Chekhov, the Humanities, and the Physician | On Call with the Prairie Doc | April 18, 2019

>> ANTON CHEKHOV SAID: MEDICINE
IS MY LAWFUL WIFE AND
LITERATURE MY MISTRESS. WHEN I GET TIRED OF ONE, I
SPEND THE NIGHT WITH THE OTHER. “CHEKOV, THE HUMANITIES, AND THE PHYSICIAN,” TONIGHT, “ON CALL WITH THE PRAIRIE DOC.” >> GOOD EVENING, AND WELCOME TO
“ON CALL WITH THE PRAIRIE DOC.” THE TECHNOLOGY OF MEDICINE
OFTEN TAKES CENTER STAGE BUT THE PHILOSOPHY, COMPASSION, AND
ETHICS ARE KEY TO THE APPLICATION OF THOSE
TECHNOLOGIES. FIRST, LET’S TAKE A LOOK AT
THIS WEEK’S PRAIRIE DOC QUIZ
QUESTION. VERACITY IS A TERM IN ETHICS
THAT MEANS WHAT? A: HOW FAST MEDICAL ATTENTION
IS APPLIED IN A SITUATION. B: THE DIFFERENCE BETWEEN URBAN
AND RURAL MEDICINE. C: A HEALTH PROFESSIONAL SHOULD
BE HONEST, GIVE FULL DISCLOSURE
TO PATIENT WITHOUT
MISREPRESENTATION OF THE FACTS. VIEWERS WHO CALL IN THE CORRECT
ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF
OUR BOOK, “THE PICTURE OF
HEALTH.” EACH OF MY ESSAYS, ORIGINALLY
WRITTEN FOR THIS SHOW, COMES WITH A WONDERFUL ACCOMPANYING
PHOTOGRAPH BY DR. JUDITH
PETERSON. WE WILL ANNOUNCE THE ANSWER AND
THE WINNER AT THE END OF THE
SHOW. REMEMBER, YOU ONLY HAVE 10
MINUTES TO GET YOUR ANSWER IN! BUT WE ANSWER YOUR QUESTIONS
THROUGH THE WHOLE SHOW AS THEY ARE CALLED IN OR SEPTEMBER TO
US VIA Facebook OR EMAIL. CALL IN QUESTIONS TO
1-888-376-6225, OR SEND US AN
EMAIL TO THE ADDRESS ON THE
SCREEN. I KNOW THIS IS AN INTERESTING
AND DIFFERENT TOPIC THAT DOESN’T SPECIFICALLY ASK
MEDICAL QUESTIONS BUT IT’S PHILOSOPHICAL, WE WANT YOUR
QUESTIONS. PLEASE GIVE US YOUR
QUESTIONS. JOINING US TONIGHT ARE DR.
JEROME FREEMAN, M.D., WHO IS A PROFESSOR AND THE CHAIR OF
THE DEPARTMENT OF NEUROSCIENCES AT THE UNIVERSOTY OF SOUTH
DAKOTA SANFORD SCHOOL OF MEDICINE AND SEES PATIENTS AT
SANFORD CLINIC NEUROLOGY HE IS AN INTERNIST AND THEN
TRAINED AS A NEUROLOGIST. AND DR. NELS GRANHOLM, PH.D.
WHO IS A DISTINGUISHED
PROFESSOR EMERITUS OF BIOLOGY, MICROBIOLOGY AND GLOBAL STUDIES
AT SOUTH DAKOTA STATE
UNIVERSITY. GENTLEMEN, THANK YOU FOR
JOINING US. >> THANK YOU. >> SO SOME PEOPLE SAY THAT IN
MEDICINE, WE HAVE ALL THE SCIENTIFIC KNOWLEDGE THAT IS
THE IMPORTANT BACKBONE OF WHAT WE DO, AND SOME PEOPLE SAY THE
OTHER SIDE IS THE HUMAN COMPONENT, THE HUMANITIES, THE
DEPTH OF PERSONALITY THAT A PHYSICIAN OR CARE PROVIDER HAS
THAT MAKES THE REASON FOR THE
SCIENCE. THEY SEEM TO BE IF TWO
DIFFERENT AREAS. NELS, TELL US A BIT ABOUT WHAT
YOUR PERSPECTIVE IS ON THE TWO SIDES OF A PHYSICIAN, THE
SCIENCE AND THE HUMANITIES PART. >> WELL, I HAD A COLLEAGUE IN
THE BIOLOGY DEPARTMENT WHO I WOULD ASK, WOULD YOU RATHER
HAVE A PHYSICIAN WHO’S OPEN, PERSONABLE AND COULD PROVIDE
LOTS OF CARE AND WARMTH AND HEALTH AND SO ON BUT PERHAPS
WASN’T THE GREATEST OF ALL TECHNICAL PIZES OR WOULD YOU
RATHER HAVE AN INDIVIDUAL WHO WAS A SUPERB TECHNICAL SURGEON
BUT HAD VERY LITTLE PERSONALITY
OPERATE ON YOU. AND MY COLLEAGUE WOULD SAY, I
WANT THE TECHNICIAN. NOW, I WOULD THINK, ON THE
OTHER HAND, THAT I WOULD RATHER GO WITH THE PERSONABLE
PHYSICIAN BECAUSE AS YOU WERE
MENTIONING EARLIER TONIGHT, RICK, WHEN THE PERSONABLE
PHYSICIAN COMES IN YOUR ROOM
AND ASKS YOU HOW YOU’RE DOING, YOU IMMEDIATELY FEEL 100%
BETTER AND I THINK HAS ALL VERY
IMPORTANT. SO, GIVEN ONE OR THE OTHER, I
WOULD GO WITH THE MORE
PERSONABLE PHYSICIAN. >> AND MY RESPONSE AS AN
INTERNIST, NON-SURGEON IS, WELL, THE SURGEON YOU KIND OF
WANT THE TECHNICIAN A — TECHNICIAN THEN, OTHERWISE YOU
WANT THE INTERNIST. >> WELL, I WOULD ARGUE WE DON’T
WANT TO SET UP THIS DICHOTOMY. WHAT WE REALLY WANT IS
INCREDIBLY SKILLED PHYSICIANS,
TECHNICALLY, SCIENTIFICALLY, WHO ALSO HAVE THE HUMAN TOUCH
AND CAN INTERACT VERY EFFECTIVELY WITH PATIENTS AND
FAMILIES. WE WANT BOTH. THAT SHOULD BE OUR EXPECTATION.
