The Best Medicine is Sometimes No Medicine at All

As physicians in 2011, we have to consider ourselves to be very fortunate. Let's forget for a moment about all the current economic woes, the looming healthcare reform that poses enormous uncertainty for all of us, and the increased pressures placed on us by managed care to provide the least expensive care possible. Also available to us is the newest diagnostic imaging techniques and a rapidly developing field of pharmacotherapy. However, the best medicine is sometimes delivered by just a touch of the hand.

A patient came into the office earlier this week to discuss a CT scan report. He is a current coal miner, has COPD, and is starting to show symptoms of advanced pneumoconiosis. He had a routine chest X-ray at the black lung clinic and it was remarkable for a possible left-sided nodule. A follow-up CT was ordered and thankfully the radiologist thinks it is just the typical progressive massive fibrosis that is typical of black lung. The recommendation was to either go to PET scanning or a follow-up CT in three months. My patient and his wife sat in my office and as I went over their options their final answer was... "we will do whatever you suggest because we trust you." Just before they left, I held both their hands and had prayer with them. What started as a very anxious office visit for the couple ended with a sense of calm and a few tears.

When I was in residency, I cut my teeth by doing weekend shifts in a small town ER. I feel the moonlighting experiences I had were especially important for not only providing excellent learning examples, but for forcing me to think on my own very quickly. Before I had even ten shifts under my belt, I was working the Sunday day shift and it was typical in the south to have your "after church big meal chest pain" patients. This nice lady was brought in by EMS and was quickly found to be having a myocardial infarction. Her ST segments were elevated and cardiac markers were elevated as well. I rapidly thrombolysed her and she did well for a few minutes but then coded. I intubated her and went through several cardioversion sequences and she finally responded. I sat there with her and held her hand until the helicopter landed outside. The nurses and I pushed her gurney out to the helicopter and just before she was loaded, she started waving her hands back and forth. She was not able to speak because she was still intubated and as I moved over to assess her, she grabbed my hand and kissed it. I will never forget that day as long as I live.

At the end of the day, I feel the most satisfaction when the treatment provided to my patients uses no medicine at all. Whether it’s a comforting hand on the shoulder of a patient who has just lost his job, holding the hand of a grieving relative, or just simply a hug. Our patients have tremendous confidence and trust in us and we must not forget to show them that we truly care.

Learn more about J. Scott Litton, Jr., MD, and our other contributing bloggers here.