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'I'm already in so much pain, I was stuck in the car for hours, and now I have to see a student instead of my doctor?' She scoffs, crosses her arms, and looks away. Trying to understand why she is in so much pain I ask, 'Are you happy with the care you're receiving?' She looks at me for the first time and I see her shoulders drop. The response that followed is one I will never forget, and is part of a larger lesson I learned involving the power of open-ended questions and their ability to foster understanding of patients in the context of their life stories. Here, I share patient stories and the 7 words that taught me the gift of genuine curiosity. Key words: patient-centered care; personal narrative; narrative medicine; physician-patient relations; primary health care; medical education, PART I While in a mobile care van looking for anyone who might need help, we find a man sitting in a wheelchair trying and failing to light a cigarette [...]

Many years have passed since I visited Donny in the hospital, where he was admitted with a newly diagnosed and terminal lung cancer. Despite years of separation, his wife Rose took him back into her home and cared for Donny at the end of his life. In the months after his death, I learned more about their relationship; Donny's drinking and infidelities, the emotional and verbal abuse that Rose put up with. At the end of one office visit, I was incredulous in silent amazement and asked her, 'Why did you do it?' Rose looked at me and simply said, 'Because he was one of us; because he was family.' As she repeated this, I saw the face of God gazing at me. Well before caring for Donny and Rose, a spiritual director encouraged me to work on describing my image of God. It was an arid time and place on my interior journey and the activity felt forced and inauthentic. Although Rose died more than 5 years ago, I still think of her and reflect on my life as a physician practicing in the shadow of the COVID-19 pandemic. As she looks at me, my uncertainties scatter and her image draws down and stirs divine wellsprings in me. Key words: patient-practitioner relationship; end of life care; caregiver, Many years have passed since I visited Donny and his wife Rose (not their real names) in the hospital. Donny was admitted with a pleural effusion that was due to [...]

Continuity of care has long held a hallowed place in the halls of family medicine. Indeed, it is one of the 4 pillars of an ideal family practice, along with first contact, comprehensive, and coordinated care. But what does it mean to the patient, the doctor, and our sense of identity and purpose? And why, in recent years, has it receded from the discourse of family medicine values? This author suggests that continuity is an expression of the value we place on human relationships, a contract of sorts with the people we care for both inside and outside the office. Such relationships are not lightly discarded, for they serve us best in the long haul when our own sense of identity and purpose is tested and worn. Key words: continuity of care; relationship; residency training, 'I find my thoughts drifting to the Sabbath, the day of rest ... when one can feel that one's work is done, and one may in good conscience, rest.'--Oliver Sacks [...]

The story depicts my close relationship with Mr Schwartz, an elderly Holocaust survivor, spanning over 20 years. During those years, he became a significant patient to me; during my many home visits, we often shared significant conversations about life. When Mr Schwartz was diagnosed at age 90 with advanced cancer, we made an alliance whereby I would represent him in his decision not to receive medical interventions. For the next 4 years until his death, Mr Schwartz pleaded with me to kill him, which I could not do either legally or morally. Over the years; I was moved by his honesty, frustrated at my inability to offer him relief or a sense of meaning, and pensive, as I would inevitably reflect on existential issues pertaining to myself and my dear ones. Mourning his loss was complex, for I was very close to him, yet not a part of his family. With whom can we physicians share our sadness at the loss of a person with whom we never actually spent a holiday or family dinner? Key words: physician narrative; doctor-patient relationship; advance care planning; palliative care, For 20 years, before every holiday, I would receive a phone call from my longtime patient Mr Schwartz, exclaiming in a heavy Hungarian accent, 'Happy holiday, Dr Kannai!' Years before [...]

When the immediate threat of COVID-19 subsides, the future of health care will involve more virtual care. Before the pandemic, patient choice rather than clinician guidance determined which medium (telephone visits, video visits, electronic messaging) was used to receive care. Two media synchronicity theory principles--conveyance and convergence-can create a framework for determining how to choose the right medium of care for the patient. The author describes how it changed their practice and decision making with a patient story that required the use of multiple virtual care options. Key words: telemedicine; judgement; office visits; primary health care, In my integrated health system, patients can connect with clinicians through multiple virtual care options. In my mind, however, these options were all complementary to the traditional office visit. Until [...]

On a humid, 92-degree June day in southern Maine, my medical office is steamy. The air conditioning has broken. When I tell my staff that we need to close until [...]

The author, a psychologist who has been specializing in end-of-life issues for over a decade, uses the death of his fiancee (Becky),following the withdrawal of a ventilator and the refusal to place her back on the machine, to discuss research and analysis of end-of-life care in the United States. After briefly discussing his own background, Becky's history, and their relationship, he details Becky's last weeks of life and the first weeks of his grieving process. This story provides a background for discussing end-of-life issues including what constitutes a 'good death,' concerns about aggressive treatment and the cost of care near the end of life, prognosis, advance directives, and demographic issues. There is also a major section on psychosocial issues that arise when a person is dying. The author concludes with a set of 'lessons learned' as a result of his relationship with Becky and going through the dying process with her and her family.