>> YES. >> NOT THAT IT’S OKAY TO BE ONE
OR THE OTHER. >> YEAH. >> THE PROBLEM IS, THOUGH, AND
SOME WOULD ARGUE THAT IN THE LAST YEARS AS WE’VE GONE FOR
4-POINT STUDENTS WHO ARE BRILLIANT PEOPLE, WHO CAN
REALLY DO TESTS WELL, THAT WE HAVE IGNORED THAT HUMANITIES
SIDE AND SOMETIMES WE’VE LET INTO OUR MEDICAL SCHOOLS PEOPLE
WHO ONLY HAD THAT ONE SIDE. >> BUT I THINK THAT’S A
CHALLENGE FOR ALL MEDICAL SCHOOLS AND IT’S A CHALLENGE
THAT WE FEEL, WE, THE FACULTY
FEEL AT OUR MEDICAL SCHOOL. WE WANT PHYSICIANS WHO ARE —
CAN TREAT THE ENTIRETY OF A PERSON AND SO WE WANT OUR
SKILLED, TECHNICAL EXPERTS TO ALSO BE COMPASSIONATE, HUMAN
AND KIND, SO WE REALLY DO HAVE PROGRAMMING THAT STRIVES TO
BRING BOTH ASPECTS TOGETHER AND I THINK THAT’S THE BEST WAY TO
GO. >> I REALLY DO, TOO. >> WELL, THE HUMANITIES, THE
STUDY OF THE HUMANITIES INCLUDES A LOT MORE THAN
SCIENCE AND MATH. WHAT IS THE STUDIES OF
HUMANITIES IN HIGH SCHOOL AND
— WELL, GRADES SCHOOL, HIGH SCHOOL, COLLEGE, THAT
SHOULD EXTEND — SHOULD TEACH
US THE HUMAN SIDE OF THINGS,
NELS? >> WELL, I THINK ONE OF THE
BEST THINGS, RICK, ABOUT BEING ABLE TO TEACH BIOETHICS IS THAT
THE FIRST THREE TO OUR OR FIVE WEEKS OF THE COURSE WAS DEVOTED
TO FUNDAMENTAL PRINCIPLES OF MORAL PHILOSOPHY, SO WE WOULD
GET INTO THE HISTORY OF PHILOSOPHY, MAYBE WOULD TALK
ABOUT DIFFERENT MORAL SYSTEMS, HOW ONE MAKES DECISIONS AND
OFTENTIMES THAT WOULD LEAD INTO
A DISCUSSION OF GREAT
LITERATURE. FOR EXAMPLE, WE WOULD TALK
ABOUT BOOKS THAT WE’VE BEEN READING AND BOOKS WE HAD READ
IN CLASSES AND JUST TO QUOTE ONE PARTICULAR BOOK THAT WE
USED TO LIKE TO READ, WE USED TO READ A BOOK CALLED “THINGS
FALL APART.” AND IN THAT TEXT, THE AUTHOR,
ACHABE, WAS ABLE TO PROVIDE US
A REAL FUNDAMENTAL UNDERSTANDING OF WHAT’S SUPER
IMPORTANT WITH REGARD TO HUMAN FEELINGS AND HUMAN BEHAVIOR,
AND WHAT’S IMPORTANT IN LIFE. SO WE THOUGHT THAT THAT WAS A
VERY FUNDAMENTALLY IMPORTANT THING TO DO AS WELL AS TO TEACH
THE FUNDAMENTAL PRINCIPLES. BUT, I REALLY BELIEVE THAT WE
NEED TO STRESS MORE ON THE HUMANITIES AND LESS ON THE
MECHANICAL ASPECTS OF THE
SUBJECTS WE’RE TEACHING. >> JERRY, DO YOU THINK WE CAN
TEACH — DO YOU TEACH A PERSON
TO HAVE KINDNESS, COMPASSION, CAN YOU TEACH THAT OR IS THAT
SOMETHING THAT JUST COMES BECAUSE OF THE — HIS OR HER
CHILDHOOD EXPERIENCE OR IS IT
BUILT IN IN THEIR PERSONALITY
OR — >> I MEAN THERE CERTAINLY ARE
PERSONALITY CHARACTERISTICS THAT ENABLE SOME PEOPLE TO MORE
EASILY ACT IN A COMPASSIONATE UNDERSTANDING MANNER BUT I
THINK IT CAN BE TAUGHT AND PART OF THE ISSUE IS THE MEDICAL
PROFESSION HOLDS UP AS AN IMPORTANT CHARACTERISTIC AND SO
IF PROFESSIONALISM AND KINDNESS AND INTEGRITY ARE HELD UP AS
BEING CRUCIAL, IF THESE ARE TALKED ABOUT, IF THEY’RE
EMULATED TO STUDENTS, I THINK
STUDENTS GRASP ON TO THIS. THEY UNDERSTAND IT. AND SO I DO
THINK IT CAN BE MODELED AND ENHANCED IN THE
MEDICAL SCHOOL AND IN EDUCATION. >> THERE WAS A PRIEST Ph.D.,
M.D., WHO IS — I’M BLOCKING ON HIS NAME BUT I MET HIM AND I
WAS ON A COMMITTEE WITH HIM, WHO WROTE ABOUT THE VALUE OF
PHYSICIAN TEACHERS SHOWING KINDNESS TO THEIR STUDENTS TO
TEACH — AND TO THEIR PATIENTS AND THAT’S HOW YOU TEACH THE
STUDENTS TO BE KIND. YOU SAID
THE SAME THING. YOU’VE WRITTEN — I’VE READ
YOUR WORDS THAT SAID WE ARE THE
EXAMPLES BY WHICH THEY LEARN. ALTHOUGH I CAN REMEMBER SOME OF
MY TEACHERS AT MEDICAL SCHOOL WHO WERE TEACHING BY THE
SOCRATIC METHOD AND WERE HARSH AND DEMANDING AND EXPECTED
EVERYTHING OF ME, AND EVERY ONE
OF US. >> SURE, SURE. >> WHICH I
THOUGHT ALSO HAD SOME
CREDIBILITY. NELS, WHAT DO YOU — WHAT’S
YOUR RESPONSE TO THAT? >> WELL, I THINK YOU’RE RIGHT
ON WITH THAT ANALYSIS. ONE OF THE THINGS I THOUGHT WAS
PARTICULARLY VALUABLE WITH TEACHING BIOETHICS, THE
STUDENTS WERE EAGER, RICK, TO
GRAPPLE WITH THESE PROBLEMS. AND ONE OF THE THINGS WE USED
TO DO, WE MET FOR TWO HOURS
TWICE A WEEK. DURING THE FIRST HOUR, YOU
WOULD INTRODUCE THE SUBJECT OF
THE DAY. WE WOULD HAVE A LITTLE TALK
ABOUT WHAT THE EXPERTS SAID
ABOUT IT AND [INDISCERNIBLE] SAID ABOUT IT, AND IN THE
SECOND HOUR, WE WOULD DELIBERATE SPECIFIC CASE
STUDIES SO THE STUDENTS WOULD WORK AND BREAK UP AND WORK IN
GROUPS OF FOUR OR FIVE, AND THEY WOULD DELIBERATE A
PARTICULAR CASE. THEN IN THE LAST 15 MINUTES OF
THE SECOND HOUR, THEY WOULD REPORT BACK TO THE GROUP AS A
WHOLE HOW THEY EVALUATED THOSE PARTICULAR CASES BASED ON
DIFFERENT KIND OF MORAL
PHILOSOPHIES. THERE WAS SO MUCH ENTHUSIASM
GOING ON DURING THOSE MEETINGS AND SO MUCH GOOD STUFF THAT
WOULD BE OCCURRING, THAT EVEN AFTER THE PERIOD WAS OVER, THE
12:00 BELL RANG, THEY WOULD GO DOWN THE HALL, STILL ARGUING
THE CASES. SO I THOUGHT THAT WAS REALLY
INTERESTING AND I THOUGHT IT WAS A VERY GOOD SIGN OF — WE
WERE ACCOMPLISHING SOMETHING OF
GREAT VALUE. >> MAKING A DIFFERENCE. >> YES. >> JERRY, YOU’VE TAUGHT ETHICS
