Sid Schwab: No more and no less a human being than my patients

There’s an old joke about a guy waiting in line at the Pearly Gates, slowing working his way forward to sign in with St. Peter. Wearing a white coat, carrying a black bag and with a stethoscope slung around his neck, a man walks past those in line and is waved right into Heaven. “Hey, what’s up with that?” asks the guy in line. “How come that person gets to cut in?” “Oh, he’s not cutting,” says St. Peter. “That’s God. He just likes to play doctor sometimes.”

To many, the stereotypical doctor – especially a surgeon, of which subspecies I am a member – is arrogant, god-playing, a talker-down. And whereas I know many docs who break that mold, the concept contains a dose of truth. When I’ve touched on the subject on my own blog, some comments I’ve gotten from patients, about their doctors, are downright embarrassing. In the matter of connecting with people, my profession has a long way to go.

I really can’t figure it out. At what point do some of us go wrong? Conventional wisdom to the contrary, I’ve always felt that people choose medical school for the most altruistic of reasons. (The admissions dean of my medical school used to have a favorite follow-up to the usual response to the standard question, “Why do you want to be a doctor?” “Because I like people,” is the archetypal answer. “Yes,” he’d say. “But do you like SICK people?”) Somewhere, between those idealistic and innocent days, and a few years in practice, lots of doctors forget who the hell they are. Yes, it’s hard work. There are frustrations, and they mount up. To make ends meet, we have to spend less time with, and see more, patients. But none of it excuses losing our humanity, our empathy.

Far be it from me to toot my own horn. Far be it from you to believe me sight unseen. But I’m saying I didn’t lose those things. In fact I was always amazed that people let me do the things to them that I was allowed to do: cut them open, rearrange or remove pieces they came into the room with. When I called the operating room in the middle of the night to announce an emergency case, I half expected someone to ask me if my mother knew what I was doing, even into my sixth decade! I am ““ I remained acutely aware ““ no more and no less a human being than my patients. I’ve learned some things they didn’t; but it’s not some sort of transcendent gift.

When my dad was in his final hospitalization, a group of internists-in-training and a student came into his room. Ignoring my mom entirely, and barely addressing my dad, they thumped him a couple of times, eared his lungs, talked among themselves, and exited the room. Righteously indignant, I followed them out. Addressing the student, my back to the others, I told him he’d just seen a perfect example of how NOT to treat a patient and his family. Me. A surgeon! Telling medical docs how to behave humanely.

For me (I’m telling you) it wasn’t artifice: I simply felt an obligation and a desire to treat patients the way I’d want to be treated; I considered myself not different from them. I sat down. I faced them. I explained things in conversational terms, drew diagrams, solicited questions. Without absolute proof, I’m convinced a patient who is satisfied with and confident in his/her doctor is likely to do better than one who isn’t.

So my message to my fellow physicians is simple: you have special knowledge but you’re not special. If you don’t have natural empathy, fake it! It’s not just right: it’s therapeutic.

Sid Schwab is a retired surgeon and author of Cutting Remarks: Insights and Recollections of a Surgeon.

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  • rlbates

    I agree with you Sid. I know I am not perfect, but I try to treat them as you say “the way I would want to be treated” or “like they were my family”. I won’t say it is always easy, so people are difficult to like [so is my family at times :) ] but I try.

  • Anonymous

    Myabe sid “The internist who operates” schwab, needs to take his own advice.

  • The Happy Hospitalist

    I couldn’t agree more. I think Sid and I would get along very well.

  • Anonymous

    Thanks for posting the nice essay.

    Can’t say I’ve encountered any doctors who weren’t at least civil — most have been very nice.

    Now, if you can teach humanity to health care administrators and risk management lawyers…then we’d have something to talk about!

  • Sid Schwab

    anonymous 10:29: non-sequitur much?

  • Texas Reader

    Everything that I’ve read on Sid’s blog has given me a good feeling about him as a person and a doctor. I’m glad I ran across this on your blog, Kevin.

    All my regular doctors are warm, compassionate people but when I was hospitalized in December with pneumonia the pulmonary doc was a jerk. He came in to my room on day two, when we didn’t know that the pneumonia in one lung had spread to the other and I had an as-yet undiagnosed electrolyte imbalance. He looked at me and said “if you don’t get out of that bed you’re not going to get better.” I was too sick to be angry, but 8 days later when I was discharged the memory of it made me irate.

  • Toni Brayer MD

    Very nicely written, Dr. Sid. You clearly “get it” and understand that healing is all about diligence, kindness, attentiveness and competence. All are required.

  • TBTAM

    Nice post, Sid. I think a lot of the impersonal nature of physician interactions stems from our need for speed due to the overwhelming burdens and demands on our mtime in a given day. I don’t think it’s arrogance or deliberate.

    I have learned over the years that if I start an interaction with a patient by imagining I am on their side of the conversation, I immediately slow down and become a better dcotor. But it takes daily concentrated effort, each time I pick up the phone or grab a chart -to stop for just a split second, put myself in the patient’ shoes, and then start. I’m not always so good at it, and I often forget. Thanks for reminding me today.