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Physicianship Amongst Physicians-in-Training

Balayla, Jacques MD

doi: 10.1097/ACM.0b013e3182613f48
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Dr. Balayla is a first-year resident, Department of Obstetrics and Gynecology, University of Montreal, Quebec, Canada; e-mail: jacques.balayla@umontreal.ca.

As medical students, we are taught to consider the patient, not simply the diagnosis. This concept, known as physicianship, encourages us to validate and dignify the lives of our patients while empathically looking for pertinent clues and findings to diagnose their condition. Despite its inherent humanism, we often hesitate to practice physicianship because, in our clinical experiences, carrying on a conversation with a patient does not extend far beyond the science of his or her condition.

During medical school, an encounter with a patient, Mr. O, led me to realize that the distinction between science and physicianship is not always clear and that, in medicine, the two often overlap.

On an otherwise typical Tuesday afternoon in the clinic, I was assigned to see the last patient of the day, Mr. O. As usual, I entered the exam room and said hello. Mr. O was a 78-year-old gentleman who appeared quite healthy upon my initial exam. I spent the next 30 minutes completing my duties as a medical student—taking a history, checking his vital signs. During this time, I did most of the talking. I learned that, since his last visit, Mr. O had achieved his weight loss goal and had regained full range of motion in his previously injured knee.

Despite the good news, I recognized that Mr. O still was dissatisfied. I doubted that his dissatisfaction was with me or with our recent interaction. Instead, I sensed that he was looking for someone simply to listen to him. Was it possible that not one of his doctors had taken the time recently to listen to what he had to say if what he had to say wasn’t the answer to a question on his chart? Because I had extra time before my supervisor would be ready to review Mr. O’s case with me, I decided to spend that time with Mr. O in the hopes of remedying his apparent loneliness in addition to his physical ailments. I started with the question “What do you like to do for fun?” Out of nothing, something remarkable evolved.

For the next half hour, Mr. O did all of the talking. Uncontrollably, he spoke, yelled, cried, and laughed, ridding himself of some of the pain that he had carried for so many years. Slowly, he slid his hand into his pocket and retrieved the list of his prescriptions. He stared intently at the name tag that hung from my white coat and began to write my name on the same piece of paper. He hugged me and politely asked, “Can I add you to my list of medications?”

If I ever doubted the merits of physicianship, Mr. O reinforced them in a way that I will never forget. That day, I thanked God not for my voice or for my name but for having blessed me with the ability to listen. I learned how simple caring for patients could be—just be there to listen to them. As medical students, we may not be licensed to write prescriptions yet, but our white coats are, more often than not, the safest, most powerful medication that our patients need.

Author’s Note: The name in this essay has been changed to protect the identity of the patient.

© 2012 by the Association of American Medical Colleges