Something totally non-medical

Something totally non-medical

An editorial in The Journal of Family Practice (1), from thirty years ago, significantly impacted my career.

I had only been a physician for eleven years but was intermittently questioning my career choice in family medicine. I was being productive, by navigating as quickly as possible through most patient encounters but couldn’t envision “just this” for years to come.

In part of the editorial, George S. Poehlman MD advised, “always ask your patients about something that is totally non-medical before closing out the patient encounter. You will ensure that your life’s work is made up of more than simply treating disease. You will become an amateur anthropologist of whom people’s stories are bestowed. This is what makes men and women of medicine wise.”

I started to do just that, as well as briefly record (in a journal) part of an encounter, after most days of patient care, that was unique, uplifting, or humorous, such as the following:

·         Mr. M. is 60 years old. He played baseball in college, was a medic in the military, once fought Chuck Norris in a martial arts contest, and went on to become a nurse. He has also written several children’s books.

I saw tears welling up in his eyes.

“Are you alright?” I asked, “You’ve done some great things in your life.”

“You’re the first doctor, in about twenty years, who has asked me about what I did when I was younger, and thinner (he now weighs over 500 pounds). Most people, even health care professionals, look at me and assume I’ve always been this way. I haven’t been.”

(It felt like this time together would allow us to work successfully as a team moving forward, and it did.)

·         Mr. and Mrs. G. are proud of being “simple country folks.” They had thick southern accents and talked really s--l--o--w. I asked them about their children. Mrs. G. answered.

“My oldest son lives up north in Pennsylvania with his family. He’s a nuclear engineer. My oldest daughter lives just a few miles from here…she’s a nurse practitioner. My youngest daughter lives in the next town over with her family. She’s the chief of pharmacy at the regional hospital.”

(To be completely honest, I wasn’t expecting an answer such as this. It was awesome.)

·         I asked Mr. F. how he and his wife met. He said (while looking at his wife), “she thought I was wealthy because I dressed well and had a nice car. It wasn’t until after we were married that she found out my nickname, for years, had been “all show and no dough.”

Mr. and Mrs. F. are both in their 90’s.

(Seeing them laugh so heartily after 65 years of marriage was wonderful.)

·         Mr. S. has advanced dementia. Mrs. S. is a devoted caregiver and showed me many pictures of their children and extended family members. I thanked her and asked if there was anything else she wanted me to know about her husband (who could no longer communicate).

“I married my first husband at age 16 and we had 4 children in 5 years. He died unexpectedly from a brain hemorrhage soon after our last child was born. I didn’t know what I would do. Rob was a college professor. We fell in love and got married. The kids were all still so young. We’ve been married for 54 years, and he’s been a wonderful husband and father. We had a family celebration on our 45^th wedding anniversary and everyone wanted us to give a speech. Rob’s was short. He wanted to thank two people: my mother for giving birth to me and my first husband for being the biological father of his 4 amazing children. There was not a dry eye in the room that day.”

(There was not a dry eye in the room this day.)

·         Mr. K. is 69 years old and has metastatic lung cancer. His wife of 45 years was with him. She was originally from Sweden and had come over to the states for a vacation.  They met on the beach in Ft. Lauderdale, Florida. I asked Mr. K., “what pick-up line did you use?”

He replied, “man, I was so out of my league. She was, and still is, so beautiful. I never thought I would get to first base with her, much less hit a home run. But I didn’t need a pick-up line because I had a puppy and she loved dogs. I’m sure that’s the only reason she ever agreed to go out with me.”

(His wife shook her head yes and then we all laughed together.)

Occasionally, I would even cognitively reframe a less-than-optimal encounter by teasing out a portion that still highlighted something positive.

I transitioned home to my family each day in a much better frame of mind.

More than 50% of physicians experience burnout. Burnout is a reason cited by many who either significantly decrease their clinical exposure to patients or quit medicine altogether.

Simply asking a non-medical question didn’t add a significant amount of time to most encounters and brought an element of intimacy, and joy, into many patient encounters.

As a result, my resilience (to burnout) increased.

Re-reading journal entries, some of which are from years ago, brings me right back to our time together.

A one-page editorial significantly impacted my career.

I’ve shared it with many colleagues and medical trainees over the years.

Reference:

1.      Poehlman, G S, Dr. Poehlman’s Pearls, J Fam Pract. 1996 Oct;43(4):411.