One physician attributes much of her knowledge about patients to experience rather than lectures, books or continuing education. Her dealings with a woman in labor, for instance, helped her realize that patients often welcome the knowledge that their physicians have experienced what they are going through. She also says that many patients hide their worries behind humor and that difficult patients should be viewed as challenges., The author has learned to use verbal cues, body language, and emotions to help her in her work. She shares her insights here. I was still in medical school when [...]

Physicians are sometimes ordered by the courts to act as legal guardians of their patients in cases where the latter's relatives cannot be reached and they are in a state where they cannot make decisions for themselves. Physicians have the difficult task of deciding on whether they should allow patients to undergo medical procedures that could result in death or aggravate their condition, or allow them to stay in their present condition. Often, doctors wonder whether they made the right choice., A court ordered the author to be guardian of his desperately ill patient. Should he sign a DNR order or not? As I stood by his ICU bed, Dan, my [...]

A doctor narrates two incidents from her personal experience in two intensive care units in two out-of-state hospitals. The first case was with her husband's brother who was stricken with a life-threatening illness. He died but the family was able to cope with this dreadful outcome because of the kindness, compassion and the informative way that the hospital staff treated them. The second case was the experience of her mother who was treated coldly, rudely and carelessly. Her mother suffered complications because of the arrogance of the doctors who refused to discuss her medical history., Even for a doctor, a relative's illness can be scary. In one ICU, a compassionate staff helped; in another, nobody seemed to care. Last winter was a time of personal [...]

A woman who attempted to commit suicide was treated in a small North Carolina town and was discovered to have murdered her husband whom she suspected of having an affair with another woman. Despite this, the state and university psychiatric facilities refused to take her in on the grounds that the woman was not bound for outpatient care and was homicidal. Fortunately, a policeman from her place of origin was able to serve an appropriate warrant of arrest before she can make her escape. She was subsequently sentenced to a maximum of four years imprisonment., She had failed to kill herself. But, as this doctor was to learn, there was a lot more to her story than he first suspected. She hadn't left her room [...]

Many physicians, in mastering the enormous amount of information required in their profession, come to approach it as a code that tends to obscure their view of the mystery of death. Two of a physician's encounters with death are described, one abrupt and one, involving his father, slow and painful. In both cases the ordinary way of thinking fell away momentarily, and death was encountered as the passage from a familiar world to an unknown one.

A doctor tells of his sadness and frustration when a patient who was a heavy smoker died of lung cancer. The patient was his nurse's husband so they had a personal relationship, as well as a professional one. The doctor describes the course of the patient's illness and his last days. He also expresses his anger at the tobacco industry and government officials who are influenced by the tobacco lobbyists., My nurse, Brenda, met me at the office door one morning a few years ago. I could see concern in her eyes, and my mind conjured up images of a [...]

Elderly patients may pose no problems for physicians, but their adult children may decide to meddle in their parents' medical affairs. A relative who believes that an elderly patient should not be placed in a nursing home should become the patient's caretaker for 48 hours before speaking with the doctor. The most important thing for physicians to remember is that the patient's privacy and independence are more important than a family member's wishes, except in cases of severe disability., No one taught physicians how to handle elderly patients' meddlesome adult children. So this M.D. devised his own strategy. Your patient's in her early 80s and wants to fly to [...]

The experience of one small town physician when confronted with evidence of child abuse indicates the extent to which doctors can become embroiled in family matters, against their will. This physician found himself caught in the middle of a triangle involving his patient - a four year old girl, her unbalanced mother, and her father and stepmother. His professional detachment was severely tested, but he resolved his dilemma by offering evidence only after being subpoenaed and by notifying his malpractice insurer of a potential lawsuit., We all have at least one patient who problems take up too much of our time-but whom we become deeply committed to. I met mine in July 1986, on my [...]

Doctors often have difficulty in understanding why some patients refuse critical care. Those working in clinics serving indigent populations need special compassion for the situations of their patients. Even critically ill patients can have concerns beyond their life expectancy., In this era of rising costs and decreasing funds, it's tough to be a good doctor. The frustrations are particularly acute for those of us who serve a disadvantaged population. [...]

I learn a lot from patients who leave me Almost every doctor occasionally gets those sobering notes from patients saying they're switching to another physician and want their records transferred. [...]

MY PATIENT GOT MAD WHEN I CURED HER "Suffering" from a bleeding disorder and high fever, she seemed proud of here maladies. Then the author discovered her game. It was [...]

FOR THREE YEARS, I TREATED THE WRONG PATIENT I couldn't believe it when I heard that my patient, 3-year-old Mike Benson, had suffered cardiac arrest and was in intensive care. [...]

After providing hospital care for more than 20 years, I turned over my hospitalized patients to the inpatient team because I was ill. When I felt better and was ready [...]

It was a cold, rainy Saturday afternoon in March and I was on call. I'd been at the hospital all morning and about half the afternoon, and had only been [...]