IN THE SAME MANNER, I’M SURE. >> WELL, WHAT NELS IS TALKING
ABOUT IS THE POWER OF HUMAN LIVES, HUMAN STORY, AND RATHER
HAND JUST DEALING WITH ABSTRACT PRINCIPLES, IF WE TALK ABOUT
WHAT ACTIONS MEAN TO PEOPLE, WHAT STRUGGLES TAKE PLACE WHEN
YOU TRY TO DECIDE WHAT TO DO AND WHAT NOT TO DO, IT’S VERY
COMPELLING. IT’S COMPELLING FOR STUDENTS
AND IT’S COMPELLING FOR
CLINICIANS. >> SO I’LL GIVE YOU A STORY. SO
I’M AN INTERN AND I’M ASKING
YOU TO GIVE STORIES, TOO. SO I’M A BRAND-NEW INTERN AND
THE ONCOLOGIST IS A Dr. KELLER FROM EMORY, AND I
THINK HE’S STILL ALIVE, AND HE’S BEEN — I’VE HEARD THIS
SAME STORY FROM MULTIPLE OTHER DOCTORS WHO WERE OUT THERE THAT
HE TAUGHT, AND THAT WAS, WATCHING THAT MAN WITH THE
COMPASSION AND THE EMPATHY AND THE WILLINGNESS TO HELP A MAN
THROUGH, OR A PATIENT THROUGH THEIR DYING PROCESS, AND
WATCHING HIM AS HE HAD THE SCIENCE BEHIND IT, BUT IT WAS
THE LOVING KINDNESS THAT HE JUST EMULATED AND THEN HE
TURNED IT ON US, AND IT WAS THAT TEACHER THAT STILL STICKS
IN MY MIND AS ONE OF THE BEST
TEACHERS I EVER HAD. >> I THINK ALL OF US HAVE HAD
THOSE EXPERIENCES AND THE THING ABOUT THE KINDNESS YOU
MENTIONED IS THAT IT’S NOT JUST BEING COMPASSIONATE OR
EMPATHETIC, KINDNESS IS WHAT WHAT WE DO AND HOW WE DO IT BUT
IT’S AN ACTION AND THAT’S I THINK WHAT MAKES IT ALL THE
MORE POWERFUL. WE ALL KNOW WHEN
WE’RE TREATED TREATED KINDLY OR
NOT. >> MY WIFE SAYS, WHEN SOMEONE
SAYS WHAT’S CHURCH, AND THEY SAY GOD, AND SHE SAYS LOVE IN
ACTION. THAT’S IT. >> THERE IS A TENDENCY THESE
DAYS TO FEEL ISOLATED, AWAY FROM OTHERS AND MAKING
DISCUSSIONS ABOUT “THEM” AND
“US.” BUT WOULDN’T IT BE A NICER
WORLD IF WE LISTENED, TOO? >> THE NUMBER ONE REASON I
THINK LITERATURE IS IMPORTANT
TO ALL PEOPLE IS BECAUSE THROUGH LITERATURE, WE LEARN
EMPATHY, AND EMPATHY IS ABOUT FEELING WHAT OTHER PEOPLE ARE
FEELING, GETTING INSIDE
SOMEONE’S SKIN AND PROCESSING WHAT THEY’RE THINKING AND
FEELING. I MEAN, I CAN’T IMAGINE
ANYTHING MORE IMPORTANT THAN BEING ABLE TO RELATE TO A
PATIENT AND NOT JUST WITH SYMPATHY BUT WITH EMPATHY,
REALLY, TRULY UNDERSTANDING. WHEN WE READ THE SHORT STORY,
THE “SCARLET IBIS,” I REMEMBER ONE TIME I HAD A YOUNG MAN,
EIGHTH GRADER WHO WAS A SMART
KID, A GOOD STUDENT, CONSCIENTIOUS STUDENT, SO I
KNEW HE WOULD BE SUCCESSFUL. HE WAS A SUCCESSFUL STUDENT BUT
AT THE END OF THE STORY, HE PUT HIS HEAD DOWN ON HIS DESK AND
HE CRIED. AND I THOUGHT, THIS
KID IS EMPATHETIC. HE’S GOING TO BE A SUCCESSFUL
DAD AND PARTNER AND BUSINESSMAN
AND COMMITTEE MEMBER. HUMAN BEING. BECAUSE HE KNOWS
HOW TO BE EMPATHETIC. I THINK THERE IS A REAL CONCERN
IN TODAY’S CULTURE THAT WE’RE NOT EMPATHETIC ENOUGH, THAT WE
ARE MORE CONCERNED WITH OUR OWN FEELINGS AND I THINK THAT IT’S
SO IMPORTANT THAT WE REMEMBER THAT BEING EMPATHETIC MEANS
BEING A BETTER HUMAN BEING. IT ISN’T JUST ABOUT RELATING TO
PATIENTS OR, IN MY CASE, STUDENTS AND TEACHERS, IT’S
ABOUT BEING ABLE TO RELATE
BETTER TO COLLEAGUES. SOMEBODY WHO’S EMPATHETIC WILL
MAKE A BETTER COMMITTEE MEMBER, A BETTER GROUP MEMBER BECAUSE
THEY’LL LISTEN TO EACH OTHER AND WORK HARD TO UNDERSTAND
EACH OTHER, WHERE PEOPLE ARE
COMING FROM. AND WOULDN’T THAT BE A BETTER
WORLD IF WE ALL DID THAT? READING IS HIMSELF A GREAT FORM
OF RELAXATION. I DON’T KNOW IF YOU CAUGHT
DORIS KERNS GOODWIN THE OTHER NIGHT, SHE WAS TALKING ABOUT
PRESIDENTS WHO UNDERSTAND THAT YOU NEED TO LET GO OF STRESS TO
BE A HEALTHIER PERSON. FDR, FOR EXAMPLE, HAD HIS
EVENING COCKTAIL PARTIES BECAUSE THAT WAS HIS WAY TO
DE-STRESS. TEDDY ROOSEVELT WOULD GO OUT
AND RIDE HORSES TO DESTRESS. WELL, I MAKE A CASE FOR READING
BOOKS. BECAUSE NOT ONLY ARE YOU DOING
ALL THE THINGS I MENTIONED PREVIOUSLY, ABOUT BEING
EMPATHETIC AND, A GOOD INTUITIVE READER, WHEN YOU
READ, YOU ESCAPE AND IT’S SUCH A GREAT WAY TO LET GO OF OTHER
THINGS, SO I WOULD SAY, DON’T
GIVE UP ON READING LITERATURE. ANYBODY, YES, YOU READ YOUR
TRADE MAGAZINES AND, YES, YOU READ THE NEWSPAPER AND THAT’S
ALL GOOD. BUT THERE’S SOMETHING TO BE
SAID FOR LITERATURE THAT WILL BE GOOD FOR YOUR BRAIN AND GOOD
FOR YOUR SOUL. >> THANK YOU, BECKY, FOR THAT
WONDERFUL COMMENT. I THINK WHEN SHE SAID ABOUT
LISTENING WAS SO VERY POWERFUL
AND EMPATHY. THIS IS YOUR PROGRAM AND YOUR
QUESTIONS ARE KEY TO THE
DIRECTION OF OUR DISCUSSION. CALL IN YOUR QUESTIONS TO
1-888-376-6225 OR SEND US AN
EMAIL TO [email protected] AND WE DO HAVE A QUESTION, A
FEW QUESTIONS HIM A WOMAN FROM SIOUX FALLS ASKS ABOUT A FEMALE
FRIEND WHO HAS DEMENTIA. IN HER DEMENTIA, SHE THINKS
SHE’S NOT PRESENT BECAUSE SHE
HAS A GIRLFRIEND. WHAT IS THE BEST WAY TO HANDLE
IT? SHE THINKS HE IS NOT PRESENT
BECAUSE — IT’S A HUSBAND,
APPARENTLY. WHAT IS THE BEST WAY TO HANDLE
THIS? THE CALLER ALSO PRAISES US FOR
HAVING Dr. FREEMAN ON THE SHOW. DIDN’T SAY A WORD ABOUT YOU,
NELS. [Laughter] SO WHAT ABOUT THIS DEMENTIA?
