A physician’s tribute to nurses [PODCAST]

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“At the hospital, the nurse is the one who is at the patient’s bedside around the clock. When the patient has to go to the bathroom or needs help to sit up in a chair, he or she calls the nurse. The nurse is the one who is changing the diapers for the elderly; she is the one cleaning the sputum and the spilled urine; she is the one holding the patient’s hand and stroking his hair while he is having a painful procedure done. She is the one arranging the flowers and picture frames in the room. She is the one administering the medications when the patient is in pain or nauseous. She is the foremost advocate for the patient. She is at the bedside when the patient is taking his last breath, and she is the one to call the doctor to pronounce him dead after having first witnessed and confirmed it herself.”

Farhan S. Imran is a hematology-oncology physician who blogs at Did I Ask?

He shares his story and discusses his KevinMD article, “A nurse is to a patient what a mother is to a child.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Farhan Imran. He is a hematology-oncology physician, and he wrote the KevinMD article “A nurse is to a patient what a mother is to a child.” Farhan, welcome back to the show.

Farhan S. Imran: Thank you, Kevin. Thanks. Good to be back as a guest at your broadcast.

Kevin Pho: We’ll get into your article in a little bit, but for those who didn’t listen to our first few episodes, can you just briefly share your story and journey to where you are today?

Farhan S. Imran: Sure. I’m originally from the northern part of Pakistan, and I went to medical school at Khyber Medical College. After that, I moved to the United States, and I’ve been in Rochester, New York. I did my training in hematology and oncology at Georgetown University, and then I’ve been practicing here in Rochester, New York, at the Lipson Cancer Center for several years. So that’s really my journey to where I am today.

Kevin Pho: So you had some of your medical training in Pakistan and some here in the United States. Tell me a little about that transition, and what are some of the big challenges that you face in coming over to the States?

Farhan S. Imran: So of course, that is a very loaded question. It could be a topic for a full podcast, but I would say that it is one of the best experiences for any professional. My dad was himself a physician, and he did part of his training in Pakistan and part in the United States, but then went back to Pakistan and had a very fulfilling career. I always wanted to become a very thorough professional, and we always knew that if you go to the United States, the training is the best, which it really is. I feel that we are trained very well, and it really feels nice to be working in such a cutting-edge environment where all the new research and all the new studies are coming from.

But that is never to minimize the work that people are doing in countries like Pakistan or other resource-limited countries, because I personally feel care providers, physicians, and nurses there are doing much more of a job than we are over here, because we have a lot of resources at our hands. Over there, you have to use your clinical expertise. You may have patients who may not have too much income or resources, and to help those masses within the limited resources is really what they are doing better than us. So it’s a pleasure to practice here or to practice there. You just need to love your profession and enjoy it wherever you are.

Kevin Pho: So for those other physicians who started their medical training abroad and then come into the United States for fellowship or residency, what kind of advice do you have for them based on your own experience?

Farhan S. Imran: So my advice to those physicians is to work hard and to follow your passion. There is great potential for a lot of fields in the United States, and so in medicine as well. One should not make it into an eventually repetitive, boring kind of job, but really try to find your interest and your niche. It could be anything. It could be related to a certain field of medicine, it could be medical humanities, it could be social work, and not really limit oneself to medicine only. The more people can work on their personalities outside of medicine, that will end up making them into better physicians as well.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote. It’s titled “A nurse is to a patient what a mother is to a child.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Farhan S. Imran: Yeah. So there are a lot of thoughts in my mind about the nursing profession, and this particular article, I wrote it around the time of Nurses Week, which was being celebrated across the world. It was my way, my tribute or my thoughts for the profession of nursing, as coming from a physician. When we were in medical school, you do get interaction with nurses at all stages of your career, but you really start having that exposure when you finish your medical school and when you actually start your residency. That’s where, for the first time, you see the actual work that a nurse does versus the work that a doctor does.

For the outside world, people who look at the profession of medicine from the outside, in their mind, always, in terms of, if you were to call it the hierarchy, the doctor comes first, because they probably make the bigger decisions, or for whatever reason. People will always talk about the doctor. So if you ask any patient, they will know who their doctor is. They’ll say, “My doctor is so-and-so.” But you will never hear anybody ask a patient, “Who is your nurse?” or “My nurse is so-and-so, and by the way, the doctor also sees me.” So I felt that the kind of work that the nurses are doing is so much more hands-on, and it is so, so important. Although nurses are given the recognition, still, doctors are given more recognition than the nurses. And in my mind, that is a little bit, nurses should be given more recognition than doctors.

So in my article, I approached this subject, and I compared what happens inside a house versus what happens inside a hospital, and that’s where I titled it, that if hospitals were households, nurses would be mothers and doctors would be fathers. Now, where that comes from is a little bit of my background at home, where I’m one of five brothers. My mom was a stay-at-home mom, and my dad was a doctor, and he would go out of the house and, sort of say, earn money, put bread on the table, but everything else was done by my mom.

Right now, with the way societies have changed in the West and across the world, the gender roles are blending, where a mom is also working and doing stuff at home, and the same thing, a dad is also going outside of the house and participating in household activities. But still, even if you look at America a few decades ago, as I speak with my colleagues here, there was this nuclear family where the mom stays at home and the dad goes out, and there was a lot of pride in that and there was a lot of recognition of that. But somehow I feel that the recognition of a stay-at-home mom has been lost, or it is being lost. So for example, if there is a working mom, which, by the way, is double the work of a stay-at-home mom, as a working mom you get degrees or diplomas or a paycheck, and you’re given all that recognition by the society. But a stay-at-home, her work is still invisible. If you look at a child, and if the child is very well dressed and well rested and has eaten well, and the house is in great order, nobody would really say anything about it. But if you see something not, that’s when you would point it out, that this is not done.

