Chapter 4: Dear Bringer of Doom
A quick story to start off our conversation. While I was lying in bed during my weeklong seizure study in Cleveland a doctor came into my room and introduced himself. He said, “The Cleveland Clinic has a partnership with the medical school at Case Western Reserve University. We bring medical students into the hospital, and with the permission of the patients, we let them get real experience on real people. Would you mind helping out?”
“Sure.”
So, three hours later, 5 second-year medical students come into my room. It turns out that the day’s lesson was in using the ophthalmoscope. As you know an ophthalmoscope is that handheld tool with a light on the end of it that you use to look into eyes. You know, the one where the doctor gets like 2 inches from your face? For the next 40 minutes I had students with trembling hands hovering a lighted scope millimeters from my eye as they strained to identify the major parts of the inner eye.
Now, why did I say yes? Because I’m a doctor. Not that kind of doctor: I have a Ph.D. Did you know the word “doctor” comes from the Latin for teacher. Of course, I don’t blame you if you didn’t realize I had a doctorate. In the past two years I have been in four different hospitals, a dedicated oncology practice, numerous imaging practices, and two surgical offices and I have never once been referred to as Doctor Lankes. I point this out not out of a bruised ego, but rather to highlight a culture of exception you are in. I’m sure a big part of being “Mr. Lankes” is just to avoid confusion. I get that. (“The doctor is going to doctor the paperwork so he can save the doctor some time”). However, a better explanation may be that with few exceptions, doctors have not actually asked what it is I do for a living.
Since we’re on the topic, while technically my name is Richard, I go by David. If I am not referred to as Mr. Lankes, it is normally Richard, Rick, or Rich. My full name is Richard David Lankes. My Grandfather was Richard George Lankes, Senior. My father was Richard George Lankes, Junior, who went by Dick Lankes. My parents didn’t want a Richard George Lankes the Third, so I was named Richard David Lankes. They called me David (as my father tells it, he wanted to always make sure he was always the biggest Dick in the house). I tried once, in kindergarten, to go by Richard, but when it was time for milk and cookies, and the teacher called out, “Richard….Richard,” and I missed my snack. It was David from then on.
That is until I was in grad school and I got a call from my health insurance company. They were tired of getting forms with R. David, or just David, or sometimes Richard D. so they told me “From now on, if you want to stay healthy you are just Richard!” So I’m not surprised that doctors call me Richard…that’s what it says right on the form. What does surprise me is that doctors who I see every day for 22 days in the hospital still call me Richard.
Speaking of names, do you know why you earned the nickname Bringer of Doom? It’s not because you were the bearer of bad news. I’ve gotten a lot of bad news from folks in this process that did not get a nickname. The nickname came because you didn’t seem to know it was bad news. Your actions, your demeanor, were clearly focused on your new experience, and me as a puzzle. Now this is something I understand. As a researcher, problems are interesting. Identifying the solution to a problem, or at least that there is a solution to the problem, is a fantastic feeling. It is a joyful feeling. Telling someone they have cancer, however, is not a joyful experience (“Good news Bob it looks like it’s cancer!” “Oh boy doc, thanks. I always wanted to lose some weight, and some hair, and mobility, and my ability to stay awake for more than 5 hours straight, and…”)
Your patient is a person. They have a name, they have skills, they have a perspective on the world. This perspective will influence how they treat you, and how they treat themselves. Very simple steps can be used to build a relationship. Being a competent doctor with the knowledge and skills to diagnose problems and identify appropriate treatments is your first and foremost responsibility. However, you must understand that you cannot treat any condition without the patient as a partner. Patients lie, and patients hide embarrassing things. But here’s the most important thing…no one is just a patient. They are fathers, and professors, and neighbors, and if you treat them as such they are more likely to respond and be open. Respect and credibility are earned far beyond the conferring of a degree or title, and will be much more forthcoming if you take the time and effort to know me beyond my wounds and disorders.
So what do I want you to take this from this chapter? Being a good doctor means being concerned with my life, not what might end it.