Patients don’t care what you know until they know that you care

An excerpt from Pet Goats and Pap Smears.

I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me.

Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural resources from Oregon State University, but recently returned to OSU as a premedical student.

“Why did you decide to study medicine?” I ask.

“My grandma passed away in 2010. She had two doctors. One was amazing and listened to her as a person. The other treated her like a crackpot old lady and told her to take pills. I’m not saying she was an easy patient, but the difference in how she did after seeing each doctor was amazing. Her body did better on the days she saw the doctor who cared.”

“What a powerful story. Have you had an opportunity to work with patients?”

“I volunteer at a hospice and the free clinic. I really enjoy it.”

“You must meet a lot of wonderful doctors there.”

“Not really. Doctors are on automatic pilot as they try to navigate through a staggeringly high volume of patients. It’s so disheartening. And what’s worse, everyone I speak with says, ‘That’s just the way it is. It is too expensive, difficult, and risky to go into private practice anymore. You can’t be a solo doctor in this day and age.’ After meeting you, I know there is another way.”

“You haven’t worked with solo docs?”

“No. I haven’t met anyone else who has escaped our broken system to practice medicine as it should be practiced—on a personal and human level. I was worried that I was having childish delusions of grandeur by thinking I could actually practice medicine in such a way in today’s climate. I worried I’d go through med school and residency only to find that in the end there was no refuge from our inhumane health care system. But hearing you speak to the premeds the other night was so inspiring. It gave me goosebumps.”

“Maybe I should write a book to help premedical students. Do you mind if I include you?”

“Sure. I’m here because there are no tools or mentors to help me be the doctor I’d like to be. Several medical students have told me they haven’t found any real mentors either. I feel like we are just shoved out to sea in a rowboat with no oars.”

Mentorless Medical Students

I recall how lonely I felt as a medical student. “How sad. I thought medical education had improved since I was in school.”

“Pamela, the doctors are so busy. They run around scared. It seems we should never do anything for patients outside of the clinic, as we should be terrified that patients will sue the pants off us. That’s like saying don’t help anyone because they might be mean sometimes. That’s why I want to watch you with patients, Pamela. I want to learn how to be a real doctor who cares. You are creating a life raft for us. You survived and did not become a robot.”

Now students apprentice with me the same way I apprenticed with my dad. Today I announce, “This is Brooke. She’s a doctor-in-training. Do you mind if she sits here while I talk to you?”

Nobody ever says no.

Brooke and I spend the afternoon together. I never imagined our small community clinic would be so exciting. Brooke doesn’t follow me to the morgue, the addiction clinic, city jail, or state psychiatric hospital. My patients are not generally recovering heroin addicts, prison inmates, or suicidal schizophrenics. Our patients this afternoon are run-of-the-mill folks, compared to my dad’s patients. But evidently, for Brooke, watching a doctor who cares is exciting.

At the end of each appointment I ask the same question my dad asked his patients: “What words of wisdom do you have for this young doctor-in-training?” Patients give lots of advice:

Listen and never lose compassion for people; remember you are human; even doctors make mistakes; please be patient with yourself; look for health, not just disease; warm your hands; don’t be afraid to use your intuition; put down the pen, turn off the computer, and then put your hands on the patient and look, listen, feel, and smell, but never judge; look your patients in the eyes; take time to mentor young people because it makes you a better person and a better professional when you take time to share what you know; and the best way to learn is to teach.

The word “doctor” is derived from the Latin word docere, meaning to show or teach. Doctors are really teachers. But I learned a long time ago that patients don’t care what you know until they know that you care.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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