated HAI from Teaching Hospital she was admitted to; then she was moved to a big-name Teaching Hospital, which discovered the infection, but made their own series of errors. Mainly ones of — astoundingly — logic in the process of problem solving; and errors in judgment regarding intubation in ICU, which resulted in death.
So, take your bows. You deserve them it sounds like. But move forward with clear eyes, Dr. Gruner; for a patient, your profession is like entering the Wild West. Please contemplate these observations as you move forward. Human beings make mistakes. We make them every day and docs are no different. But ADULT human beings take responsibility for their mistakes and learn from them, not duck their heads and hide them, and then lie about having committed one. That is the act of a child.
I work as a surgeon in a big city county hospital. I actually got out of private practice to do “pure” medicine there after 15 years. My advice is to keep doing what you are doing. I have found that as I treat people with respect and compassion, thousands and thousands over the years, most respond appropriately. There are always some who are off the bell curve and think of you as the enemy, someone you are not, or even belittle you as just a source of meds.
1) Keep at it. Normal patients gravitate towards compassion.
2) There are always outliers. Everywhere. In my practice it’s about 1/200 (?) will kind of mess with my day. But they affect me less and less emotionally as the years go by. I do good work. But not everyone clicks with me.
3) Bring humor into your practice. Sometimes it works just as well as compassion and they will never forget you.
4) As a fellow doctor with a baby-face: It gets better with age. I looked like I was twelve when I started. I felt like the patients were “carding” me when I walked in for a few years. (Are you old enough to operate?)
My grey hair and such are a positive. I look more the part now when I walk in the room and comments stopped.
The author doesn’t say whether she told the patient that she was indeed her doctor. It would have been better to clarify the situation on the spot than to lament later to strangers on the internet.
Yes, she did. She specifically states in the second paragraph that she had told the patient she was one of her doctors. I wonder how you managed to miss that.
Did you ever see the movie “Capote”, Dr. Okwerekwu? The oscar winning movie with Philip Seymour Hoffman? This column reminds me of one of the final scenes in that movie, where Truman Capote walks into a “holding room” where the two men who had murdered a family in Kansas were being held just before they were to be hanged. Capote stood there weeping and trying to explain how he had “done everything I could” to help them. He made one of those men’s final moments of life into an emotional issue for him. One of the men, Perry Smith, comforted Capote. He said, “it’s okay. I know you did.” So, the man who was about to be hanged was manipulated, once again, by Capote into being Capote’s sympathizer; his enabler.
This isn’t about you, doc. This is about people who are sick. Human beings who are sick, maybe dying, who have come to the medical profession for help. Whatever the reason you got into medicine, if you cannot make it about the patient, then you need to get out of medicine. Doctors wield enormous power over people who are sick. Doctors and hospitals kill over 1200 people a day, needlessly, from medical errors that were preventable. You know, the one’s that are referred to as “adverse events.” Those “events” are human beings.
Excuse me, Mr Pierce. You don’t seem to understand the issue. The article is about humanity. There are two types of empathy: The one which is taught in textbooks (just recently I again read on how to show ’empathy’, by putting my hand on my chin, frowning slightly whilst maintaining eye contact…). The other type is where I am a HUMAN being and see my patient as a HUMAN being. If I don’t look after my own feelings as doctor then there is no way I can show true empathy. My emotional well-being is just as important as the patient’s, without it I cannot do this very demanding job.
Regarding your stab at the ‘killer doctors’ – interesting that nobody ever mentions the number of patients whose lives are saved every day….
This is totally understandable – from both sides of view. Patients also can make mistakes, and the age, sex and race of the doctor can have contributed.
In the future, maybe we need to be more assertive in introducing ourselves: Hi, I am DOCTOR ……, I am a Family doctor, Lung specialist etc. And using nametags which clearly state the DR in front of the name…
I see a lot of intellectual contortions that several writers are going through in order to avoid the elephant in the room–race.
Donald Trump stated this about Ben Carson, the most accomplished neurosurgeon of our generation “He was a doctor, perhaps an OK doctor,” . Have the Trump supporters repudiated this and defended the qualifications of this Doc? Implicit bias is a powerful thing…