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What’s His Name? Medical Training in the Age of Technology and Health Care Reform

2013; Lippincott Williams & Wilkins; Volume: 88; Issue: 5 Linguagem: Inglês

10.1097/acm.0b013e31828a6cce

1938-808X

Dhruv Khullar,

Primary Care and Health Outcomes

“What’s his name?” the attending asked, referring to the patient I was presenting during morning rounds. I froze. My pulse quickened, and I felt blood rushing to my face. I could recite his lab values to the nearest tenth. I had read and reread the results of his liver biopsy. I knew he recently underwent a “percutaneous transluminal coronary angioplasty”—18 syllables I had spent half an hour memorizing the night before. But the patient’s name, I did not know. And had the attending asked how living with hepatitis C was affecting his life or what his goals of treatment were, I wouldn’t have known the answers to those questions either. Surely, I could attribute much of my nervousness and ineptitude to my status as a third-year medical student. But that’s only part of the story. During my clinical rotations, I often was struck by how little of a young doctor’s day is spent with patients. We live in an age when taking a careful medical history means clicking away on a computer, and a complete physical examination includes an MRI and echocardiogram. We spend more time describing complex procedures, imaging, and tests than exploring our patients’ feelings about them. A central challenge for my generation of physicians will be maintaining close relationships with patients while harnessing the full power of a rapidly growing body of medical science and information technology. I cannot say that I have always risen to this challenge. Earlier in the year, during oncology clinic, Dr. Charles observed me in a follow-up visit with Ms. Johnson, a pleasant middle-aged woman scheduled to start her second round of chemotherapy. I checked my posture, wiped the coffee stain off my white coat, and plodded through an extensive list of questions. “Any nausea or vomiting?” “No.” “Recent weight loss?” “No.” I continued for a few minutes and checked the appropriate boxes. When I finally looked up, I saw Ms. Johnson in tears. Dr. Charles walked over and took her hand in both of his own. “How’ve you been, dear?” he asked gently. Between sobs she told him how thoroughly fatigued she was during her last round of chemotherapy, how she had trouble performing at work, how she could not enjoy time with her children. Now, her father had fallen ill, and she wanted some time to arrange his care before starting treatment again. Dr. Charles listened carefully, silently, thoughtfully. “Let’s go over our options,” he said. “There are always things we can do to make this work better for you.” Now I had tears in my eyes. Suddenly it no longer seemed to matter how straight I was standing or how clean my white coat was. I realized then that empathy was the ability to step completely outside oneself. It occurs in those moments when another’s worries become paramount to one’s own. Remembering Dr. Charles’ lesson, I returned to solve the mystery of my patient’s name. “Mr. Gorski,” he told me. “But call me Bernie.” During the next month, I got to know Bernie far beyond his liver disease. He told me about growing up in Poland and immigrating to the United States as a young man. Over the years, he had worked as a farmer, mechanic, engineer, and teacher. Perhaps most important, his mother made the world’s best pierogi. I looked forward to seeing Bernie each morning. With him, every day I stepped outside myself, and every evening—no matter how many hours I had worked—I felt energized. As my attending and I were leaving the room after discussing the possibility of transitioning to hospice care, Bernie shook my hand as firmly and confidently as he did that first day when he was still just a nameless man with hepatitis C. “Good luck,” he said. “And thanks for everything.” I smiled and thought how best to respond. You’re welcome? My pleasure? Anytime? “Thank you, Bernie.” In the midst of health care reform debates about individual mandates and death panels, I believe it is this fundamental human connection that is most in danger, and most in need of stewardship, moving forward. We must recognize that while empathy will never be reimbursed, its therapeutic value is priceless. Author’s Note: The names in this essay have been changed to protect the identities of the individuals.