The Physician’s Role in the Rising Cost of Prescription Drugs

By Angira Patel

When I started my medical training, my pediatrics residency program banned all pharmaceutical sponsorship of activities.  No free lunch in the middle of the day, no fancy dinners at expensive restaurants, or trips to conferences paid for by a pharmaceutical company.  Even my lab coat was unadorned by the colorful pens given by various drug representatives.  At the time, I remember thinking a pen or a free lunch would never influence how and what I prescribe to my patients.

As a young trainee, I did not appreciate why my residency program took this stance, but I do now.   Read More »

“You Had To Be There …” Caring for a Patient to the End of Her Life

By David C. Leach

It has been more than thirty years since she first came to see me – a vital woman in her early seventies who had detected a lump in her breast on a self-exam. A diagnostic work up confirmed cancer and the smallish lesion was removed. It never recurred. By the time a second lump appeared in the other breast we had come to know each other. She was now in her late seventies and this lump also proved to be cancer. It was removed. Postoperatively in the hospital she looked a bit depressed.

She was not an alcoholic, however, she had told me that she enjoyed an occasional martini before dinner. I did something I had never done before and have never done since. I brought a Waterford crystal glass containing a nicely mixed martini to her hospital room. She accepted it without comment. We talked while she sipped. She told me that she had discovered and joined the Hemlock Society. In her words: “Dr. Leach, I know that given your lily white ethics you would never countenance euthanasia so I joined the Hemlock Society. I now know what to do and you needn’t trouble yourself.” I thanked her for her consideration and we talked briefly about her concerns and choices. In my opinion she was not at risk for suicide. She knew that this lesion also was small and with negative nodes would likely not recur. What she wanted was to be empowered to make her own life decisions. I assured her that she was. . .

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“There’s a Person in There”

By Joe Burns

The elderly female patient was a frequent visitor of the dermatology clinic.  Her physician had provided routine care for her, removing suspicious spots for decades.  Today she was presenting for an exacerbation of her psoriasis.  We entered the room and the patient was visibly distraught.  She was wearing a wrinkled t-shirt and old jeans, a stark contrast to her usual Southern Lilly Pulitzer dresses.  As we began taking her history, she broke down, bawling over her psoriasis…
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Caregiving: Can It Be An Attribute of Our Healthcare System?

By David C. Leach

An old joke begins by asking that you imagine a man drowning 100 feet offshore while a conservative and a liberal are observing.  The conservative throws him a 50 foot rope and says: “swim the extra distance, it’s good for you.”  The liberal, on the other hand, throws him a 100 foot line and then promptly drops his end of the line in order to go and do another good deed.

While offering insight into our politics the story also illuminates some of our habits around caregiving in our current healthcare system and the policies supporting that system.  Certainly individual stories of near heroic caring can be found, but the system itself is designed around processes and structures that seem to diminish the importance of the caring relationships at the heart of our work.  Caregivers frequently depend on work arounds.  What would it take to develop a system that respects, rewards, or at least enables genuine caregiving?

Caregiving, of course, is an attribute of humans, not systems.  To care for another requires a voluntary opening of the heart to compassion; it requires noticing and acknowledging the uniqueness of the other and a willingness to enter into their context.  Keenan defines mercy as the willingness to enter into the chaos of the other.  (1) The biblical story of the Good Samaritan (Luke, 10:33) illuminates an interesting attribute of caregiving that may indicate why humans can care and systems cannot; the clue is in the voice of the verbs used.  The story is well known: a traveler has been assaulted and robbed. Two others pass by without helping while the third, a Samaritan, “was moved by compassion” and stopped to help.  I believe that the passive voice of the verb is not an accident.  The first step in caring is to allow oneself to be moved by compassion.  “Be compassionate” doesn’t fit naturally on a to do list; the initial step is not a “doing” but an emergent openness when one has been moved.  Subsequently there may be many action steps, but it starts by being moved by something greater than the caregiver…
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Growing Up with Doctors: A Mother’s Reflection on Physicians, Healthcare Teams, and a Lifetime with Spina Bifida

By Marsha Miller

Almost ten years ago, I wrote a story about my experience navigating the healthcare system as a young woman with a myelomeningocele baby.  It was a story about “forgiveness” because my baby was two-months old before his back was closed, his brain shunted, and his prolapsed rectum repaired. It was a system failure.  Now, I would like to talk about how different medical encounters can be when a person with a disability is an adult rather than a pediatric patient…
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