Hospitalists: We are not simply providers in the patient journey.

By  |  August 26, 2019 | 

The doctor opened the door after a gentle knock. He was greeted with warmth, offered a seat by Mary, and promptly sat down on the end of the hospital bed. As he sat, the family stood to greet him. They discussed the grandkids, the trips taken since they last saw each other. The room felt peaceful. Time slowed down.

Walking in behind my attending, I had been ruminating about the lengthy patient list, the work to be done. Then I awaited the medical questions to begin, the cancer diagnosis, the difficult prognosis, and the long road ahead. Instead, those thoughts were pushed out of the room, floating away like a giant balloon. The Cubs were going to miss the playoffs again, the weather was still cold in Chicago, they were glad to be in Atlanta, and the grandkids were taking years off Mary’s life.

I had never seen or felt anything like that before.

This moment was halfway through my residency, yet the first time I saw a physician work in a way I didn’t know existed. I was pressed against the wall, as much as part of the conversation as the picture I was melting into. And then, it didn’t matter – the time slipping by, the other patients to see, my selfish musings.

This patient and her family were the story. I was an interloper in their journey, and to get the story right, my attending was present, thoughtful, compassionate and acted like he was in their living room. Attending to their care, not simply providing care. The business of the treatment plan, the poor prognosis came, after the setting and the mood was set. This was a healer, a physician, a clinician, an attending: a doctor, embodying all the origins of the names for our profession. The word that did not come to mind was provider, with its definition of someone that provides something. Something. I think we do a lot more than providing something. Much has been written about the nomenclature, including by Drs. Groopman and Ofri. The words that come to mind are imbued with a history originating millennia and I hope can last for as long.

When we walk into a room, in the hospital, we are entering a story. In media res. A moment in the patient’s journey, filled with upcoming successes, failures, wins, losses, knowns and unknowns. The hospital is a way station in that process, in which we facilitate the next stops. The hero of the journey then is the one who suffers: the patient.

The origin of the word patient comes from the Latin, patior, to suffer. It’s also the root of words such as passion, passionate, and hence compassion. Compassion, with the roots, com-, patior, to suffer with. Hospital comes from the Latin hospes, which means stranger, foreigner. And it also gave root to hospitality, hospice, hostel. We are caring for strangers with hospitality. We do this caring at the bedside, hence clinical medicine. The words clinical, clinic, clinician all originate from kline- in Latin, meaning bed. A Roman couch was called a kline. A good clinician comes to the bedside.

In addition to clinician, the doctor has many names. Doctor comes from doceo, to teach. We are teachers, whether in academics or not. We are teaching our patients, colleagues, nursing, in addition to those who are educators of students and residents daily. To teach is to know, and in a field with rapidly changing knowledge, we all need to be teachers to distill and instill the barrage of new information. This connects with our other nom de plume, physician.

Physician emerged from physic, the name for doctors of yore. The physic was the expert in natural science, in that quest for knowledge. The centuries of anatomy done first by the artists, then by the great anatomists such as Vesalius, in seeking truth. Vesalius stands on the frontpiece of de Fabrica holding the hand of the corpse he’s dissecting. The hand emblematic of the passage of wisdom and truth from God. Here’s medicine, in the anatomy theater, a word from theatron, the seeing place, searching for answers to life’s mysteries. Physicians in the Renaissance were students of geometry, philosophy, art, and of course, medicine. True polymaths. As physicians, we seek the arts, the humanities, in addition to the science, the benchwork, to get closer to the truth.

One of our old names was leech, meaning healer. The leech, one of our tools for the treatment of excess humors, also caught on as a name for physicians. A hospital in 19th century France would have a leech room with millions of leeches, captured by the ankles of local women wading in the nearby marshes.

We don’t do this alone; we are there with our colleagues in arms, the ones at the bedside 24 hours a day, the nursing staff. Nurse comes from the same root as nurture. We are there with the physician assistants, nurse practitioners as well. If we need one word when discussing all of the health care providers together, I would prefer clinicians instead of providers

These echoes in words are written down for centuries in the ancient stories. I always thank the gods who came before us: Asclepius, the god of medicine, son of Apollo, god of music, medicine, arts. Asclepius was mentored by Chiron, the centaur taught by Apollo in the art of medicine. Hygiea, where hygiene originates from, and Panacea, which became a word for a cure-all, are the daughters of Asclepius. Chiron gave us the word Chirugeon, an ancient word for surgeon.

Let’s take this sentence and break it down then: The doctor and nurse in clinical medicine compassionately treat the patient.

The healers/teachers/philosophers/nurturers offer hospitality at the bedside and suffer with the stranger in our midst, who is in distress.

That describes my mentor, my attending from residency. An archetype that I’ve seen few and far between since, but one that does exist. What he was not doing was providing, not simply a provider. He was in the moment, in the story, and shaping the path for the patient to make that hard journey ahead just a bit easier.

The origin of provider in medicine? That something became a service. Likely started by administrators, insurance companies. I would guess an unnamed bureaucrat, looking to atomize, itemize, minimize and quantify a role that can’t be simplified. A leech in the modern sense, perhaps. But when we are applying our knowledge, constantly learning, offering active empathy at the bedside with our patients, we are not simply providers. We are the full essence of doctors and physicians and healers. We are more than that, we have centuries of words that are imbued with deep meaning.

In these stories, the words, the names matter. We may forget the deep roots, but there’s a story to them that is poetic, long-reaching and inculcates our understanding with the subconscious and conscious meaning that we should bring upfront.

The doctor, the physician, the healer will see you now.

2 Comments

  1. Avatar
    Dr. Harold Shinitzky August 29, 2019 at 12:06 am - Reply

    Dr. Messler offers a philosophical perspective of true care by a healer. The dynamic, human relationship and partnership between all parties involved is vital for good care. The mindset, truthfulness, and sentiment in your sentence, “The healers/teachers/philosophers/nurturers offer hospitality at the bedside and suffer with the stranger in our midst, who is in distress” could not be more accurate. This is the way I recall being taught by my mentors. It is an honor and privilege to be a member of the team with the patient and family being at the center. Dr. Messler, thank you for sharing your experience.

  2. Avatar
    James O'Brien October 17, 2019 at 10:15 am - Reply

    I love word derivations because you can see the meaning behind a grouping of letters and sounds. Put hospital and patient word derivations together and it could loosely translate to place where strangers suffer. This article by Dr. Messler captures how a true physician applies the evidence based science in the most human terms possible to flip “strangers suffering” to people you care about healing. It’s special to most people when someone important like a doctor takes the time to get to know them. And that much more special when the understanding of their story impacts their healing as only that knowledge can. Virtual care should directly support that relationship as only it can. I love what my friend who is a hospitalist, says about telehealth, that virtual care is practicing medicine, not practicing technology. We thought some of the power in digital technology was removing the human element and replacing it with AI and automation- high efficiency to free us to do other things. But truly the benefit is making the human element more accessible. We’re working on a startup which I hope will contribute to that mission. BTW it was nice to read this article with an actual story written in to it and some great prose.

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About the Author: Jordan Messler

Jordan Messler
Jordan Messler, MD is the Executive Director, Quality Initiatives at Glytec and works as a hospitalist at Morton Plant Hospitalist group in Clearwater, Florida. He previously chaired SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, including 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 and 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. But inevitably, he will have his daughter dumping sand on him and then has to explain to his wife why their daughter is buried up to her neck.

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