Best part of being a doctor? The stories

The best thing about being a doctor and practicing Medicine are the stories – the patient’s stories. Each day, I get to hear someone’s life story, to share in their life’s successes, their failures, and the meaning they derive from their experiences. I have heard of the adventures and the atrocities of The Great Wars, of those who have watched the impact and have additionally been the research subjects of a miraculous new drug called Penicillin, of those who have witnessed the invention of a strange picture device called the TV, and an even more peculiar machine called the computer, capable of calculating incredible sums of numbers in a split second. Patients have described to me the challenges of trying to wrap their heads around a bewildering and intangible beast known as The Internet, carried now in our pockets on cell phones and to which all of life seems to be dependent. To some of them, it all seems to be a strange fairytale – or fantastic nightmare – depending on their point of view.

As a doctor, each day I fill the pages of my life with the chapters of others, and all the while hope that I have been bookmarked into the tomes of their experience as I try to treat their various ailments.

I have learned in two short years as a resident in Internal Medicine that there is no substitute for a patient’s story in trying to figure out what is going on with them. With the advent of the electronic medical record, a patient’s medical history can now be compiled through a comprehensive list of blood tests, echocardiograms, CT scans and MRIs. So much information about one-person can been gleaned off a computer that some might question whether it is even necessary to see patients in person at all! Yet the richest stories, even those that may have little relevance to the illness at hand but are paramount to the emotional connection between my patient and me (and hence are the most enjoyable on a personal level) come directly from the source – the patient. A computer can tell only so much of the story, and I am often left at the end of my electronic record data collection still wondering, ‘what is going with my patient?’

Dr. Suzanna Mak, a staff cardiologist at Mount Sinai Hospital recently wrote in a wonderful piece on advice to generations of physicians behind her, “one has to stand at the foot of many beds to develop “physician’s intuition,” which remains essential to the art of diagnosis.”

In fact, there is good evidence to support the importance of seeing your patient and hearing their story. In an article entitled, “Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital”, Dr. Liza Paley and colleagues conducted a study where four hundred and forty-two consecutive patients were admitted from the emergency department to an academic hospital over a period of 53 days. What they found was striking – the patient’s history was the most powerful and important modality identified in arriving at a correct diagnosis. In 60% of cases, the history and physical examination alone were all that were needed. Basic diagnostic testing such as routine bloodwork, a chest x-ray and electrocardiogram provided an additional 30% of diagnoses when used in combination with the history and physical exam, and advanced testing or imaging was of little additional benefit. And while the elements of a thorough medical history are critical, the nuances uncovered in a person’s recollection of their life are equally valuable in helping to inform a physician’s treatment decisions in order to better align them with a patient’s underlying values. So I have learned to take the time to listen.

The irony in Medicine is that privacy laws and patient confidentiality mean that I am unable to share the incredible stories of people’s lives that I listen to everyday with those around me. Volume after volume continue to pile up in my personal library of patient encounters, and I keep it locked away in the catacombs of my mind, to relish on a sunny Sunday afternoon over a quiet cup of coffee, knowing that each and every story, and not a picture of the organs in their chest, was the key to unlocking the secret of their lives.