Alumni essay: Artless medicine

A physician’s view of a profession in crisis

Photo: Leslie Williamson


The first time I met her, she wore a beautiful blonde wig.

She dressed cleanly and smartly, for she was an executive recruiter. Her demeanor was warm, her facial features were rounded by obesity. And her eyes sparkled. This patient, I’ll call her Holly, came to my office and we spent our first visit sharing her story. She had inflammatory breast cancer, and she told me how an inexperienced surgeon had given her the news:

“Your biopsy came back positive. You have a rare and aggressive form of cancer. You will need a total mastectomy, chemotherapy and radiation. You might have three years to live. I encourage you to take care of your personal matters immediately. Do you have any questions?”

She told me that she had been shocked. She had stared at her nicely manicured hands and had asked him: “Do you think the radiation therapy will make my fingernails fall off?”

Holly recalled that the doctor looked surprised and replied, “Miss, I think you have more important things to worry about.”

She told me she had looked him squarely in the eye and shook her head, tears welling. “Shame on you,” she had said. “What if a doctor had delivered this news to your mother, your wife, your sister or your daughter in this way? Shame on you.”

When I first entered the “system” as a medical student 18 years ago, I felt the rumbling of “managed health care.” I watched old timers resist, often leaving medical practice. I heard doctors counsel pre-med students against going into medicine. But eager, idealistic and with no basis for comparisons, I accepted the new rules. I didn’t have the experience to appreciate what the hidden costs would be.

Now I know differently. I have felt the loss of the patient trust and watched as the system for teaching the art of medicine falls apart. Medical students, residents and fellows train with a different kind of practitioner than existed 20 years ago, limited by the pressure of increased productivity and piles of paperwork.

In my clinic, we are scheduled to see patients every 15 minutes. This means 32 patients per day. We are urged to tell patients who come in with multiple complaints, “Sorry, you need to make another appointment to talk about that additional problem.” Our office administrator creates monthly reports tabulating productivity markers, billing codes used and income generated. Previously I worked in a clinic where I received a monthly report tallying the costs I incurred (diagnostic tests ordered and specialist referrals made) compared with other practitioners.

While these tools and statistics help quantify and qualify patient services, they come at a considerable price to the patient and the practitioner.

It’s seven years since my first meeting with Holly. She passed away a few months ago. She leaves behind a 10-year-old daughter, loving family and friends and many reminders for me to treat not just the disease but also the whole person. Ironically, several of her horrific experiences negotiating the health-care system have become meaningful lessons for guiding my practice.

Holly belonged to a support group of breast cancer survivors. One day she told me that a member had returned from a scientific conference, appalled by an incident during a renowned oncologist’s presentation. Displayed on a screen in a large auditorium was a photo of one of their support group members (face blacked out), standing with bare breasts and a healing crystal around her neck. At the end of the presentation, the lecturer smiled and closed with, “Oh, and by the way, the crystal didn’t work.” Some in the audience chuckled. But Holly’s fellow support group member had known this woman. A chill passed down my spine.

This is a grim reminder of how far off the path we have wandered. Overwhelmed by demands, physicians no longer have the time and patience to pass down the art of medicine to colleagues and students. This, perhaps, is the health-care system’s most serious long-term consequence. The health-care crisis may not be killing our patients, but it is certainly killing our profession.

Evaleen Jones, MD, Stanford School of Medicine Class of 1991, is a family physician at Stanford Hospital and president and founder of Child Family Health International, which supports the development of sustainable health-care services in underserved communities.

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