HOW DO YOU HANDLE COMMENTED
PEOPLE WHO ARE OFF ON A TANGENT? >> WELL, A KEY IS YOU CAN’T
REASON OR ARGUE A PERSON TO A DIFFERENT POSITION OR A
DIFFERENT UNDERSTANDING. THEY JUST HAVEN’T CAPABLE OF
RECALLING ALL THE TIME WHAT YOU
SAY. SO IT’S IMPORTANT TO BE
REASSURING, SOMETIMES JUST READ — KINDLY REDIRECTING
SOMEBODY’S INTEREST. IT TAKES AN INCREDIBLE AMOUNT
OF PATIENCE AND I HAVE TO SAY I’VE BEEN SO IMPRESSED OVER THE
YEARS THE SKILL THAT FAMILIES BRING TO DEALING WITH AN
IMPAIRED FAMILY MEMBER. IT’S JUST HEART-WARMING TO SEE
THE LOVE AND DEVOTION AND
TENDERNESS THAT PEOPLE EXHIBIT. >> LIKE YOU SAY, I THINK YOU
DON’T HAVE TO — YOU DON’T NEED TO DENY THEM A DELUSION, JUST
GO WITH THE FLOW, REDIRECT THEM
AND LOVE THEM. >> AND LOVE
THEM, YEAH. >> A SIOUX FALLS MAN ASKS COULD
YOU COMMENT ABOUT THE HUMANITY OF NOT ONLY THE DOCTORS’
MATTERS BUT ALSO OF THE STAFF. ONE TIME I CHANGED SURGEONS
BECAUSE OF THE SURGEON’S
RECEPTIONIST. THAT’S
INTERESTING. NELS? >> YEAH, IT’S KIND OF TOO BAD
THE RECEPTIONIST HAD TO BE INFLUENTIALAL IN THAT MAJOR
DECISION BECAUSE, REALLY, THAT HAD NOTHING TO DO WITH THE
MEDICINE OR THE MEDICAL ASPECT
OF THAT. >> THE STAFF NEEDS TO BE KIND.
>> YES. >> I CAN TELL YOU, THEY
CERTAINLY TRAIN PEOPLE IN CERTAIN INSTITUTIONS TO BE
KINDER. >> YEAH, YEAH. >> AND I’VE FOUND VERY KIND
STAFF IN DIFFERENT SCENARIOS. ONE THING, THOUGH, WHEN I COME
BACK — TODAY I WAS AT THE HOSPITAL FOR SOME TESTING SO
I’M BROUGHT IN BY THE RECEPTIONIST AND THE PERSON AT
THE FRONT DESK AND THE PERSON WHO SETS ME UP AND WHO STARTS
THE I.V. AND DRAWS THE BLOOD AND DOES THE CAT SCAN AND I
COULDN’T HAVE FELT MORE LOVED. IT’S JUST BEING IN MY OWN HOME,
YOU KNOW, AND THEY KNEW ME, AND I THINK TO MYSELF, WELL, IT’S
UNFAIR FOR ME TO JUDGE BECAUSE THEY — I’VE BEEN A DOCTOR
THERE FOR SO LONG. >> LET ME FOLLOW UP ON
SOMETHING THAT JERRY SAID. WHEN I WAS A YOUNG MAN, I HAD A
FRIEND WHO HAD A LITTLE BROTHER WHO WAS MENTALLY — HAD MENTAL
PROBLEMS AND REALLY DIDN’T LIVE IN WHAT WE MIGHT CALL REALITY. HE WOULD MAKE THESE CLAIMS AND
ASSERTIONS ABOUT DIFFERENT THINGS, AND I FOUND IT WAS A
VERY GOOD IDEA NEVER TO COUNTER THOSE CLAIMS, BUT TO JUST BE
PATIENT. TALK ABOUT BASEBALL OR TALK
ABOUT GOING TO THE SWIMMING POOL OR SOME OTHER THINGS, TELL
HIM A JOKE OR WHATEVER, AND WE GOTTA LONG FAMOUSLY, AND HE WAS
VERY HAPPY DURING THOSE INTERIMS WHEN WE WOULD HAVE
THOSE DISCUSSIONS. >> YOU
DIDN’T HAVE TO COUNTER HIM. >> NO, NO. >> YOU JUST WENT
WITH THE FLOW. >> CORRECT. >> SOMETIMES I WONDER IF THAT
MIGHT BE THE RIGHT THING TO DO
IN A PERSON WHO ISN’T DEMENTED.
[Laughter] >> I DON’T THINK IT COULD DO
ANY HARM. >> NO, THERE IS A TIME WHEN YOU
COUNTER PEOPLE AND YOU FIGHT FOR THE PRINCIPLE AND THEN
THERE IS A TIME WHEN THEIR BELIEF IN THIS POLITICAL
CHARACTER OR THAT POLITICAL POINT IS NOT WORTH ARGUING AND
THE VALUE OF YOUR RELATIONSHIP
IS MORE IMPORTANT. >> YEAH,
YEAH. >> SO I THINK ABOUT THE ISSUE
OF THE — DEALING WITH DEMENTED PEOPLE AND, THAT’S A CHALLENGE
FOR A PHYSICIAN, TOO, IS IT NOT? >> YES, IT IS A CHALLENGE AND
ONE OF THE THINGS THAT I THINK IS SO IMPORTANT IN HEALTH CARE
TODAY IS THAT IT IS A
COLLABORATION. THE TREATING PHYSICIAN IS
COLLABORATING WITH FAMILY MEMBERS TO TRY TO HELP A
PATIENT BUT TO GET BACK TO THE LAST QUESTION ABOUT STAFF, TOO,
A PHYSICIAN CANNOT REALLY BE EFFECTIVE, IN MY OPINION,
WITHOUT A STRONG TEAM OF NURSES AND ANCILLARY STAFF AND IT’S
THE RESPONSIBILITY OF ALL OF US TO TRY TO NURTURE THE STAFF SO
THAT THEY ARE — >> THEY’RE
HAPPY. >> THEY’RE HAPPY AND ATTUNED TO
THE SAME VALUES WE HOPE TO
PORTRAY. >> YOU KNOW, BASICALLY, IT MAY
WELL BE THAT THAT SURGEON WAS NOT VERY FRIENDLY TO THAT
RECEPTIONIST AND HER LIFE OR HIS LIFE WAS NOT GREAT, WORKING
WITH THAT SURGEON. I THINK YOU HAVE A HAPPY STAFF,
YOU HAVE A MUCH BETTER BUSINESS. >> I FEEL SO BLESSED TO HAVE
THE EXCELLENT NURSING STAFF I HAVE, I HAVE TWO EXCELLENT
NURSES AND A LOT OF TIMES THE PATIENTS THINK I’M A PRETTY
LUCKY GUY BECAUSE THE NURSES TAKE SUCH GOOD CARE OF THE
PATIENTS AND THE PATIENTS IN
TURN FEEL GRATEFUL TO ME. >> YOU WIN. [Laughter] >> THE NURSING STAFF AND OTHER
ANCILLARY STAFF IS CRITICAL TO
GIVING GOOD HEALTH CARE. >> AND THEY REFLECT THE
LEADERSHIP THAT’S AROUND THEM,
TOO. >> YEP. >> SO, RICK, LET ME ASK
YOU A QUICK QUESTION. WHEN YOU MEET A NEW PATIENT
YOU’VE NEVER SEEN BEFORE, HOW
