Heroes Not Zombies

As I am about to enter my last week of 36 years of clinical practice, it’s probably inevitable that I find myself reflecting a bit.

One of the things I’ve been thinking about is what good I might have done as a doctor, and, for me, I don’t think of that in terms of “outcomes”. What I’ve been thinking about instead is what did patients find valuable about their contact with me? The answer to that question has been made clear by the letters, cards and verbal feedback I’ve been receiving over these last few weeks.

There are certain themes which recur again and again amongst the thanks and good wishes people have expressed. Five of the main themes are in those verbs in the title of this post.

Listening. This is what is mentioned more than anything else. I’m not at all surprised by that. I just love listening to people’s stories. Endlessly fascinating and always unique. I don’t really see how any doctor can practice good medicine without being an attentive, non-judgmental, active listener.

Understanding. I think its important not just that I understand a patient, but that in the process of the consultation, they not only feel understood, but they come to understand themselves better. Making a diagnosis is a form of understanding. Diagnosing a particular disease process is a useful part of understanding…..but it’s only a start. As Osler said

The good physician treats the disease; the great physician treats the patient who has the disease.

Supporting. Many patients thank me for my support. That support isn’t just compassionate emotional support, but it involves supporting people in their choices and decisions, and supporting the natural capacity for self-healing which every human has.

Advising. I don’t think patients come to see doctors just to be listened to, understood and supported. They come for advice. Advice in the form of information, diagnosis, help in making choices, and in the form of therapies. All therapies are, in one sense, a form of advice. If I prescribe a treatment, that treatment takes some information and energy into the person’s body, and their adaptive system responds….it changes the inner state.

Inspiring. This is the word which pleases me most, and which is most repeated by patients, colleagues and students. I just love that people feel inspired by me, and I hope that, through my writing and photography that I inspire many more people in the years ahead.

A few years back I wrote a post listing the three verbs based on light which I thought were at the core of my values – lighten, brighten and enlighten………still relevant now.