American College of Physicians: Internal Medicine — Doctors for Adults ®

Thursday, November 20, 2014


I got a call yesterday. It's not the kind of call most people get; it was a call from someone who is dying and wanted to talk with me.

“How are you doing?” I asked, not knowing exactly what to ask.

“Pretty lousy. They say my cancer is spreading and the oncologist told me there wasn't much more to do at this point.”

There were a few seconds of silence, and I was about to say something when the patient said, with voice cracking, “I just want to thank you for all you've done for me over the years. You've been a good doctor, someone I can talk to when I needed. Thank you for all you've done.”

“Thank you for letting me take care of you,” I answered, “It really is an honor when people trust me with their care.”

Another pause.

“Just let me know if I can help in any way” I said, again not knowing what to say. ”I assume they've set you up with hospice. You are facing that time that we all will face some day. It's just got to be weird when it's actually happening to you.”

“Yeah, doc,” the patient said. ”It's not something normal, that's for sure.”

I thought about that conversation for the rest of the day. Someone had felt strongly enough to call me and thank be before they died. I was a person on their list that they wanted to contact before death. That's amazing. It may not be the first time this has happened, but it was the first time I was acutely aware of its significance.

We talked for a while after the things I chronicled above, talking about family, plans for wrapping things up, about whether quitting smoking had brought on the cancer (I didn't debate the point), and about our shared experiences in my office. It was hard to say goodbye, as it could easily be my last conversation with the person.

This all got me thinking about a conversation I heard on sports radio about the definition of the word “heroic.” One of the hosts was complaining about the use of the word “hero” in conjunction with the amazing efforts of Madison Bumgarner in the World Series. Yes, it was amazing how he pitched 5 scoreless innings on 2 days of rest, but would you truly call his efforts heroic? ”Shouldn't we reserve the term for people who are true heroes,” the host asked, “like soldiers, firefighters, and doctors? This guy pitched in a game; he didn't save anyone's life or find a cure for cancer. It just bugs me when people call this heroic

The reference that caught me was his assumption that doctors were heroes. This is something that has been said to me before, after I discovered heart disease, found cancer early, or helped a person gain control of their difficult disease. I can't deny it: I have saved many people's lives, but I resist any suggestion that what I do is heroic.

It is my job to find cancer early, diagnose heart disease, and put people on the path to health. I am supposed to save people's lives. I would consider myself a poor doctor if I didn't do these things, just as a firefighter or soldier would deflect the title of “hero” for their doing their job as they should. Are there truly nobler jobs than others? If so, does having a noble job confer its nobility to the people who do it? I must say, I've known many doctors where the terms “hero” and “noble” would be far down on the list. Yet these people also save lives and help the helpless for a living.

I think there is something in us that makes us want to make heroes. This is part of the attraction of sport and other entertainment. We want to see people doing things that are amazing, superhuman, and heroic. As a child, I imagined me hitting the home run in the bottom of the 9th inning, or hitting the basket with no time left on the clock. I imagined the adulation and praise of my skill from the adoring masses. I dreamed of being a hero.

But then, is the fact that Bumgarner plays a game and doesn't save lives make his superhuman effort less heroic? I tend to think this is an unnecessary distinction. It is the effort that is heroic, not the outcome. It is the person being in the place that matters, when nobody else is able to do the task. It is when we are truly ourselves when we are the only people who can make a difference.

So, in some ways, the fact that this person wanted to call me before they died, that fact makes me feel heroic. This is not the heroism that attracts outside praise from the masses (I say ironically as I publish this on my blog). Really, I am not writing this to garner praise, but to say that we all can and should be heroes. Being heroic is to be who we are in the position we've been given. It isn't sexy, loud, or earth-shaking.

Being truly heroic is something solid, which comes from ourselves, not from the opinions of others. In a strange way, this patient, by calling me and letting me know how much I've done, did something heroic for me.

Thank you for being my hero.

After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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