Moneeza Walji is CMAJ's editorial fellow 2014-15
Some would say it is strange to remind physicians or health care workers of the humanity of medicine, I would argue with the onslaught of new drugs, new research, and new technology to make medicine a faster evolving machine… we have sometimes forgotten the art of interacting as humans. So when gave a talk at TEDMED 2014 on metaphor and medicine (and language and medicine more broadly) it struck a chord.
During my medical school training I had often heard (sometimes from older and wiser physicians) that the art of the physical exam was dying with the increase in tests that allowed us, at times, to not touch or even see patients before making a diagnosis, let alone speak with them. One physician said we were losing the intimacy in medicine that allowed us to really listen to what was needed from those in our care. Much of what I gleaned from Dr. Verghese’s TEDMED speech was similar, we needed those moments of communication.
Dr. Verghese is Professor of the Theory and Practice of Medicine and Senior Associate Chair of the Department of Internal Medicine, at Stanford University Medical School. He is also a best-selling author, having written fiction and non-fiction throughout his career. So when he asked “What is a metaphor?” I found I really wanted to hear his answer. Metaphors and language more generally, he said, work to make the strange familiar. He spoke of how the metaphor impacted our communication in medicine, whether it be with eponyms (such as Hunter’s canal), conditions named after fruits (strawberry hemangiomas came to mind) or the “great imitator” (syphilis).
More than what he said, his talk conveyed his passion for medicine as a service to humanity, and how integral language was to convey this to patients and to ourselves. Medicine is the privilege to be a part of the most intimate and vulnerable moments in an individual’s life.
Perhaps my favorite part of the talk was the poem “What the doctor said” he shared by Raymond Carver (which I have posted below), and made me pause and reflect about how I will use language the next time I speak to a patient.
What the doctor said
He said it doesn't look good
he said it looks bad in fact real bad
he said I counted thirty-two of them on one lung before
I quit counting them
I said I'm glad I wouldn't want to know
about any more being there than that
he said are you a religious man do you kneel down
in forest groves and let yourself ask for help
when you come to a waterfall
mist blowing against your face and arms
do you stop and ask for understanding at those moments
I said not yet but I intend to start today
he said I'm real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else
I didn't catch and not knowing what else to do
and not wanting him to have to repeat it
and me to have to fully digest it
I just looked at him
for a minute and he looked back it was then
I jumped up and shook hands with this man who'd just given me
something no one else on earth had ever given me
I may have even thanked him habit being so strong