In contempt of a physician
Plaques adorn the walls of this palace
I was accompanied by a fair maiden
Winning the love of this fair maiden
In slow, warm showers did I feel the tinge
In rapid waves did the lack of feeling creep
In these duties as a provider I was failing
Oh, the wretched wind that stole my maiden!
I am attended in a hut on the forest’s edge
No one has written in the parchment scrolls
But hush! The king appears in his white robe
In gratitude to a stranger
In this room where the walls have arms,
Dear God! We imagine the worst as,
Should we touch him? Should we cry?
Suddenly, someone seems to be talking;
He tells us about Gramps’ operation
He says Gramps will be himself again
Gramps now hobbles to reach the post office
While being inundated with information on most things that are normal and abnormal about the human body, it is important to remember that we learn all this information to treat patients, not to treat diseases. Patients also present with an entire life history filled with hopes and achievements, failures, friends and frustrations. Disease is just one part of a patient’s life. Seasoned physicians will aver that they have blundered by not considering the circumstances of patients beyond their chief complaint or medical care. These same physicians will also attest that the outcome of the care they delivered was enhanced when they considered such circumstances.
I have come to learn that patients do not voluntarily visit a physician because something is wrong; they seek physicians because something has become dysfunctional in their lives, causing distress or an inability to achieve a goal. These could include their ability to play tennis, fear of dying, discomfort from pain or stress at hearing of a friend’s similar condition. It is thus important to elicit from patients how their condition fits into, or interferes with, other parts of their lives. In the spirit of Kleinman, it is worthwhile to ask during the history and physical exam, “How does this affect you?” As a burgeoning physician, always remember to wonder why patients actually come to the hospital as you work through the history and physical.
As the two poems above illustrate, this approach does not just involve patients, but also their loved ones. The stories patients tell are greatly varied and naturally build over the course of a physician-patient relationship. Patients take pleasure in telling them and being listened to. This affinity may make them more likely to become more engaged in whatever you have to say. The poems illustrate that patients can perceive this effort (or lack thereof) by a physician to know them as a person. When absent, they may withhold information, some of which may prove essential to treating them. When present, they will be grateful that you took the time to build rapport with them.