I recently attended an excellent Grand Rounds on Palliative Medicine. The speaker quoted Dr. Francis Peabody’s “…for the secret of the care of the patient is in caring for the patient” while apologizing for using a quote that “we’ve all heard over and over, I’m sure”.
Well, I’m guess I’m one of those in medicine who has not had this quote burnt indelibly in my mind. Did I somehow fall asleep in that medical school class or on the wards when someone prior to today used that quote?
I certainly blanked out over the next few minutes of the speaker’s talk as I wondered, “Who is Francis Peabody?!” Dr. Peabody was born into a prominent New England family in 1881 and had his medical training at Harvard and Johns Hopkins. He is known to be an excellent bedside teacher and clinical investigator. This quote that will now be burnt
into my mind (better late than never) came from a lecture entitled “The Care of the Patient” that he gave to Harvard students at Boston City Hospital on October 21, 1926. It was later printed in the Journal of American Medical Association in 1927 (JAMA; 88:877-882), the year of his death due to cancer, and it is apparently one of the most revered articles in the medical literature. Don’t I feel silly?
In either case, I read it now and think that I must have heard a reference to this at some point, perhaps at my White Coat Ceremony. It must not have resonated with me because I had no clue then what it truly meant to be a doctor. This 86-year-old lecture is pure gold. Mr. Peabody could have been the one giving Grand Rounds last week, and I would have been as awed by his words as I’m sure the students who heard them first in 1926 were. In this day in age when the senior physicians shake their head at the demise of medicine as they know it and point their fingers at us the younger ones referring to our smartphones and tablets at every opportunity, making diagnoses based on CT-scans and MRIs, and choosing our careers based on lifestyle factors, it is oddly refreshing to see that as major advances have been made in medicine over the past 200 years the decline in the actual caring for the patient is not the fault of Generation X. We just inherited the trajectory and have done nothing yet to put it back on course.
Dr. Peabody’s words heed that “the essence of the practice of medicine is that it is an intensely personal matter…” meaning that we must not forget we are treating a human and not simply a disease process. His words call for us to be aware of how dehumanizing it can be to be hospitalized. The patient is not just a person sick in a
bed but rather one “surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes, and fears”.
We are cautioned about our attitudes to those patients who “don’t have anything wrong with them” a label we give those for whom we cannot find an organic pathological explanation for their symptoms. We are advised that were we to spend more time with them, we might understand better the psychological factors operating behind some of those symptoms. Truer words never spoken.
It may be that Dr. Peabody’s words are so brilliant because he was suffering from a terminal malignancy yet maintained a life of dignity. Quality, not quantity, of life personified, surely. Whatever inspiration he drew upon I’m
grateful for his words. Yes, we have had wonderful advances in medicine even in the 85 years since his death, but at what cost? I think Dr. Peabody would shake his head at the institution of medicine today – at the for-profit business it has become, at the insurance corporations and politicians calling the shots from their boardrooms, at the vast expense of things, at the fact that Americans of all walks of life but particularly the very old, the very young, and the poor often go without any access to care,and at the overall very critical state that is American healthcare today.
But before we start blaming others, Dr. Peabody’s words also remind us that we all have the ability to care for others. That is, to care for our fellow human beings and to care for ourselves. As humans, we need to want to heal and have reason to think we will heal.
As an infectious disease physician, I am well-trained to look at the big picture, to not lose sight of the forest and ecosystem while investigating a tree, so to speak. But as myself I’m impersonal I know. I was told by a close friend “I don’t quite see you as a doctor” when I was in college applying to medical school. That’s okay. I often said in medical school that I wasn’t interested in being a family physician because I didn’t want to have to listen to what else was going on in the patient’s home life, such as what Fido the dog did that day; that I didn’t want to take care of children because I didn’t want to have to playfully cajole them into letting me listen to the animal crackers in their abdomen. Don’t get me wrong. I am quite likable. I’ve often been asked by the patients I consult on if I could be their primary care physician and I’m humbled. I’m often embarrassed by them or their families when they reach to give me a hug. I guess I am a nice person and not that cold and uncaring. Each day practicing the art of medicine I learn that though caring doesn’t supersede competence it’s okay to be a bit more human in my interactions with patients.
“Medicine is not a trade to be learned, but a profession to be entered….
The treatment of a disease my be entirely impersonal, the care of a patient must be completely personal.”
– Francis Peabody
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