Two Ears , One Mouth
Joseph Mikhael , MD , MEd , is a Professor in the Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute ( TGen ), an affiliate of City of Hope Cancer Center , and is Chief Medical Officer of the International Myeloma Foundation .
The content of the Editor ’ s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated .
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● I CONSIDER MYSELF blessed to come from a medical family . My parents were physicians who were sweethearts in medical school in Egypt . They had a rough road , with many years of training on four continents . They were incredible role models of resilience in the face of discrimination and patience in the midst of persecution , and they were determined to make a better life for their children . My brother , who is also a physician , and I owe them an incalculable debt .
My father started practicing medicine more than 50 years ago , and he had tremendous insight into the field , matched by his compassion for his patients . I can recall numerous times and ways he served as a role model physician to me , but I ’ d like to share two pieces of advice he gave me on the day I was accepted to medical school . I can still hear his words nearly 30 years on – and they ring true perhaps at no time more than the present .
In myeloma , where we seem to have a new drug approved every month , we would do well to use all the tools we have – including the ones conveniently attached to our faces .
“ Joey ,” he said ( and don ’ t even think of calling me that now ), “ First , treat nurses like the professionals they are .”
My father practiced medicine at a time when the team model of care was still being developed , but he had already realized the importance of respecting everyone on the health care team . Long before the concept of a “ multidisciplinary team ” and its subsequent iterations were commonplace , he had already embraced these ideas .
From his example , I knew his advice was not just empty words . As a child , I often had the privilege of accompanying my dad to the hospital on Saturday mornings when he did rounds . I saw him interact with nurses , pharmacists , physical therapists , and even the hospital janitors . He was the quintessential gentleman and genuinely wanted their input . A nurse took me aside one morning and told me that my dad was special – that he listened to the nurses ’ opinions , and that most other doctors didn ’ t .
My dad had a mixed academic and community practice , but he never believed in the hierarchical , “ lone ranger ” model of the doctor at the top of the team . It was not just the structure of the team that mattered to him ; the attitude was equally important . He was completely committed to the team concept and it served him , his patients , and indeed his colleagues well .
Dad wasn ’ t done with his words of wisdom . “ Second ,” he said , “ God made you with two ears and one mouth for a reason . Listen to your patients more than you talk .”
This anatomical lesson is equally pertinent . To be clear , he was a urologist – respectfully , I am not too sure how wellknown they are for listening ( can they even hear down there ?) – but nonetheless he treated the physician-patient relationship as sacred .
This was long before the notion of active listening had permeated medicine . With all the time pressures of medicine today , further exacerbated by the COVID-19 pandemic and the challenges of telemedicine , we need to take time to listen to our patients . Sometimes we can literally “ mute ” our patients and not hear them , perhaps because we have predetermined what we think they have or need .
We all understand the value of communication with the patient , yet so often our behavior does not fully reflect it . One of the most important studies in this arena was conducted by Ethan Basch , MD , MSc , and colleagues at Memorial Sloan Kettering Cancer Center in 2016 . 1 Patients with solid tumors were randomized either to receive an iPad to report ongoing symptoms or to the standard symptom-monitoring method ( the patient calls and leaves a message and someone eventually calls them back ). The intent was to find ways to enhance communication to improve patients ’ quality of life . Not only did symptom self-reporting with the tablet improve health-related quality of life , it also was associated with prolonged survival .
In my field of myeloma , where we seem to have a new drug approved every month , we would do well to use all the tools we have – including the ones conveniently attached to our faces .
I miss my father every day . It has been nearly 10 years since cancer claimed his life . He may be gone , but his progressive advice has profoundly affected me and my daily practice . In an age of technology and social distancing , his sage words remind us of the value of the humanity in medicine and the need for a cohesive team to serve our patients .
Joseph Mikhael , MD , MEd
Associate Editor
Reference 1 . Basch E , Deal AM , Kris MG , et al . Symptom monitoring with patient-reported outcomes during routine cancer treatment : a randomized controlled trial . J Clin Oncol . 2016 ; 34:557-565 .
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10 ASH Clinical News November 2020