The Caring Physician

By Peter Laird, MD

When I first entered the arena of dialysis care in February 2007, it didn't take long to realize that being a patient is not as much fun as being a doctor, well at least the fun of the old days of medicine before government regulations and corporate greed changed our profession for the worse. I wish I had a dollar for every time I heard one of my professors during my training retort, it is always better to be the doctor than the patient.  

Being in the presence of death and human misery is much more tolerable when you can "objectively" distance yourself from the suffering of a fellow human being.  Doctors become quite facile at distancing themselves from their patients which is a necessity when quick actions dictate survival in life and death situations, yet it can also leave us hardened and callous towards our own patients who trust us to not only be competent but caring as well.

My journey through the American dialysis industry in the last 4 years is filled with many caring and competent healthcare practitioners, but I have also seen my share of healthcare professionals that in my opinion are turning a blind eye towards the plight of their patients.  Most of us in the medical field do start our journey through the rigors of training with the highest ideals of altruism.  I remember reading through a long biography of Albert Schweitzer when I was first contemplating a career in medicine.  Not only was Albert Schweitzer a Christian missionary, accomplished organist, honored scholar as well as a skillful surgeon and physician, but unlike many in my profession, he
never lost the love of his fellow man suffering in need.  In 1952, Albert Schweitzer received the Nobel Peace prize for his work in Africa:

Albert Schweitzer (14 January 1875 – 4 September 1965) was a Franco-German (Alsatian) theologian, organist, philosopher, and physician. He was born in Kaysersberg in the province of Alsace-Lorraine, in the German Empire. Schweitzer challenged both the secular view of Jesus as depicted by historical-critical methodology current at his time in certain academic circles, as well as the traditional Christian view, depicting a Jesus Christ who expected and predicted the imminent end of the world. He received the 1952 Nobel Peace Prize for his philosophy of "Reverence for Life",^[1] expressed in many ways, but most famously in founding and sustaining the Albert Schweitzer Hospital in Lambaréné, now in Gabon, west central Africa (then French Equatorial Africa).

I am quite sure that Albert Schweitzer was not only aware of the words of the Bible, but yet again with his actions lived by the Bible and its teachings. One verse that has always motivated me is found in the gospel of Matthew and is also known universally as the "golden rule."  Therefore all things whatsoever ye would that men should do to you, do ye even so to them.  The majority of nephrologists surveyed would never opt for what they routinely prescribe to over 90% of their own dialysis patients. How many of my fellow colleagues have further forgotten the simple pledges and altruistic protestations we espoused during our medical school interviews.  I can think of no greater reminder of the classical teachings on the art of the doctor patient relationship than that of Dr. Francis W. Peabody in his essay -  The Care of the Patient.

The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine – or, to put it more bluntly, they are too “scientific” and do not know how to take care of patients. . .

The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient. 

It is time that sympathy, time, understanding and caring are once again lavishly dispensed and nowhere so needfully as in the modern open wards we call dialysis units where suffering and death call upon thousands of patients daily while too many nephrologists blindly turn their eyes from their patients as if they are little more than another chair to be filled for the shift to be full.