DO YOU APPROACH THEM? >> VERY CORDIALLY. AND I REALLY
OPEN MY MIND AND, REALLY, I LISTEN, AS BECKY
ECKLUND WAS SAYING, I DON’T THINK YOU CAN GIVE A PERSON A
BETTER GIFT THAN TO TRULY, TOTALLY OPEN YOUR HEART AND
LISTEN TO WHAT THEY’RE SAYING. AND THERE IS SUCH A DIFFERENCE
BETWEEN LISTENING AND THINKING, OKAY, NOW THIS IS WHAT I’M
GOING TO SAY AND THIS IS HOW I’M GOING TO RESPOND TO THAT
AND THIS IS MY — THIS IS HOW I CAN RESPOND AND INSTEAD TO SAY
WHAT CAN I LEARN? OH, I’M LEARNING THIS, I’M
REALLY, REALLY LISTENING. AND I THINK BEING A PHYSICIAN
HAS TAUGHT ME TO LISTEN BECAUSE THAT’S WHAT YOU DO ALL DAY
LONG, YOU WALK IN THAT ROOM AND THE MORE YOU LISTEN, THE BETTER
YOU LEARN, THE BETTER YOU DO. AND, REALLY, LISTENING IS LOVE
IN ACTION. IT’S — IT’S
KINDNESS — BECAUSE PEOPLE REALLY — MANY
PEOPLE ARE NEVER HEARD, PARTICULARLY GERIATRIC PEOPLE
WHO ARE LONELY. >> AND THERE ARE MANY — WHEN
PEOPLE COME TO MY OFFICE, THEY’RE SENT FOR A REASON BUT
THAT MAIN REASON MAY NOT BE THE REASON FOR THE PERSON BEING
THERE. I WANT TO HEAR FROM THE PATIENT
HIM OR HERSELF WHAT THEY HOPE TO GET OUT OF THE MEETING,
WHAT’S IMPORTANT, MOST
IMPORTANT TO THEM. LISTENING IS CRUCIAL, AS YOU
SAY. >> I HAD A QUESTION EARLIER
ABOUT PANHANDLERS. SO THIS IS
AN ETHICAL DILEMMA. WE WERE — MY WIFE AND I WERE
IN MEMPHIS VISITING — WELL, SHE WAS AT A MEDICAL CONFERENCE
AND I WAS A TAG-ALONG, GREAT
FUN BEING A TAG-ALONG. AND WE RAN INTO SOME
PANHANDLERS. WE ALSO SOME PANHANDLERS THAT
CAME INTO BROOKINGS ON THE WAY HOME AND MY ANSWER HAS ALWAYS
BEEN, TURN MY HEAD AWAY, NO THANK YOU, AND THEY GO, NO
HARM, NO FOUL, OR THEY TURN AWAY, OR THEY SWEAR AT YOU. IT
DEPENDS. BUT I’VE ALWAYS
THOUGHT, REALLY, WHEN A PERSON IS AN
ALCOHOLIC, FOR EXAMPLE, SOMETIMES FAMILY HAS TO LET
THEM HIT THE BOTTOM BEFORE THEY
PULL THEMSELVES OUT. AND WE READ AN ARTICLE TOGETHER
TODAY THAT SAID THAT A MAN WHO HAD BEEN ON THE BOTTOM AND HAD
BEEN A DRUG ADDICT AND HAD FOUND HIS WAY OUT ALWAYS GAVE
THEM SOMETHING, AND THAT WE
SHOULD BE KIND TO THEM. >> SURE, SURE. >> WHAT’S YOUR
— I WOULD ASK THE TWO OF YOU,
YOUR RESPONSE TO THAT. I HAVE ALWAYS BEEN A, NO, I’M
NOT GOING TO GIVE YOU $5 TO GO
BUY MORE ALCOHOL. WHAT’S YOUR RESPONSE? >> JERRY? >> WELL, I THINK THIS IS — AND
I’VE BEEN IN THE SAME SITUATION MANY TIMES AND THINKING ABOUT
IT RIGHT NOW, PART OF OUR — MY STRUGGLE, AND I SUSPECT YOURS,
TOO, IS NOT KNOWING THAT INDIVIDUAL’S STORY, NOT KNOWING
THEIR NARRATIVE, NOT KNOWING WHAT TOUGH TURNS THEIR LIFE HAS
TAKEN. IT COULD GREATLY INFLUENCE EACH
OF US, IF WE KNOW WHO IS
STANDING BEFORE US. >> YES. >> OF COURSE, THE GREAT
MYTH AND IN THE BIBLE, IT SAYS, THAT’S JESUS THERE IN FRONT OF
YOU, YOU KNOW, AND THOSE WHO TREAT THE PANHANDLER OR THAT
BEGGAR OR THAT PERSON IN THAT WORST SCENARIO IS LIKE WHAT
YOU’RE BEING TREATED YOURSELF. >> WOULDN’T IT BE WONDERFUL,
RICK, IF YOU WERE ACCOSTED BY A PANHANDLER AND YOU WALKED OVER
TO THEM AND YOU SAID, LET’S YOU
AND I GO TO LUNCH. WE’LL SIT DOWN, HAVE A NICE
DINNER, WE’LL TALK THINGS OVER AND THEN WE’LL SEE HOW THINGS
GO. DO YOU THINK THAT WOULD
WORK IS THIS >> I DON’T KNOW. A GOOD
QUESTION. [Laughter] >> I DON’T
KNOW THE ANSWER TO THIS. AND MY WIFE AND I HAD A LONG
CONVERSATION AND — BUT IT WAS CERTAINLY ANOTHER WAY OF
RESPONDING TO IT. WE’VE GOT ANOTHER QUESTION, A
WOMAN ASKS, WHAT ARE YOUR THOUGHTS ABOUT THE QUALITY OF
CARE DIFFERENCES BETWEEN A HOSPITALIST AND A PRIMARY CARE
PROVIDER? HOW CAN A DOCTOR GIVE CARE TO
SOMEONE THEY JUST MET IN A
HOSPITAL? JERRY. >> WELL, IT’S AN INTERESTING
QUESTION BECAUSE THE WHOLE MODEL OF HEALTH CARE IS
CHANGING RIGHT NOW. THERE’S MORE AND MORE EMPHASIS
ON WHAT ARE CALLED HOSPITALISTS. YOU KNOW, THEY COVER THE
HOSPITAL 24/7 AND IN THE OLD DAYS, WHEN MY GROUP AND I USED
TO SEE PATIENTS IN THE OFFICE, AND THEN GO TO THE HOSPITAL,
FREQUENTLY WE WERE LITERALLY RUNNING BACK AND FORTH, IF
THERE WAS A CRISIS IN THE HOSPITAL, PEOPLE IN THE OFFICE
MIGHT WAIT A LONG TIME TO BE
SEEN. BUT WITH THE HOSPITALIST
SYSTEM, YOU DO LOSE THE PERSONAL TOUCH OF THE PHYSICIAN
YOU’VE KNOWN, WHO HAS CARED FOR YOU FOR A LONG PERIOD OF TIME,
YOU WOULD LIKE TO HAVE THAT PERSON WITH YOU IN THE
HOSPITAL, AS WELL. IT’S A DILEMMA THAT DOESN’T
HAVE AN EASY ANSWER BUT I THINK I CAN SAY WITH SOME ASSURANCE
IT’S NOT GOING TO CHANGE SOON, THAT WE ARE MOVING MORE TO
OUTPATIENT PHYSICIANS ON ONE SIDE AND HOSPITAL-BASED
