From the
PRESIDENT
JOHN L. ROBERTS, MD
GLMS President | [email protected]
THE CHARGE OF THE PHYSICIAN
“T
o 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, Ky. 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 ward 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 this
story. His 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 not, above all else, forget to console.
Dr. Roberts is a neonatologist with the
University of Louisville Physicians and the
Vice Dean for Graduate Medical Education
and Continuing Medical Education at the
University of Louisville School of Medicine. He
is married to Dr. Janet Smith, a cardiologist
with Norton Healthcare.
JULY 2016
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