My Six Favorite Words
This emergency physician hopes to make
each of his patients
feel a human, therapeutic connection with him—and utter
a special sentence.
feel a human, therapeutic connection with him—and utter
a special sentence.
For the past 17 years I have practiced
emergency medicine. I have done this primarily in Level I
Trauma centers in Detroit (Henry Ford Hospital) and suburban
Washington, DC (Inova Fairfax Hospital). It has been quite a
ride, or in the words of Jerry Garcia, “What a long
strange trip it’s been.” I have seen an amazing
array of pathology and disease processes that leaves me
breathless at times. I have been privy to the details of human
weakness, excess, suffering, and tragedy, some of which would
curl the toes of even the most hardened TV news producer. I
have seen remarkable human beings, fighting devastating illness
with grace and dignity. Most of all, I have worked alongside
some truly outstanding and dedicated physicians.
My colleagues and I
have had moments of great triumph. We have shared laughter and
camaraderie in the face of what is very difficult and often
thankless work. We have shared the pain and sadness of loss,
from losing a patient to tragic loss within our own ranks. It
has been a privilege to share these experiences with such great
people. Both my patients and my colleagues, over the years,
have been a continual source of inspiration to me. They have
made the journey a memorable one to date.
Our job in emergency
medicine is often a somewhat faceless one compared to other
specialties of medicine. We lack continuity. We may see a
patient only once in his lifetime, as opposed to his primary
care physician, cardiologist, or dermatologist. Some of our
patients are unconscious when they arrive for our care and
remain so throughout their stay. In describing emergency
medicine to people, I have often said that life is a motion
picture; in the emergency department (ED) we get to see only a
few frames. Think about how tough it would be to figure out the
plot based on only a few frames.
Patients often do not
know or recall the name of the emergency physician who cared
for them. I have been described variably as, “The guy in
doctor clothes,” and “The funny guy with the
gravelly voice,” to “Some dark looking guy with a
real long name,” and even “That Jim Belushi-looking
dude.” Many people do remember their ED visits though.
There are those who never forget us or our names. We may have
been the doctor who had to deliver the tragic news about a
loved one. In that situation, you meet someone once and they
will never forget you. Of course we would rather be remembered
as the doctor who “did a great job reducing my
fracture” or “was so patient with my son sewing his
eyebrow,” or quite simply as, “The doctor who saved
my life after my accident.”
But any emergency
physician will tell you that no matter how long you have
practiced, or if you are in the inner city or a rural ED, there
are six words that are magic, six words that signal triumph,
six words that let you know that you have so totally connected
with the patient they are compelled to utter them. They are the
six best words you can hear. They are not “Hey doctor,
your shift is over!” or “Hey doctor, you’re
going to Disneyland.” They are quite simply:
“Do you have a
private practice?”
It is indeed a simple
phrase, but by asking such a question the patient is
acknowledging to the emergency physician that she has such
confidence, such faith in the physician that she wishes to
continue the relationship. You have connected with that patient
and formed a bond. That’s were the magic is. This is the
spring from which we draw the sweetest water. After all, this
is what it’s all about for a physician. When you hear
these words you know there is truly a therapeutic relationship,
something unique and special. It is the kindest and loftiest
praise for an emergency physician.
In each and every
patient room I enter, I make it my silent goal to get that
patient to say those six words. I want to make it impossible
for them not to. I really wish to give them no choice.
This is the Art of
medicine. It takes intellect to diagnose a myocardial
infarction, but it takes something more intangible when
treating a fellow human being—something that is hard to
quantify. It is not unlike a lantern that lights the
patient’s way through a health crisis. It is something
that is very hard to teach, but it is an idea to which every
physician should aspire.
In my position as the
director of academic development for patient advocacy for BestPractices,
Inc., it is my responsibility to try to quantify these
intangibles. I am charged with making sure we all push patients
into saying these six magic words. I am the keeper of the
lantern. My colleagues will transform it into a beacon.
This light is
something that comes from within but spreads contagiously when
it gets out. That’s the beauty of it; it is infectious.
It’s easy to spot the symptoms of this disease. It is my
favorite to see and diagnose. It begins with a smile, an
enthusiastically pumped handshake. It proceeds to warm thanks
and praise. It goes on to become a compliment letter to a
hospital administrator. But it always should really end with
those six magical words:
“Do you have a
private practice?” g
Dr. Paganussi is
an emergency physician living and working in suburban
Washington, DC. He is the director of academic
development-patient advocacy for BestPractices, Inc. He is the
editor-in-chief and publishes a quarterly column in Epic, the
newsletter of the Virginia College of Emergency Physicians. He
has written and published numerous articles, textbook chapters,
and poetry. His main avocation in life is his wife Julie and
three children.
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