PHYSICIANS ON THE OTHER. >> AND ENGLAND HAS HAD THAT FOR
A LONG TIME, APPARENTLY. SO I WAS LISTENING IN MY ADULT
SUNDAY SCHOOL CLASS TO A CATHOLIC RELIGIOUS LEADER,
RICHARD ROAR. WONDERFUL PHILOSOPHER WHO
SPEAKS ABOUT THE VALUE OF NOT DUEL THINKING, YOU KNOW, GOOD
AND BAD, THAT THE WORLD IS REALLY CYCLIC AND THERE’S NO
GOOD OR BAD, THAT, REALLY, IT’S ALL TEMPORAL AND TIMING OVER
100 YEARS WHAT WAS BAD WILL BE GOOD, AND THERE’S CHANGES, AND
HE TALKS ABOUT THE TRINITY. HE’S A VERY SOLID RELIGIOUS
PHILOSOPHER. AND HIS STATEMENT IS THAT
SOMETHING HAPPENS IN MIDDLE LIFE WHERE PEOPLE CHANGE FROM
I’VE GOT TO THINK ABOUT ME BECAUSE I’VE GOT TO LEARN TO
BECOME A DOCTOR, I’VE GOT ALL THIS WORK AND IT’S ALL ABOUT ME
AND IT’S ME, ME, ME, AND THEN SOMEWHERE ALONG THE LINE
OFTENTIMES AFTER A TRAGEDY, PEOPLE BECOME MATURE
PHILOSOPHICALLY AND THEY GO,
OH, IT’S NOT ABOUT ME. WHAT DO YOU THINK ABOUT THAT,
NELS? I MEAN, MY — SOME PEOPLE REACH
THAT POINT, I THINK A LOT EARLIER, SOME PEOPLE NEVER
REACH THAT POINT. >> I WOULD WONDER, IF YOU COULD
REACH THAT POINT WITHOUT HAVING A TRAGEDY IN YOUR LIFE, AND I
THINK ONE WAY YOU MIGHT BE ABLE TO DO THAT, RICK, IS THROUGH
THE ANALYSIS OF THESE MORAL PHILOSOPHIES THAT FORM THE
BASIS OF ETHICAL THEORIES, AND YOU DID A NICE JOB OF THIS IN
YOUR BOOK, WHEN YOU TALKED
ABOUT ETHICS. YOU TALKED ABOUT VIRTUES, YOU
TALKED ABOUT FUNDAMENTAL PRINCIPLES OF ETHICS, AND YOU
TALKED ABOUT UTILITARIANISM. MY OWN PARTICULAR VIEW ON ALL
OF THAT IS I WOULD PREFER, IF POSSIBLE, TO DEVELOP A SERIES
OF MORAL PRINCIPLES, AND TO ADOPT THOSE FOR DIFFERENT
SCENARIOS AND FOR DIFFERENT
CIRCUMSTANCES. I’M NOT REAL KEEN ON THE
UTILITARIAN METHOD. >> NO. >> I’M NOT REAL KEEN ON THE
GREATEST HAPPINESS PRINCIPLE, SO I WAS INTERESTED AND
HEART-WARMED BY YOUR ANALYSIS IN YOUR TEXT OF THE ETHICAL
PRINCIPLES THAT YOU’VE USED. >> WELL, THANK YOU FOR READING
MY BOOK AND THANK YOU FOR
MENTIONING IT ON AIR. >> YOU’RE QUITE WELCOME. >> I
TRIED TO WRITE IN AN UNDERSTANDABLE WAY AND THE
PROBLEM WITH UTILITARIAN, DO
THE MOST GOOD FOR THE MOST
PEOPLE. THE PROBLEM WITH THAT IS YOU
CAN JUSTIFY ALMOST ANY — >> YES, YOU CAN, YOU CAN. >> —
ALMOST ANYTHING. JERRY, ANY
COMMENT? >> WELL, I THINK THERE IS A LOT
TO BE SAID IN LIFE IN GENERAL BUT IN MEDICINE FOR WISDOM AND
EXPERIENCE AND AS PHYSICIANS BECOME MORE EXPERIENCED IN THE
CARE OF PEOPLE, THEY BEGIN, I THINK, TO BECOME MORE
REFLECTIVE. OUR MAJOR MEDICAL JOURNALS, THE
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, NEW ENGLAND
JOURNAL, IT IS ANNALS OF INTERNAL MEDICINE, ALL OF THEM
NOW HAVE COLUMNS WHERE EXPERIENCED PHYSICIANS,
USUALLY, ARE WRITING IN AND REFLECTING WHAT IT MEANS TO BE
A DOCTOR, WHAT IT MEANS TO BE A PATIENT AND HOW WE SHOULD BEST
TREAT PEOPLE. THAT’S — THAT’S — I THINK
IT’S A VOICE OF WISDOM AND EXPERIENCE THAT CAN BENEFIT ALL
OF US. >> RIGHT. AND THOSE ARE MY JOURNALS, I
LOVE THAT YOU MENTIONED IT. THE ONLY OTHER JOURNAL WHICH
YOU USED TO BE THE EDITOR AND WRITE THOSE SAME KIND OF
ARTICLES WAS THE SOUTH DAKOTA
MEDICAL JOURNAL. JUST TO COMMENT ABOUT THANK YOU
FOR THOSES YEARS OF BEING EDITOR OF SOUTH DAKOTA MEDICAL
JOURNAL. >> TELLING STORIES OF FICTION
IS OFTEN AN EFFECTIVE METHOD TO EXPLAIN A REAL WORLD SITUATION
THAT IS DIFFICULT TO EXAMINE
ANY OTHER WAY. >> HELLO. I WOULD LIKE TO
WELCOME OUR SON, ERIC, TO THE
SHOW. THANK YOU FOR JOINING US. >> THANKS, DADS >> WHAT HAVE
YOU GOT FOR US TODAY? >> WELL, I MADE A THEATRICAL
ADAPTATION OF A SHORT STORY BY THE GREAT RUSSIAN DOCTOR, ANTON
CHEKOV. HE WAS AN AMAZING FIGURE
BECAUSE HE MAINTAINED HIS MEDICAL PRACTICE THROUGHOUT HIS
CAREER AS A REALLY INNOVATIVE PLAYWRIGHT AND SHORT-STORY
WRITER IN RUSSIA IN THE LATE
1800s. I’VE GOT THIS EXCERPT FROM THE
PLAY, CALLED WARD NUMBER 6. YOU BE THE DOCTOR, I’LL BE THE
MAD MAN, EXACTLY, SET IN AN ASYLUM FOR THE MENTALLY ILL IN
THE LATE 1800s IN RURAL RUSSIA AND GO AHEAD, GIVE US A
LITTLE OF THE — >> GIVE HER A
TRY. >> OKAY. >> THE DOCTOR HAS COME,
FINALLY. KILL THE RAT. NO, NO, KILLING’S NOT ENOUGH,
DROWN HIM IN THE OUTHOUSE. >> WHAT FOR? >> WHAT FOR? YOU
THIEF? CAM DOWN, I’VE NEVER
STOLEN ANYTHING. >> WHY DO YOU KEEP ME HERE? >>
BECAUSE YOU’RE SICK. >> WELL, MAYBE I AM BUT
HUNDREDS OF MADMEN WALK AROUND EVERY DAY AND YOU CAN’T TELL
THE DIFFERENCE. SO WE REPRESENT THE MAD MEN
LIKE SCAPEGOATS. WHERE’S THE
SENSE IN THAT? >> WELL, MAYBE YOU’RE RIGHT.
