Unsung Heroes and Heroines
“But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest
in unvisited tombs.”
– George Eliot, Middlemarch
In the past, I have described incredible feats, extraordinary deeds, and exemplary lives lived by famous healers. We can learn from their behaviors—how some of these healers lived their lives can serve as a beacon of light to those of us who may strive to “reach the unreachable star.” However, history shows that most of humankind has been cared for by ordinary, local clinicians who are not in the spotlight.
These clinicians are today’s workhorses; like Maimonides, they suffer silently from sheer fatigue and exhaustion after seeing patients late into the night. Their acts of kindness, exceptional bedside manner, astute clinical skills, and compassion are typically given without public recognition, award, or honor.
These are the clinicians that most fascinate me because they are uncelebrated and represent what it means to be a healer. They do the right thing when no one is watching. They behave this way because they follow their own inner compass and chart their own course without celebration. This month’s guest commentary is dedicated to these ordinary men and women.
Human Imperfections
Each of the healers described in past editorials have high character. And while I have spent a great amount of time pointing out incredible examples of healers practicing their art, this is not to be confused with idol worship. In my research, I came across examples of human flaws found in many of those whom I have chosen to write about. Like us, they were not perfect people. While many of the healers previously described had weaknesses, this does not mean that we cannot learn from their successes.
The Primacy of the Trusted Healing Relationship
In a previous editorial discussing the contributions of Sir William Osler,1,2 Charles S. Bryan reminds us that a clinician needs to be both competent and compassionate. However, these admirable elements matter little if your patient doesn’t trust you. According to Richard Roberts, MD, JD, professor and past chair in the department of family medicine at the University of Wisconsin Medical School in Madison, few things are as important as the “primacy of a trusted healing relationship.”
To paraphrase Osler, “more important than knowing the disease is knowing the person with the disease.” Roberts further explains that our medical knowledge is often limited or suspect3 (or at least fairly easy to look up) and what is more important and more difficult is knowing the person (eg, values, beliefs, preferences, coping style, etc.) to make a judgment call on what is best for that unique person.
Roberts uses the following example: I may be the world's greatest cardiologist and prescribe exactly the right drug for your heart, but if the odds are less than 50% that you will ever take it correctly (or at all), then what good have I done you?
Care for the Patient
A home health nurse looks after 2 homebound patients and treats them like family. She doesn’t hesitate to get in the shower and bathe them. She takes them to their doctor’s appointments and asks questions on their behalf. She has taken them out to social venues on her own time because she knows how much it means to them. Once when off duty, she heard of a problem in one of the home of her patients and immediately went there even though she was ill. She obviously knows that “the secret in the care of the patient is to care for the patient.” Not only does she care for them, she cared for them.
The Gift of Time
My personal physician gives me the impression that he has all the time in the world for me. But it’s more than that—he does give me as much time as I need. My physician listens to me. I am also fortunate that my physician is exceptionally bright, evidence-based, and kind. He has both the competence and compassion Bryan writes about.
In my town, an infectious disease doctor is known as “the doctor’s doctor.” He is the go-to person when our hospital’s physicians find themselves with an infectious disease problem. For decades he has spent very long hours walking the wards serving doctors and patients alike. Often he is called in to evaluate a patient who may be suffering from an infectious disease, but who also needs someone to just sit down and take the time to do a thorough evaluation. He lives Osler’s admonition that we be thorough in our work.
I often remind medical students and residents of the importance of being thorough at our morning report; I too often hear of someone who has admitted a patient to the hospital for abdominal pain but failed to do a rectal exam. Osler once remarked, “The chief function of the consultant is to make a rectal examination that you have omitted.” My friend, the infectious disease consultant, knows this to be true. He is a true healer because of his extreme competence and compassion, and he recognizes the value of the gift of time he gives to each patient.
Muriel Petioni, a prominent Harlem physician, died a few years ago at the age of 97. She was one of the first African-American physicians to be given admitting privileges at Harlem Hospital, breaking a tradition that forced handing over their hospitalized patients to white physicians. She was known for taking care of the famous while never abandoning the health needs of the poor. The New York Times journalist Paul Vitello quoted her assessment of her own career:4 “I would give people as much time as they needed. If you had your heart and mind bursting and needed to talk to someone who was a physician, not bleeding in the body but bleeding in mind and soul, I would listen. I wasn’t brilliant. I wasn’t the best physician in the world, but I was nice enough to make people feel good.”
This is a motto that rings true today. Several of my colleagues rarely ever give the impression that they are watching the clock. (Although they often do run late!) The waiting room of our chairman is legendary for always being full of people willing to wait hours for a quick visit, with or without appointments. They each know that when he is with them, he attends to them, and they never feel rushed. These are examples of unsung heroes and heroines who are not only attendings—but healers.
Richard Colgan, MD, is a professor at the University of Maryland School of Medicine in Baltimore, MD, and the vice chair of medical student education and clinical operations in the Department of Family and Community Medicine. He is also the author of Advice to the Healer: On the Art of Caring by Springer.
References
1. Colgan R. Aequanimaty and Imperturbability. Consultant. 2013;53(9):626-627.
2. Colgan R. The Inspirational Teacher. Consultant. 2013;53(10):698-699.
3. Ioannidis JP. Why most published research findings are false. PLOS Med. 2005;2e124.
4. Vitello P. Muriel Petioni, 82, prominent Harlem physician, dies. NY Times. Dec 10, 2011. www.nytimes.com/2011/12/10/nyregion/muriel-petioni-prominent-harlem-physician-dies-at-97.html?_r=0. Accessed August 2014.