July 2016
The Charge of the Physician

"To diagnose, to prognose, to treat when and if necessary, but above all else, to console, that is the charge of the physician." 

These words were spoken to me by Dr. Billy F. Andrews many years ago when I was a junior medical student. These words have remained with me ever since and I use them in each lecture I give junior medical students today.
Last month I attended the opening session of the AMA House of Delegates and listened to Dr. Steve Stack give his final address to the House. In that address Steve told a story of an experience he had a few weeks before. He was pulling an overnight shift in an ER in Lexington, Kentucky. Around midnight an elderly man was brought to the ER by his daughter. The man was vomiting blood and a high resolution CT showed ischemic bowel, a death knell for a man in his 70s. After hours of work by Steve and his nurses the man was stabilized and sent to the ICU. Steve told the daughter that her father would probably not survive. He spent time trying to console her even though the patients were stacking up in the ER. Two days later the man had survived, "miraculously" in Steve's words, and Steve went to the wards to visit the man before he was to be discharged home. At the AMA meeting, in front of the entire AMA House of Delegates, Steve, the president of the AMA, was near tears while telling of this story. The compassion for his patient and his patient's daughter was still there weeks after the event.
Later that evening I was having dinner at a local restaurant and a young couple from Minnesota, Ann and Bob, and their young three daughters, sat down at the table next to me. Well, the adults sat down. The kids continued to jump, crawl, and explore around the tables, as young kids naturally do. As a pediatrician it was easy for me to start up a conversation with these young parents. In my mind's eye I was reliving the joys and challenges my wife and I experienced raising our five kids. Bob asked me what I did for a living and I told them I was a physician. As the conversation evolved I learned that Anne's brother had died from leukemia earlier in the year after a brief, fulminant course. I asked Bob how his brother-in-law's care was in the hospital. He said they did everything they could, but he didn't make it.             

"How was the care you got from the doctors?" I asked.

"We didn't care for most of the doctors."   He told a story of one of the specialists on morning rounds, after saying that his brother-in-law wasn't going to make it, looked at his watch and said, "I don't have time to talk with you about it now."

Bob said they saw lots of doctors during the hospitalization but, "You got the feeling the doctors don't talk to each other."
"There was one doctor we sort of liked because he always gave us some hope. He said that my brother-in-law might be able to make it." I pointed out to Bob that in the end that doctor was wrong, your brother-in-law did not make it. It was the other doctors who were telling you the truth, yet you didn't like them. "Yes," he said, "but we always needed to hope."
Bob then offered, "The nurses were great by the way."

"Why were the nurses great?" I asked.

"They showed they cared, they showed their emotions about how sad the situation was, and some of them even came to the funeral home."
On the day I wrote this article there were 20 of our neighbors in the obituary section of the Courier Journal. I wondered, before their deaths, how many of their physicians had arrived at the correct diagnosis, gave the correct prognosis and prescribed the correct treatment. How many of those patients and their families felt consoled during the final days and weeks of the patient's life? How many of their physicians visited the funeral home?
"To diagnose, to prognose, to treat when and if necessary, but above all else, to console, that is the charge of the physician."  We have become enamored with the science of medicine, with our newest technologies and treatment modalities. We have become distracted by the external forces that complicate and frustrate our efforts to practice our profession. But, if we are to be successful as physicians, and true to our profession, we must, above all else, console.

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