THERE ISN’T A LOT OF SENSE TO
THAT. >> RELEASE ME. >> I CAN’T. >>
BUT WHY NOT? >> WELL, I COULD
BUT WAS GOOD WOULD IT DO? I MEAN, SINCE PRISONS AND MAD
HOUSES EXIST, SOMEONE MUST SIT
IN THEM. IF NOT YOU, THEN ME OR IF NOT
ME, SOME OTHER THIRD PERSON. >> BETTER TIMES WILL COME. YOU
WON’T SAY IT VERY WELL, YOU MIGHT LAUGH AT ME BUT THE TRUTH
WILL WIN AND WE’LL CELEBRATE IT. YOU AND I WILL BE DEAD BY THEN
BUT SOMEBODY’S
GREAT-GRANDCHILDREN WILL SEE IT. THERE WILL BE NO MORE PRISONS
OR MAD HOUSES, AND NO WINDOWS WILL EVER AGAIN HAVE BARS ON
THEM. I SALUTE YOU,
GREAT-GRANDCHILDREN. FORWARD, FROM BEHIND THESE
BARS, I BLESS YOU. LONG LIVE
THE TRUTH. >> YOU KNOW, IN ALL THE TIME
I’VE LIVED IN THIS BROKEN LITTLE TOWN, THIS IS THE FIRST
PERSON I CAN REALLY TALK TO. YOUR FAITH IS INSPIRING AND
WITH FAITH, I’M SURE YOU CAN LIVE BEAUTIFULLY, EVEN LOCKED
IN A CAGE, I MEAN, FREE AND PROFOUND THOUGHT,
COMPREHENSION. >>
COMPREHENSION? CAN YOU REALLY
IMPLY THAT, AH — >> IVAN IS SUDDENLY SEIZED WITH
SOMETHING, CLUTCHING HIS HEAD
AND CURLING UP IN HIS BED.
WHAT’S WRONG? >> LEAVE ME ALONE, I DON’T WANT
TO TALK TO YOU ANYMORE. >> BUT
WHY? >> THE DEVIL WITH YOU. GO! AND SO Dr. ANDRE RABIN LEFT. HE
DIDN’T KNOW IT THEN BUT HIS FASCINATION WITH THIS MAD MAN
WOULD CHANGE THE DOCTOR’S LIFE.
>> BAH, BAH, BUM. >> IT’S SO INTERESTING TO READ
THE FICTION FROM A MEDICAL — BEFORE FREUD AND BEFORE WE
STARTED DEVELOPING THE LANGUAGE
OF MENTAL HEALTH. IT SEEMS LIKE Dr. CHEKOV WAS
USING LITERATURE TO DISCUSS MEDICAL ISSUES THAT HE DIDN’T
HAVE FORMAL MEDICAL LANGUAGE OR
EVEN TRAINING FOR. >> RIGHT, AND I THINK YOU SEE
THAT THROUGHOUT THE HISTORY OF
LITERATURE. YOU LOOK AT THE McBETH WHO HAD
SORT OF A POSTTRAUMATIC INABILITY TO SLEEP, MAYBE
LOSING THEIR GRIP ON REALITY, OR DIAGO, WHO ASK A SORT OF
PROTOTYPE FOR OUR UNDERSTANDING
OF PSYCHOPATHOLOGY. I MEAN NARCISSISM TURNED
VIOLENT LIKE WE EVEN SEE STILL
TODAY. >> YEAH. AND I CAN CHEKOV WAS
DOING A SIMILAR THING TO
SHAKESPEARE, LOOKING AT THIS WIDE VARIETY OF
HUMANITY, RICH AND POOR AND KINGS AND PEST ACTS AND THAT
SORT OF THING BUT IN CHEKOV,
THERE ARE NO VILLIANS. YOU COULD ARGUE IT’S EVEN MORE
SUBTLE, THERE’S JUST FLAWED AND SICK PEOPLE — I MEAN, HUMAN
BEINGS. >> HUMAN BEINGS, THAT’S RIGHT.
WELL, VERY INTERESTING. THANK
YOU. THANK YOU SO MUCH. >> THANKS VERY MUCH. >>
APPRECIATE IT, BUDDY. >> LOVE
YOU DAD. >> SPEAKING OF PHYSICIANS WHO
ARE WRITERS, YOU’RE ONE AND YOU’VE THE HOW MANY BOOKS
PUBLISHED, JERRY? >> I’VE HAD, I GUESS, FOUR
BOOKS OF ESSAYS AND FIVE OF
POETRY. >> MY QUESTION IS ALWAYS,
POETRY, HOW DOES IT DIFFER THAN AN ESSAY, IS IT MORE
CONCENTRATED, DO YOU WORK ON THE RHYTHM, WHAT IS IT THAT
MAKES IT POETRY? >> WELL, WE WORK ON ABOUT THE
BUT I LIKE TO THINK OF POETRY AS BEING A VERY SHORT LITTLE
STORY, AN ENCAPSULATION OF SOME
HUMAN EXPERIENCE. I WOULD MUCH RATHER WRITE ABOUT
FEAR, ANGER OR LOVE THAN I
WOULD A BEAUTIFUL TREE, FOR
INSTANCE. I THINK HUMAN EMOTION LENS
ITSELF VERY WELL TO SEES SHORT SNIPPETS OF HOPEFULLY
UNDERSTANDING AND REALISM. >>
OPENING YOUR HEART TO — >> OPENING YOUR HEART, OPENING
YOUR MIND TO — AS YOU WERE READING CHEKOV, I WAS THINKING
HOW UTTERLY COMPLEX OUR LIVES ARE, ALL OUR LIVES, OUR
PATIENTS’ LIVES AND OUR OWN LIVES AND IT’S SUCH A CHALLENGE
AND A GIFT TO BE ABLE TO TRY TO PEER INTO EACH OTHER’S
REALITIES AND OFFER HELP AND
SUSTENANCE. >> TO BREAK THROUGH THAT
COMPLEXITY AND… [
Indiscernible ] >> AN WE DON’T GET THAT
COMPLEXITY, REALLY — WE HAVE IT IN OUR OWN LIVES BUT, I
MEAN, WE DON’T — LITERATURE
DOES BRING IT TO US. I THINK THAT’S ONE OF THE MOST
IMPORTANT LESSONS. >> I THINK YOUR SON, ERIC, DID
A MARVELOUS JOB, RICK, AND IT’S PRETTY APPARENT TO ME THAT ERIC
IS YOUR SON. >> HE’S RELATED,
YES. [Laughter] >> LET ME TALK ABOUT ONE TEXT
THAT I THINK IS PARTICULARLY WORTHWHILE RELATIVE TO THIS
DISCUSSION AND THAT IS MARY
SHELLEY’S FRANKENSTEIN. AND LAST YEAR WAS THE 200TH
ANNIVERSARY OF THE PUBLICATION OF THAT TEXT AND WE REREAD IT
IN OUR HONORS LITERATURE CIRCLE. THE POINT ABOUT THAT THAT’S SO
COMPELLING IS THAT VICTOR REALLY WANTED TO CREATE NEW
LIFE AND WHEN HE DID CREATE NEW LIFE, THE MONSTER BECAME THEN
AVAILABLE TO HIM IN THE SENSE THAT HE NO LONGER TOOK
RESPONSIBILITY FOR HIS CREATION. SO IT WAS A VERY VALUABLE
LESSON THERE, RICK, WITH REGARDS TO SCIENCE AND THE
HUMANITIES. >> YES. FIRST OF ALL, DO NO HARM. HE
CAUSED — ALL THE COMPLEXITY WAS ALL THE CASCADE OF SADNESS
THAT FOLLOWED HIS EFFORT TO TRY
TO DO GOOD. >> RIGHT, RIGHT. >> A STORY
LIKE THAT OR I TEACH A CLASS IN
THE MED SCHOOL, MEDICINE AND HUMANITIES AND THE
STUDENTS JUST LOVE IT. WE USE SHORT STORIES AND NOVEL,
POETRY, INDIVIDUAL I DON’T AND IT’S AMAZING TO ME THE
DISCUSSION THAT TAKES PLACE. THESE STORIES, THESE ACCOUNTS
JUST IT’S LIKE A WELLSPRING OF ENTHUSIASM COMES FORTH, WANTING TO TELL ABOUT THEIR OWN
EXPERIENCES, THEIR LIVES WITH PATIENTS AND TEACHERS, IT’S
VERY VALUABLE AND I HADN’T READ FRANKENSTEIN FOR YEARS UNTIL
YOU TOLD ME TO SOME YEARS AGO.
