Dr. Chuck Radis: Keynote address to medical school graduates on empathy in medicine

University of New England College of Osteopathic Medicine 5/16/2020

 

“Dean Carreiro, members of the faculty, board of directors, and graduating class of 2020, thank you for giving me the opportunity to talk with you today. In looking back at the names of previous speakers, I see colleagues and physicians whom I hold in the highest regard: Dr. Robert and Dr. Kathryne Leonard, Dr. Chase Rand, Dr. John Chang, Dr. Ira Stockwell, to name only a few. I am truly honored to be here today.     

Today is both a joyful and somber time in our lives. Many of you have friends and relatives who have been sickened by the Covid-19 virus. I hope they are recovering. Although you can’t hear their applause or look out into the audience to see them, I am sure they are immensely proud of you as you transition from medical student to physician. Congratulations! What an immense achievement!  

This morning, I want to speak with you about empathy and the expression of empathy, kindness. Along with a solid grounding in the foundations of medical knowledge, a physician’s empathy and kindness is the mortar which binds us to our patients and promotes trust. They are particularly important today, in view of the rapid development of technologies which are picking away at the foundations of the physician/patient relationship. 

One would hope with our osteopathic holistic philosophical tradition we would be relatively immune to these forces, but Len Calabrese DO, a rheumatologist at the Cleveland clinic in an editorial several years ago in the Journal of the American Osteopathic Association, found that both allopathic and osteopathic students and residents, as a whole, have diminished empathy as their training progresses.  

How do you immunize yourself against empathy burnout?   

In 1980, I was a fourth-year medical student on the service of Richard Bond, DO, an internist who was devoted to the care of his patients. We had admitted an unstable diabetic and he had instructed me to call him at home with the results of a 3 a.m. blood sugar. I called the number; it rang and rang. On the 10^th ring, Dr. Bond answered. “Hello,” he said in a weak, faraway voice.  

“Dr. Bond, this is student Dr. Chuck Radis. You wanted me to call you with the 3 a.m. blood sugar on our patient in 228.” Silence. Had he fallen back to sleep?  

Finally, “Student Dr. Radis, I was just thinking about you…what do you have for me?” 

I reported the result. He asked me how much insulin I recommended. “12 units of regular insulin.”  

“Brilliant. Absolutely brilliant.”  His comment picked me up for the rest of the night.  

In 1983, I was in my second year of a primary care internal medicine residency at what was proudly named OHM (the Osteopathic Hospital of Maine), here in Portland. My attending was Phil Slocum, a DO pulmonary specialist, and as we rounded on our patient’s he was obviously ill with a respiratory illness. He was scheduled to teach second year UNECOM medical students the next day on the topic of pulmonary complications of rheumatoid arthritis.  

I said, “Tomorrow?  

“Don’t worry, I have someone to fill in for me.” Without skipping a beat, he said, “You.”  

And yes, after 37 years, I continue to teach that class at UNE. 

I mention Dr. Bond and Dr. Slocum for a specific reason. Of course, they were both excellent clinicians. But as importantly, their patients immediately felt at ease with them. Their patients trusted them. When they walked into a room, they not only knew the details of the case, but asked about the photograph a patient kept on the bed-stand. As osteopathic physicians, they strove to understand the whole person. Their humanity and empathy were on constant display.  They were excellent role models and mentors. 

If you would, take a moment and reflect on who was your best attending in the past 2 years. Visualize that person, and if you are of a mind, jot down a note reminding yourself to send them an e-mail of thanks. They’d appreciate it.  

I’d also like you to reflect for a moment on who was your most disappointing attending. A person who, perhaps was burnt out, disengaged, or bitter about the way medicine is practiced today. Perhaps they complained about the intrusion of the EMR into office visits or were required to see patients at 15-minute intervals in clinic. Visualize that person. Take note of how they handled stress. Did they demonstrate much empathy with their patients? 

Of course, it’s obvious who you want to emulate as you begin your residencies. But remember, the physician who disappointed you as an attending didn’t start out that way. At one point they may have been outstanding physicians. More than likely, they began their career treating patients with kindness and genuine concern. In your interactions with them, you may not know the heartbreaks and disappointments they’ve experienced. They may struggle with depression or chemical dependency or, perhaps, they are simply burned out.   

What went wrong? And…how can you avoid a similar fate? Here are some suggestions: 

 It goes without saying, Seek out the Dr. Slocum’s and Dr. Bonds during your residency. Develop a relationship with them as mentors.  

Second: Concentrate on your residencies but carve out room for your friends and family. Yes, a residency is an extraordinary time commitment. But here’s the thing: Being the best doctor you can be goes hand in hand with becoming the best person you can be. Be aware that saying yes to all things in medicine, is often saying no to people you love. Read outside your field. Keep a journal. Maintain old friendships. Exercise. If stress is overwhelming, don’t hesitate to seek mental health counseling.  

Strive towards finding a work/life balance. Not that you will ever find that balance; its elusive. But striving is what counts.  “Super Docs,” those physicians whose lives are devoted completely to medicine often do not age well. Paradoxically, they are at the most risk of losing their empathetic connection to their patients. They are smart and well read, but all too often, their private lives have become unbearable, and they bring this sadness and frustration with them to work.     

On a practical note: when you are looking for your first job, think beyond salary and practice location and ask hard questions. Is there a lot of turn-over in the organization? Are physicians empowered to be their patient advocates? Or do they feel helpless to make changes from within? Do physicians occupy positions of leadership in the organization?  Are they overburdened by the demands of the EMR? An organization in which the physician is viewed as just another bean, is a recipe for empathy burnout.  

When you do take that first job, and begin seeing patients, consider typing or dictating a personal comment about the patient at the top of the note. “She has a cat named Joe,” is perfectly fine; so is, “patient is 85 and enjoys roller-skating.” If the patient is struggling with a son or daughter, jot that down, as a reminder to ask about at their next visit. These quick one-liners help us understand our patient’s lives. They build a connection. They promote trust. Find a place to put them in the EMR. 

Finally, from time to time, call your patients. Do it for you. There is no better way to charge your empathy battery than to hear a delighted patient grateful beyond measure that you took the time to call. 

Again, thank you for this great honor. You are beyond the beginning, but it will be a fantastic ride. I wish you all the best in your careers. Thank you.”