A focus on technical and scientific advances in patient care takes us ever farther from our role as healers.
Mary was my first ever patient. I’m calling her Mary, though in truth I don’t remember her name. She was 70 if a day, I barely 21, in the first month of my clinical clerkships, proud of myself in my still clean new white coat. She snoozed, an early afternoon snooze, in a sunny corner bed by a window in Dr. Barnaville’s female ward.
A decade or so earlier Mary had undergone an alcohol injection into her gasserian ganglion to alleviate trigeminal neuralgia, a procedure that left her with some facial anesthesia and eventual return of her pain. Significant worsening of this pain had led to a hospitalization to try some different medications. The resident told me to examine her cranial nerves.
Prior to entering the ward I sat on a hard wooden bench in the corridor carefully reading how to examine the cranial nerves in the pocket version of McLeod’s “Clinical Examination”. As bushy-tailed as my white coat was bright, I moved from Olfactory through to Hypoglossal, felt confident, and entered the door.
I could not have had a better first patient – a thin grey-haired widow woman whose metal bedside table held neither cards, flowers nor reading material – her loneliness and innate courtesy outmatched any discomfort and the transparent reality that I was a novice of novices. I introduced myself and asked if I could speak with her. She smiled and said “of course, luvv” as only a Dubliner says “luvv” and my first solo patient interaction began.
I asked a question; she answered and I listened well, both to match her courtesy and because I, knowing nothing, could only offer her my listening. I’m sure for her it was a way to while away a lonely hour, while I, some 30 years later, recall it well. I doubt I ever listened as well as when I had nothing else to offer in return.
An hour later found me back on the wooden bench. Reviewing my McLeod, I realized I’d left out at least 3 or 4 of the nerves and only partially examined another 2-3. No neurology prodigy, I. Yet I walked away as if carried on air, proud in a non-prideful way. I might have missed the nerves but I’d connected with Mary and she with me.
Thirty years, thousands of patients, countless clinic visits, hospital rounds and laboratory studies. A career dedicated to ever more refined layers of knowledge and technical expertise, to becoming an authority even amidst the experts in one’s own field, increasingly being asked to fix the unfixable, to travel and teach/preach.
Thirty years and a lot of distance from the way I felt after leaving Mary’s bedside that afternoon.
It’s as if the more you are asked to drill down to fix a piece of a piece of the patient, the more you draw on your highly developed technical or scientific expertise, the more distance you travel away from being a healer of a patient’s illness to being a technician fixing their disease.
For how many physicians is the practice of medicine dissatisfying because they are expected to function as glorified technicians, an expectation either acquired (especially by the younger) through imprinting in medical school or residency, or for those middle-aged or older an imposed set of expectations by a profoundly flawed system of care driven primarily by economic concerns?
I’ll be carrying this theme forward over the next several postings.