So I drew a parallel that in the hospital, although the doctor is coming in and the doctor is making the bigger decisions, he is spending, what, like 10 or 15 minutes with the patient. But a nurse is by the bedside and is doing all the hands-on care. She’s the one delivering medications. She’s the one taking care of the emotional aspect of the patient. Nurses are doing more and more procedures. They’re making more and more decisions. But still, most of the recognition is given to the doctors as opposed to the nurses. So I try to draw. Some people who have not lived in that kind of household, where they would see what a stay-at-home mom’s power is, they may not understand this parallel. But in my mind, I truly feel that a nurse is doing much more work for a patient than a doctor is. So this was the overall concept in this article.

Kevin Pho: In your world of hematology oncology, can you share a story, example, or case study of your interactions with nurses and how they affect how you care for patients?

Farhan S. Imran: So sometimes the inpatient setting is different than the outpatient setting, and one great story comes to my mind. I had a patient, I still have a patient, who had small cell cancer of the lungs, and I started her on treatments. She luckily did very well, and her disease was under very good control. She was a patient who drank alcohol heavily and was more of a loner, where she did not really want other people to come to her house. She would just stay at home, and that was her life, and she was happy and comfortable in that life. But still, she had not built long-term relationships with anyone in her life, and that’s why, when she was upset or when she was sad or crying or when she had any symptoms, she didn’t have anyone for her.

Now, what I would do is I would meet her at a follow-up appointment, and I would just tell her, “Hey, your scans are looking good, blood work is looking good, immunotherapy is going OK, and let’s just keep going.” I would talk to her a little bit about how things were at home, but that was the limit to which I went. But then the nurses detected that in the cancer center, and the next thing I learned, without anybody asking, the nurses actually started going to her house and really helping her with organizing her home, and just to spend time with her. They were sometimes taking turns, and they were not doing it because they were supposed to. They were not getting paid for it. They were doing it totally out of the goodness of their heart.

You could see the smile of that patient whenever she came back to the cancer center, which is a scary thing for many people. But for this woman, and this is just one story, many other women or men, they come to the cancer center literally feeling that they’re coming home, or to a friend’s house or someone’s house like that. So this is one example where nurses have, so to say, a maternal instinct. Even though, as much as I tried to, I had a role to play, and they would still give me the credit: “Oh, Dr. Imran has given you treatment, and she’s doing so good.” But I was telling them, “No, I just did what I learned in my residency. But you guys are the ones who are taking care of the actual patient. I just took care of the disease.”

Kevin Pho: We’re talking to Farhan Imran. He’s a hematology-oncology physician, and he wrote the KevinMD article “A nurse is to a patient what a mother is to a child.” Farhan, through your perspective as a hematology-oncology physician, what do you see are some of the specific challenges facing nurses today?

Farhan S. Imran: So nurses are being asked to do more and more, which they are doing as well. They’re very competent, they’re very capable. And other than that, probably, if I talk to some of the nurses, they may be overburdened with being assigned a lot of patients, which sometimes the hospitals can help it, but other times they may not be able to help it. But I’ve seen nurses having such great resilience. When our ERs are full, our hospitals are building these makeshift places for patients who are coming in, and with the COVID pandemic and everything, the way the nurses handled everything, I thought that this was amazing, and I can’t say enough good things about nurses.

And then one other quick thing that I would also want to say here, Kevin, is that if you look at the number of males versus females that would go into becoming doctors, if you look at the statistics from a few decades ago, it was a majority of males and just a few female doctors. And now, literally, if you look at a lot of statistics, it’s 50 percent: Half of the physicians are male and half of the physicians are female. But if you look at the profession of nursing, still, I would say less than 10 percent of nurses are male. Why? Why is that? Why aren’t males going into the nursing profession? You don’t hear about it. You don’t see it promoted. You don’t see it recognized.

So that is one other thing that I really wanted to bring through your broadcast, for some of my younger colleagues who are planning on becoming doctors or trying to be in the health care profession. They should not really focus on just becoming a physician or a surgeon. They should also try to look into becoming a nurse. I think that just like women over the decades have increased their numbers in becoming physicians, now men over the next few decades should participate in the nursing profession. In 20 years from now, it should be a 50-50 chance that when I’m getting admitted to the hospital with a heart attack or a stroke, I may get a male or a female nurse, and it should not be a surprise. That is another point.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Farhan S. Imran: For this one, really, the take-home message is not looking for some sort of an improvement or a correction or a solution. This is simply my expression of the magnificence of the profession of nursing. I just feel like, we always say the first rule that you learn when you become a doctor is, “Keep your nurses happy and your nurses will keep you happy.” Initially, you’re doing that just to maybe network or something, but as you spend years and years in this profession, you realize how important the profession of nursing is and how great of a work they do. Nurses in the U.S. and in the West are still respected a lot, but unfortunately, where I grew up, nurses did not have much respect, and the society does not look at the nurses the way they should. So I just want to make people aware that next time, whenever you’re thinking of thanking your doctor, please stop and thank your nurse first, and then turn to your doctor. That’s what my take-home message is.

Kevin Pho: Farhan, thank you so much again for coming back on the show and sharing your time and insight.

Farhan S. Imran: Thank you.

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