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Tuesday, February 06, 2007

A patient as "a fellow creature in pain"

A reprint of a  no longer recent " A Piece of My Mind" section of JAMA should be handed out to all medical students. The title- "The importance of the Right Heart" by Dr. Lawrence J. Hergott. (reference-JAMA Feb.,7,2007 vol. 297, no 5 p 447)

He speaks about making judgments "beyond the medical judgment". Much is being written about the diseases that are "self inflicted " and the blame that physicians may place on those patients which may well be manifest as "an attitude that would be difficult to conceal from such people they treat."Obesity, diseases closely associated with cigarette use and excess alcohol and "unsafe" sex come to mind. We have all seen that attitude manifest as comments about patients who are obese or who abuse themselves with drugs and alcohol and I remember hearing and making those comments from the time I was a medical student and intern. Who has not tended to treat with " greater feeling" the blameless patients, perhaps a young mother ravaged by cancer than the street bum reeking of alcohol and dirt dumped in your hospital while you are on call.

Dr. Hergott's current essay is only available by subscription but an earlier JAMA submission is full text available here and is more than worth the reading time.Here he speaks of the difference between reputation and character.Another essay entitled "Playing the Moonlight Sonata from Memory" is found in a 2002 issue of JAMA and in it he writes eloquently about the anguish a physician experiences when a patient dies because of what the physician did and the extremely long half life that anguish possess. All of his essays would be valuable to medical students and all resonate with physicians who have been there and done that for a while.

Near the end of his current manuscript he quotes part of the Oath of Maimonides:

May I never see in the patients anything but a fellow creature in pain.

Not as someone who deserves his dyspnea because of cigarette use defying years of advice to quit, not as someone whose ascites is his just due from profligate use of alcohol, not as someone who should not be in this country at all, not as someone who would not be having the myocardial infarction at all if he had done what his doctors told him to do and not as someone who is taking "scarce medical resources" from someone who deserves them more or for whom the treatment could be more cost effective but as a fellow human whose is in need of what physicians spent so many years of their lives preparing themselves to be able to offer.

The oath should remind us that being face to face with a fellow human in need

..makes judgment beyond the biomedical not only unnecessary but inappropriate.

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