Tuesday, February 12, 2008

Letter #3

Dear Physician of the Future:

There's so much I want to tell you, so much that is so very important that you will only be able to learn on the job from other physicians and most importantly, from your patients. I don't envy your learning curve, and I don't envy the heavy responsibility you bear in the lives of others. But I greatly admire that you've chosen this path, and I wish you the very best in your career. What a privilege you hold to come alongside the sick and to be a partner in alleviating suffering.

I say partnership because medicine -- the actual donning of your white coat and meeting with another human being who is looking to you for help -- must be rooted in this notion of partnership. As I walk through my mother's last days with cancer, I feel grateful to those many who have communicated truth and kindness to her (from doctors to nurses to phlebotomists to those individuals who sign her in and type up her ubiquitous bracelets that allow her to receive chemo treatment), but those professionals who have listened, really listened, between-the-lines listened -- those people? They have quite literally saved her life. Instead of seeing an elderly woman who has quite frankly, a really crappy cancer (multiple myeloma, stage 3), they have seen a fighter, a mother and grandmother, a wife, a sister, a best friend. They have heard the woman who wanted more summers to spend at Lake Erie with her husband and who wanted to live long enough for her three young grandchildren to have her indelibly imprinted in their memories. They have seen a person with great humor and a wide range of ever-changing emotions -- from concrete hope to almost complete despair at times. And they have helped her navigate the minefield of those emotions, as she suffers through treatment that sometimes feels worse than the disease. Did she necessarily explain all of the above-mentioned situations in so many words? No, but the best physicians she has encountered, have chosen to respect her and to believe her and to partner with her.

You will learn that there is as much art as there is science in this gig.

The best doctors know that their patients are their best resources, and they don't resent a patient's desire for more knowledge. They welcome patients who scour the internet trying to learn, and they understand that some patients want less information. Please -- never have your hand on the doorknob when a patient is asking another question. Speaking from personal experience, please don't talk to my husband about hockey while I'm trying to explain the intricacies of how my thyroid symptoms have changed. You don't need to cite every horrible statistic (as my mom's first oncologist did) as to the many and horrific ways she could possibly die, but you need to be honest when she asks a specific question, because if she's asking, then she damn well wants to know the truth. Believe your patients -- oh God, how we want to be believed when we're sick. Maybe you have never seen our particular symptoms present in this particular way, but believe us, and you will learn from us.

I recommend joining the conversation as to what doctors and patients do for one another -- Dr. Jerome Grooopman's, The Anatomy of Hope, and Dr.Atul Gawande's books, Complications and Better, should have a part inside your very crowded, and I'm sure over-taxed, brain. Groopman's book, in particular, gives pitch perfect perspective on how to walk the tightrope of communicating truth alongside hope. After my mom was diagnosed three years ago (and given an incredibly poor prognosis, incredibly poorly delivered), I e-mailed Groopman to ask him about how to find hope amid hopelessness. He e-mailed me back within 45 minutes, not with some big secret key as to how to sustain hope, but with compassion and gentleness. 45 minutes. Be that kind of doctor.

In truth, you will fumble all of this many times, I'm sure. Because you, too, are only human. You can only do your best and like any of us, you don't get any do-overs. But if you let kindness guide you, if you remember that any particular patient is the most important person in the world to someone -- you will succeed far more than you fail. You will heal. You will give life where life might have seemed impossible. You will be a good doctor.

Thank you for your time.


1 comment:

Diana said...

Oh I'm SO glad someone mentioned both of those phenomenal authors. Those were two things on the top of my list for my own personal letter that I will get to soon, and I think they are so important! Kristie if you haven't read them I highly recommend them - Complications (A Surgeon's Notes on an Imperfect Science) especially, it's simply fascinating! Thanks for posting these - I love reading them!