There is no greater professional satisfaction than the knowledge that you have cared for a patient and the care brought an improvement in the patient's health. Regardless of the level of appreciation, whether the patient is cured or not, and even if the patient's sense of well-being may be psychological rather than physical, we as physicians gain from the interaction. All economics aside, this is the essence of being a doctor.
The Doctor-Patient Relationship
Patients have taught me so much about courage, spirituality, and dignity. Enduring surgery, chemotherapy, and radiation therapy takes a singularity of thought and a leap of faith. The lessons learned from my patients gave me the understanding and fortitude I needed when I was ill.1 Being with a patient who has accepted the inevitable end of life with dignity and resolve has taught me how to help others in the same situation. These experiences cannot be taught in medical school lectures or books. There is a palpable connection that clearly defines the doctor-patient relationship. Nothing else in professional life can match it.
I remember an elderly patient with widespread metastatic prostate cancer who tearfully told me that he could not afford the copay on the LHRH agonist that I prescribed. He did not want to spend the money that his wife would need once he was gone, and he did not want to sully his memory by her thinking that the copay for the medication he was receiving was causing her to struggle. Even though I beseeched him to continue and offered programs through various agencies or the pharmaceutical company, his determination and pride resulted in him no longer accepting the medication. This man embodied resolve and dignity. He lived and died as he wanted to be remembered.
I remember a bedridden man who had aphasia due to a stroke. I saw him and his wife of 65 years engage in a lifetime of memories and conversation simply by looking into each other's eyes. The nonverbal communication was more than a thousand words could have conveyed. That experience taught me that how I present myself to my patients can enormously impact the confidence they have and the words I speak.
Patients who donate their organs, whether as living or deceased donors, have impacted my understanding of selfless love for the future. Living related donors are remarkable, but living unrelated donors are awe-inspiring. And those who donate organs upon their death demonstrate an immeasurable sense of hope for the future.
Patients whose emotions and personalities have evolved from childhood innocence to adult maturity and to fighting critical illness have taught me about the necessity of embracing friends and family.
A doctor is an aggregate of experiences. Wisdom is knowledge plus experience. The thousands of interactions I have had resulted in the development of my personality, philosophy, and a measure of wisdom. I have gained enormously from listening to my patients. Their stories-landing on Normandy, living through the hell of Iwo Jima, suffering through the jungles of Vietnam, losing a loved one or a job, enjoying life to its fullest, or not being able to enjoy even one minute-these are the stories that make up the tapestry of life.
I am a better person and physician to have been in the privileged position of confidant and doctor to so many people. I am very fortunate to have been on the receiving end of my patients' teachings. It has made me who I am today. ■
Disclosure: Dr. Boxer reported no potential conflicts of interest.
Dr. Boxer is Professor of Clinical Urology at the University of Miami, and Clinical Professor at the University of Wisconsin, Madison, and the Medical College of Wisconsin.
1. Boxer RB: Physician as patient: A personal perspective. The ASCO Post 1(3):1, 2010.