A Letter to My Patients

To my next patient:

I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing.

I may know about your criminal past. I see that tattoo underneath your gown. I hear your profanity-filled screed because you won’t get that MRI today. I know you don’t follow the treatment plan, that you are here illegally or that you are a refugee from another country.

I will still care for you no matter what. It’s one of the blessed things we instill in each other in medicine.

I saw someone like you recently: 28 years old, working hard, with 2 jobs, but neither provided insurance. She was doing well, without health problems, but then became fatigued and swollen. She came to the ER after weeks of suffering with what turned out to be failing kidneys. Lupus. She required expensive medications that would aim to reverse her kidney disease. She left the hospital not knowing what would happen next, as there was no way she could afford the treatment. The fates of medicine handed her an unexpected illness, and we had no good way to reassure her of what would come next. I am sorry that more patients without insurance will arrive, instead of the steady decline I had been used to the past few years.

You also remind of another patient I saw last week. She was sweet in the face, smiling despite her travails, and wore the skimpy gown with pride. She had some fluid just outside her lung that shouldn’t be there: a pleural effusion. We discussed the different possible diagnoses. She had cancer in the past, surgically treated and presumably cured. Was this the cancer back? Was it an infection, easily treated? We couldn’t tell by the exam or the x-ray.

On Tuesday, we took the fluid out. The results trickled in slowly, and initial tests suggested it was benign. We allowed a smile, but final tests were pending. What will turn up? When the final results return? Can we dance in the room with joy? Or will we hold hands, bear the cross, shed a tear, but then lift our heads up and know we will fight for another day, and another day, and not stop fighting until the cancer upon us is gone?

Medicine doesn’t have a terrific history, but we have worked hard to gain that trust back. We supported eugenics 100 years ago, leading to the institutionalizing and sterilization of our fellow Americans. We thought homosexuality was a mental illness until 1973. We performed research unethically for decades. Echoes continue today as mistrust in the medical system.

However, I see the moral arc follow Martin Luther King Jr.’s path as it bends towards justice. I see the hospital as a microcosm of what I want the world to become: a safe haven for compassionate care, regardless of who arrives through the doors. Caring for all like a brother or sister, treating each other with respect, wishing health and recovery, holding the hands of the sick and sitting with you at the bedside while you are suffering. Watching a nurse expertly care for a patient, while a physician offers words of solace and comfort – all of different genders, ethnicities, religions.

Perhaps, outside of these walls, we are not ready for that vision. I want to believe that the arc still aims for justice and travels in the right direction.

Everything may change in the next few years, but nothing changes in how I will care for you. As a physician, I swore that oath to you. I will extend that fight outside the walls more that I perhaps should have in the past. I will fight for you, write for you and let you know we are in this together.

We are all children of someone. We are all patients at some point. We are all in this together.

I promise to treat you with compassion like I do with all my patients. I don’t take it for granted and work to continue to improve. I will heal you and fight for you every day.

I am with you.

Sincerely,

Your doctor

Jordan Messler

Jordan is a hospitalist at Morton Plant Hospitalists in Clearwater, Florida. He currently chairs SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University.

He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality (Anti-UpToDate reading material). But inevitably will get a five year old dumping sand on him, and then has to explain why she is buried up to her neck.

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