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I have taught medicine for over 60 years. I am now 90 years of age, so the interns and residents come to my retirement home on the second Tuesday of the month for dinner and a teaching session. We usually discuss the pathophysiology related to clinical conditions, but we occasionally discuss the current ethical problems related to medicine.
On one occasion, after reading 2 different stories about the unprofessional work of a few physicians, I pointed out that our profession needed Dr. Francis W. Peabody. The trainees had never heard of him, although he left indelible tracks for medical students, house officers, and practicing physicians to follow. I read to them the last part of the speech that Peabody gave to the medical students at Harvard on 21 October 1926:
Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.1
I said, “I do not have the temerity to add to those statements, but I will emphasize them by asking two questions. Is it important for patients to know that their doctor cares about them, and what do caring doctors do that indicates to their patients that they care about them?”
The 10 trainees nodded their heads, indicating that patients should know that their doctor cares about them.
I then asked, “Why should patients know that their doctor cares about them?”
They discussed the matter and concluded that when patients know that their doctor cares about them as a person, it helps create a bond of trust, which improves compliance. When compliance improves, the patient improves.
“The caring doctor studies all aspects of the patient’s case, but the patient does not know that. How do you show your patients that you care about them?”
One resident said that the doctor should smile, sit down, and use the patient’s name when speaking.
I said, “I agree. That’s a good start. No patient likes a gloomy doctor, and no doctor should see a patient without using the patient’s name. The reverse is also true—the patient should know the doctor’s name. The history-taking period is when the doctor not only obtains vital clinical information, but also has the opportunity to know the patient as a person—as a human being. This is also when patients begin to know their doctor as a person. It is during the history-taking period that patients decide if the doctor is a robot with no feeling or a caring individual.
“At times, it is useful to hold the patient’s hand, elbow, or shoulder. Older people, especially, are often frightened and feel rejected. They feel comforted when they are touched. They recognize the human touch as a signal of caring because machines don’t comfort people.”
“Talk with others who are in the patient’s room. Speaking with the spouse and children is a must.”
“The doctor who asks questions like an interrogating lawyer and pays little attention to a patient’s answers is doomed to being a poor diagnostician, because the patient’s medical history is often the doctor’s best diagnostic tool. Patients should know that the doctor cares about them as persons, after the history-taking period is over.”
The interns and residents said that doctors should listen to their patients and address all of their worries, including the non-medical ones. They insisted that the doctor should spend time explaining everything clearly and explain over again if the patient still does not understand the situation. They all indicated that a follow-up call is important.
I asked, “How do you know when the patient understands? I suggest that the doctor should explain his or her diagnosis and treatment and then ask the patient to repeat it. You must teach. Use a white board and black marker—draw pictures—teach and teach.”
I checked my watch. It was 8:15. We had been discussing the subject for more than 2 hours.
Accordingly, I later added the following:
“Never keep patients waiting for more than 10 minutes unless you explain to them why you are running late. Should you have an emergency, tell the patients who are scheduled to see you that you can’t see them on time. They will understand if you point out that you would go to them if they had an emergency.”
“Discuss whom the patient should call if you are not available. Introduce your back-up doctor to your patients. Point out that you might be attending a post-graduate course or be on vacation with your family. Assure your patients that during such times they will always be covered by the competent back-up physician.”
“If a patient has trouble while you are away, call him or her as soon as you return.”
“Hospitalized patients need special care. Go see the patient you admit as soon as possible—night or day. Go see the patient who is seriously ill and deteriorating—night and day. No drug or substitute doctor will be as effective as your presence.”
“Discuss the options in care with your patient. Learn to bring bad news to a patient with skill and empathy, including end-of-life discussions.”
“You, the doctor, should call a new patient the day after he or she has been seen in the office, in order to re-emphasize some of your previous discussion and to answer any questions.”
“You should call your patient when you receive any new information. Do not turn this action over to any other person.”
“The caring physician’s goal is to deliver the best medical care for as little cost as possible. Accordingly, the caring physician helps the patient and the system save money. The doctor should explain why an expensive, high-tech procedure is needed. Caring doctors do not over-test or over-treat their patients.”
“You must sense when patients want to consult another doctor. Help them do that. Remember, when your patient is not doing well, it might be smarter to call on another doctor than to order more procedures.”
“You should give your patients a copy of your work-up. They will especially appreciate a copy of your well-formulated Problem List that you keep up-to-date on them.”
“Finally, patients want to know their doctor as a person. Accordingly, all of a doctor’s actions should be colored by his or her personality. Every action and comment made by the doctor must be genuine. Doctors must not simply memorize their actions and comments like actors do when they act in a play. Remember, patients can identify the doctor who is not sincere.”
Dr. Peabody, the profession of medicine needs you.
(NOTE: Dr J.Hurst, author of this email, passed away in 2011)