You could barely hear the footsteps down the hall, it was more like shuffling. Eventually, it grew louder and then came to a brief stop in front of my mother’s hospital room door. There was no knock, just an entourage of physicians walking through. My mother was in one of her last battles against breast cancer. I was sitting in a pale green chair next to her. This was an almost daily ritual that hot summer of 1973 in Detroit’s Grace Hospital.
She had been sick for several years now and we all knew the end of the fight was near. In those days, most women died from breast cancer. Amazing what a generation of medical advances can do. Dr. Michael Sampson was the lead physician on those rounds and was my mother’s physician. After some questions from the team, the group turned to leave and Sampson turned to me. “Did you eat lunch yet?”
I answered in as big a 16-year-old’s voice as possible, “No.” He then asked my mother if he could take me with him to the doctor’s dining room. Yes, in those days, there was a real dining room in the hospital for doctors with real waiters. I walked with Sampson with my head high and chest out. I sat with him and his colleagues for almost an hour. He asked how I was doing, how I was holding up, and what if anything they could do to help me, not my mother, but me.
I had already decided I wanted to be a physician. I also knew I wanted to be a physician like Sampson, compassionate, caring beyond measure, and treating the whole patient, meaning his or her family. It has now been 40 years since I graduated from the University of Michigan School of Medicine, and I think back to that day more and more.
Maybe you notice, I have been using the term “physician,” and not “doctor” or “health care provider.” This is intentional. A physician is defined by Oxford dictionary as “a person qualified to practice medicine.” A doctor is a person qualified in almost any specialty, even Greek mythology or medieval history. A health care provider is anyone qualified with providing any level of health care to the patient.
This brings me to the topic at hand. How does someone choose their own physician? Medicine really is different than it was when I grew up, and even different from 10 years ago. Physicians currently take the Hippocratic Oath or the Oath of Maimonedes. The simplified version is that we take an “oath of allegiance to our patient,” that we are our patient’s champion.
There are some in health care who want the physician’s oath to change to the “oath of allegiance to the health of the state.” That potential change reflects one of the major changes in the new version of medical care—the use of guidelines, algorithms, and protocols. These often seem to place the individual needs of our specific patient second to the needs of the health of the state. The logic goes, if the state is healthy then the patient will be as well.
That’s very different from an approach I learned long ago. I had a physician in medical school who taught us that when entering a patient’s hospital room, to look around the entire room. You can learn so much about a person by what is around them. Were there any family photos, get-well cards, flowers, or any touch of “care” in the room? In other words, look at the whole being, not just the illness. That’s a quality you want in your physician.
Choosing your primary care physician is critical in getting the best care possible for you and your family. Sadly, with some health care plans, you don’t get a choice: you are assigned a health care provider. If you’re not happy, complain until you get one you like and you can even demand a physician. Most of us do have some choice, so how do we decide? This goes back to finding your champion, one who cares about you.
Several years back, I had a patient. I had delivered her first baby four years prior to her move to a town about 20 miles away. So for her second baby, she decided to deliver near her new home and found a doctor she didn’t particularly click with, but was convenient.
She was term and had been complaining about the baby moving much less than normal. The doctor did what the protocols told the doctor to do. They did a fetal monitor strip and an ultrasound. The baby “looked good” and she was sent home. She called the doctor that very night and again said she still didn’t feel the baby moving much. She was told she was just tested a few hours ago, give it until tomorrow and not to worry. Later that evening, she went to the hospital in spite of the advice and was found to have a fetal demise (stillborn). The protocols weren’t wrong, the doctor was. This doctor (notice I did not use the term physician?) didn’t listen, this doctor just followed the protocol or algorithm.
When searching for a physician, make sure you get a feel for this person. Is he or she someone you would trust with your life, or that of your spouse or children? Your physician should be your champion, not just your provider of guidelines. Remember my Sampson rule. It hasn’t failed me yet. Your physician needs to care more about a patient’s well-being than about guidelines, protocols, or algorithms. He or she must listen. It’s OK not to know everything, I sure as heck don’t. Now I wish I could find Sampson and let him know just how much that 16-year-old boy learned from a simple lunch.
