Medicine is filled with intricacies and subtleties about the human condition. Within these nuances, and embalmed with the science of the profession, lies the true art of medicine, a concept not hastily understood, nor easily defined. Although the practice of medicine continually changes in response to new biological understandings, novel technologies, and evolving cultural contexts, the ethical foundations of the clinical relationship between patients and physicians paradoxically remain constant. There are fundamental characteristics with respect to character, behavior, and responsibilities that are descriptive of and necessary to the role of healer and that underpin the notion of what has been defined as “physicianship.”
Teaching by example is one of the ways in which mentors impart wisdom to trainees in this regard; After all, physicianship is not acquired in textbooks or lecture halls. The traditional paradigm in medicine has been one where the transfer of knowledge stems from the elders to the young, where experienced physicians train apprentices to take on the challenges of the future. With the evolution of patient-centered care, the source of insight and knowledge, particularly with regards to the aptitudes of the physician as a healer, is increasingly found within the patient. The following encounter tells the tale of one of the biggest lessons I ever acquired in as a medical student, a lesson this particular mentor did not even know he conveyed.
It was a typical Tuesday afternoon in the family medicine clinic where I was assigned to see the last patient of the day, Mr. M. Without any expectations, I entered the examining room and introduced myself. Mr. M was a 78-year-old gentleman who upon initial inspection appeared quite healthy: he was in good physical condition, dressed very formally, was very courteous and exhibited a confidence about his mannerisms that was fairly inspiring for a man his age.
As I sat down, a frantic knock was heard at the door. After apologizing to Mr. M for the sudden interruption, I opened the door to find my supervisor looking agitated and in distress. In short, he informed me that another one of his patients had become acutely incapacitated and required his immediate assistance. This meant that the 30 minutes that I was to spend with Mr. M would likely become 60 minutes before I could review the case with the attending physician. With hesitation, I returned to the examining room and completed my duties as a clerk in the usual 30 minutes, a period in which I did most of the talking. Since his last visit a year prior, Mr. M had achieved his weight loss goal and had regained full range of motion on his previously injured knee.
Despite the good news, it soon became apparent that Mr. M was dissatisfied. However, I could tell that his dissatisfaction was neither with me nor with the interaction that we had just shared. Though to this day I cannot say why, I was almost certain that it had more to do with a greater dissatisfaction with his life. I sensed in his eyes a longstanding desire to express his fears and a craving to empty his emotional reservoir, which seemed to have been long ignored. It is not inconceivable that given the pace of modern medicine, no one had ever taken a minute to listen to what this man fully had to say. As I would soon find out, Mr. M was, in fact, a very lonely man. Instead of asking him to return to an empty waiting room, I decided that given the situation, I would pursue my meeting with him in the hopes of rendering our encounter therapeutic and not simply diagnostic. So I began. “What do you like to do for fun?” I asked him. Out of nothing, something remarkable evolved.
For the remainder of the hour, I remained absolutely quiet, and I let the patient take me with his conversation wherever his heart desired. I smiled. Uncontrollably, Mr. M spoke, yelled, cried and laughed, ridding himself of some of the pain he had carried for so many years. Slowly, he slid his hand into his pocket and retrieved the list of his prescriptions. He then stared intently into the ID card that hung from my white coat, and began to write my name on the same paper. He stared into my eyes, hugged me, leaving some of his tears on my coat, and politely asked:
“Can I add you to my list of medications?”
From a distance and through an abstract yet genuine and simple act, I was able to relieve suffering in a fellow human being. If I ever doubted what Physicianship was all about, Mr. M reinforced that lesson one last time, forever.
That day, I thanked God not for my voice, nor for my name, but for having blessed me with the ability to listen. I learned how simple it all was: just be there. With a strong conviction and desire to do well unto others: just be there. Our white coat is, more often than not, the safest, most powerful medication.
I am forever grateful to Mr. M, and to all of our patients whose wisdom is far greater than that of our books, our lecture halls, and our mentors.
Jacques Balayla is an obstetrics-gynecology physician.
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