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On Being a Doctor |

A Matter of the Heart

Joshua Liao, BA, BS
[+] Article and Author Information

From Baylor College of Medicine, Houston, TX 77030.


Requests for Single Reprints: Joshua Liao, BA, BS; e-mail, jmliao@bcm.edu.


Ann Intern Med. 2011;155(10):716. doi:10.7326/0003-4819-155-10-201111150-00013
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Standing there with the sun against my back, I understood—deeply, for the first time since I donned my white coat and swore that sacred oath as a hopeful, wide-eyed, first-year medical student—that the practice of medicine needed to be about more than correct diagnoses and management.

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Comments

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Too many pitfalls as yet to endorse screening for lung cancer
Posted on November 14, 2011
Stephen L., Hansen, Physician
Conflict of Interest: None Declared

Let's put our effort and dollars behind cessation, increased tobacco taxes, smokefree environs, anti-tobacco ads and education. As California has shown, this will produce large reductions in ALL of the myriad risks of tobaccoism, without the complications of this small benefit from CT screening. Do we really think that these study parameters and the technical expertise of the study centers will be replicated in everyday practice settings?

Are your radiology groups already doing loss-leader promotions for screening with no attempt at an open risk/benefit discussion--? It's a growth industry, not usually covered by insurance, and setting the stage for new liability claims--use your imagination.

I'll show patients this article--I'll bet most will opt not to screen.

Conflict of Interest:

None declared

Consider caring for all of the patient's support team
Posted on December 5, 2011
Michael E., Miller, MD
Boston University Affiliated Physicians
Conflict of Interest: None Declared

Kudos to Joshua Liao (A Matter of the Heart, Annals November 15, 2011) for not only his recognition of, but for his profound appreciation of his acknowledgement that providing good patient care begins with caring for the patient; and that in the real world, patients don't exist in a clinical vacuum.

In our current environment of depersonalized ICD9's, CPT's, DRG's, and quality measures, there is no existent metric for caring for the patient in totality. I remind myself, and trainees I interact with that we don't just treat (or "present" for that matter) a case of diabetes, cancer, heart or respiratory failure, or stroke; we are providing care for a patient, a person suffering from that illness or condition.

That patient/person most likely has a spouse, a family, friends and concerned people, as well as other involved care givers. They are all heavily invested in the patient's care, some quite evidently, other more passively. We must consider caring for all of them.

When a patient's life approaches its end, and treatment options are exhausted, the actual care decisions become paradoxically much less difficult: we focus our efforts on terminal or "comfort care." However, the care of these "others," not patients, but people close to the patient, obligates us to work diligently to help them negotiate this difficult passage. After all, the patient has died, and no longer needs our care; but for these people, the ones who care most about the deceased and must live on and grieve, we as good physicians, and moral persons, can provide a priceless gift of immense value by heartfully "caring" for them. By doing so, we in turn graciously gift ourselves with the reaffirmation of our humanity and moral values.

Best wishes to you on your journey Joshua, and to your fellow students and medical trainees.

Conflict of Interest:

None declared

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