“How do we preserve the art of medicine?” asked liver-transplant surgeon Pauline Chen in her address for the 20th annual Jonathan J. King Lecture at Stanford Medical School on Monday night.
Chen is a surgeon, a frequent contributor to The New York Times and the author of The New York Times bestseller “Final Exam: A Surgeon’s Reflection on Mortality.” The Jonathan J. King Lecture commemorates Dr. King’s vision of enhancing patient care through empathy, compassion and hope.
“It is a fact that our work becomes routine with time,” Chen said. “Our patients benefit from this clinical experience. But with that experience we begin to develop assumptions that prevent us from delivering truly patient-centered care.”
In a world where the average medical resident witnesses 28 deaths a year, it’s hard to remember that it’s the patient’s first time while still tapping into one’s wealth of experience as a doctor, Chen said.
Chen admitted that she used to consider the dying patients in the internal care unit as “crumpled” and the frightened patients who refused to accept treatment until they asked all their questions as “difficult.”
By doing so, she forgot what she now calls a crucial aspect of her profession: it is always the patient’s first time.
She credited this realization to a former attending physician for “defamiliarizing the familiar,” causing her to see her work in new light. Rather than leave a woman alone with her dying husband in the internal care unit, as Chen thought was the norm, this doctor would remain in the room to comfort the woman.
Chen realized that some rare doctors, such as this man, saw suffering and dying as an opportunity to care and a chance to practice the art of medicine.
“They replaced suffering, unbearable grief and fear with comfort, true healing and hope,” Chen said. “They managed to bring the two threads [of medicine] back together–the science and the art–and they weaved them back into the same thread that was stronger than each thread alone.”
From these models, Chen began to stay with her dying internal care unit patients and families to provide comfort as if for the first time.
“Hold onto the incredible role models you have,” Chen said, addressing the medical students. “Their behaviors are beacons of inspiration.”
Chen also urged medical students to hold fast to their newness and idealism, as they remind older physicians of the necessity of patient-centered care.
Leo Ungar, a first-year medical school student in attendance, echoed Chen’s perception of a fine balance between burning out and being a truly compassionate physician.
“I remember when I was applying to med school the question I got a lot was, ‘What do you think the most difficult part of medicine is?’” Ungar said. “The answer that I gave was maintaining the distance that you need to do your job effectively and not burn out while at the same time appreciating the gravity of each case.”