“Son.” I froze; with my limited JMS training, it was not too difficult to realize that when a patient addresses you as “son,” it is probably best to stop talking. I was in my fourth week of Family Medicine and had been mindlessly regurgitating our generic script on keys to lose weight. After weeks of 40-plus patients a day and a majority of them qualifying for weight loss advice, I felt as if I could handle this subject without attending supervision. Even without training I felt confident I could deliver wise counsel, because, after all, I work out every day, monitor my diet, and live in a family that does not tolerate fat. When I first arrived at Family Medicine, I did not mention weight unless the patient brought it up, but as my confidence grew, so did the unsolicited advice. “Ma’am, how’s your weight loss? Sir, how has your weight been lately?” Nine times out of 10, a frustrated sigh would escape the patient as they assured me they were losing weight but recently had suffered some setbacks. Some would enthusiastically declare weight loss success, but a brief review of the chart would normally curb their enthusiasm. I would try empathizing with the difficulty to lose weight, while reassuring them all was not lost. At this point the advice began…. It usually starts with the facts. A pound contains 3,500 calories. The best way to lose and keep off weight is to consistently drop one to two pounds a week. Therefore, reducing 500 calories a day via diet or exercise will result in losing one pound a week. Maintaining this reduction will result in losing 50 pounds in a year! Next came the strategies.
A brief glance at the chart: knee pain. A quick mental differential: acute/chronic injury, arthritis, gout, referred hip pain. A deep breath, a smile, a knock on the door. “Hello, Mr. Smith, my name is Andrew and I am a medical student working with Dr. Jones….” Immediately, putting all my JMS training to work, I made the diagnosis with a simple glance. This patient, without a doubt, was suffering from arthritic knee/degenerative joint disease secondary to morbid obesity. As I sat there, my mind began rehearsing my weight loss speech as he began describing in excruciating detail his knee pain. Does this man not realize that the best solution to his problem is not found in this office, but in his pantry? A pause; he must be done with his story.
“I was just wondering how your weight has been.”
“It’s been better.”
“Did you know that by cutting 500 calories a day you can lose a pound a week …”
He appeared to be listening intently as I discussed strategies. He had already cut out calorie drinks, and he claimed to eat well, so I decided to jump to exercise. Forty-five seconds into the benefits of swimming, I heard it, “Son.”
“I have lost and gained more weight than you weigh now. Do you not think I know how to lose weight?”
For the next three minutes, the only words that escaped my mouth were, “Sorry, sir.” I sank deeper and deeper into my chair of conceit as he told me how hard he had tried over the years to lose weight. He then asked me a penetrating question. Why have you not asked me about smoking? Alcohol abuse? Chest pain? Or did it not occur to you since you only see me as a fat person? While that was not entirely true, I realized I had in fact seen him as little more than an overweight man who needed to lose weight.
As I sat there I realized our roles had changed. Instead of being a health care provider, I was his pupil, learning not to rush to judgment but to see the whole patient with needs greater than those visible to the eye. With much emotion, the patient shared the pain he has experienced being viewed as little more than a fat person. He explained that losing weight became more and more difficult each time he failed a diet. Exercise was difficult because his degenerative joints do not support his weight without pain. He does not mind when his doctor tries to aid his weight loss, but he grows frustrated when he feels that the doctor cares about little else.
Later, after my attending came and went, I was left in the room with my patient. With tears in his eyes, he said he hoped I had learned something. He apologized for being harsh, but he reiterated what a difficult subject it is for him. As he stepped out the door, he looked back and, with renewed hope, said he was going to start the battle to lose weight once more. I watched him limp down the hall on a cane supported by three artificial joints and saw a hurting man. I saw a man who wished he could look into the mirror without being reminded of his failure. I also saw someone who went to the doctor for healing but, instead, found painful jabs of judgment. My eyes shifted down with shame, because I knew he was right. I judged him without considering his needs and struggles. I had neglected an opportunity to bestow encouragement and healing.
Should I ignore obesity as a problem in the future? By no means! Will I approach it differently? To fulfill my calling as a healer, I must. I must take into account all aspects of my patients’ health, and most of all I need to listen. I must hear the patients’ cries for help. I must affirm their victories and reassure them in defeat. With enough listening and gentle prodding, I have since learned that most patients will volunteer their physical needs, including weight. It is then that I partner with the patient and together seek the path of healing.
The Francis A. Velay Humanism in Medicine Essay Contest Presented by the Arnold P. Gold Foundation
The Arnold P. Gold Foundation is a not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of the compassionate physician. Today, students, residents, and faculty participate in at least one Gold Foundation program at 92% of our nation’s medical schools and at schools abroad. Its programs and projects are derived from the beliefs that compassion and respect are essential to the practice of medicine and enhance the healing process; the habits of humanistic care can and should be taught; and medical role-model and mentor practitioners who embody humanistic values deserve support and recognition.
In 1999, the Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest’s beginning, the foundation has received close to 2,000 essays from more than 110 schools of medicine and osteopathy.
Contestants for the 2008 Humanism in Medicine Essay Contest were asked to draw on real-life experiences to explain, “How patients teach their doctors about humanism in medicine.” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the seventh year in a row, Academic Medicine is pleased to publish the winning essays from the contest. The third-place essay by Andrew Lehn appears here.
Winning essays are also published on the foundation’s Web site (www.humanism-in-medicine.org) and in the foundation’s DOC newsletter. For further information, please call The Arnold P. Gold Foundation at (201) 567-7999 or e-mail: ([email protected]).