>> OH, GOSH. YOU MENTIONED — WAS THE BOOK
THAT YOU AND Dr. OLSON AND —
>> I DIDN’T COUNT THAT ONE. >> SOME HAVE SIX BOOKS. >> THAT
WAS AN ANTHOLOGY THAT WE DID FOR WHAT WAS CALLED A
CAPSTONE COURSE AT AUGUSTANA UNIVERSITY, IT WAS ON LIFE,
DEATH AND DYING, AND FOUR OF US FACULTY COLLABORATED ON THAT
BOOK AND WE USED IT AS A TEXT
FOR MANY YEARS. >> GETTING READY FOR THIS
EVENING’S SESSION, I REREAD
SOME OF YOUR BOOK AND I LOVED
IT. I LOVED YOUR BOOK. >> WELL,
THANK YOU VERY MUCH. >> ALL RIGHT, WE HAVE A BUNCH
OF QUESTIONS AND WE NEED TO
ROLL THROUGH THEM PRETTY
QUICKLY. HERE THEY COME. WHAT DO YOU
THINK OF THE CONCEPTS OF PHYSICIANS FIRING
PATIENTS BECAUSE OF A VARIETY
OF REASONS, LIKE THE PATIENT MISSING APPOINTMENTS OR BEING
FREQUENTLY LATE OR NOT FOLLOWING PHYSICIAN’S ORDERS
LIKE IMMUNIZATIONS OR SMOKING
CESSATION OR DIABETES CONTROL? >> WIG HE SHOULD GO TO GREAT
LENGTHS NOT TO FIRE PATIENTS.
WE SHOULD TRY TO REACH A COMMON
GROUND. I WAS JUST TALKING ABOUT THE
COMPLEXITY OF PEOPLE’S LIVES.
WELL, THE PEOPLE WHO MISS APPOINTMENTS OR ARE
NON-COMPLIANT OR DON’T QUIT SMOKING, IT’S NOT ALWAYS
BECAUSE THEY DON’T WANT TO, IT’S OFTEN BECAUSE THEY CANNOT
DO WHAT WE WANT THEM TO DO FOR
SOME REASON. SO I THINK IT WOULD BE MUCH
PREFERRABLE TO THE EXTENT POSSIBLE TO REACH SOME ACCORD
AND UNDERSTANDING AND COMPROMISE RATHER THAN FIRING
THEM. >> YOU KNOW, PHYSICIANS ARE
GETTING RATED AS HOW GOOD WE ARE AT DOING WHAT WE DO AND
CONTROLLING THE DIABETES. IF YOUR PATIENTS DO BETTER IN
CONTROL THEN YOU, THE PHYSICIAN, GET A BETTER GRADE,
EXCEPT THEN, IT ENCOURAGES YOU TO FIRE THE SICK ONES AND JUST
TAKE CARE OF THE WELL ONES. I’VE SEEN THAT HAPPEN SO THERE
HAG TO BE A BETTER WAY. >> CAN I MAKE A COMMENT? IN
YOUR TEXT, YOU HAD A COMMENT ABOUT LOTS OF PEOPLE ARE IN A
SITUATION THAT THEY CAN’T EXTRICATE THEMSELVES FROM
BECAUSE THEY DON’T REALIZE
THEY’RE IN IT. >> YES. >> SO WE MUST NEVER
GIVE UP ON PEOPLE. A PHYSICIAN
SHOULD NEVER, EVER FIRE A
PATIENT. >> I AGREE WITH YOU. AND I SAY
THAT IF THAT PHYSICIAN IS FIRING THAT
PATIENT, THE PATIENT SHOULD SAY, WELL, I’M FIRING YOU FIRST
AND FIND ANOTHER DOCTOR BECAUSE
THAT’S THE TIME TO MOVE. >> AS WE WERE STARTING, BEFORE
WE CAME ON AIR, I QUOTED THAT ANNE SEXTON LINE, PATIENTS
SHOULD FEAR ARROGANCE MORE THAN
CARDIAC ARREST. THERE IS A CONCERN ARROW GAPS
IN BEING ABLE TO FIRE PEOPLE, WE SHOULD STRIVE TO WORK AROUND
THAT. >> WHAT IS FAMILIAL TREMOR. >>
IT’S ALSO CALLED INTENTION
TREMOR. THERE IS A SHAKING WHEN A
PERSON GOES TO DO SOMETHING. FOR INSTANCE, IF A PATIENT,
PERSON TAKES A COFFEE CUP, THEY MAY BE TREMULOUS AS THEY BRING
IT TO THEIR MOUTH OR AS THEY
POINT TO SOMETHING. >> IT’S NOT PARKINSON’S DISEASE. >> IT’S NOT PARKINSON’S
DISEASE, IT’S A BENIGN
CONDITION ALTHOUGH FRUSTRATING. MANY PEOPLE COME TO ME WITH
THAT TYPE OF TREMOR WORRYING
IT’S PARKINSON’S. I LOVE TO BE ABLE TO TELL THEM
IT’S NOT. >> AND THERE’S NOTHING TO DO —
YOU CAN TAKE DRUGS — >> THERE
ARE MEDICATIONS FOR ITS — >> THEY’RE COVER-UP DRUGS. >>
MANY TIMES — ONCE A PATIENT UNDERSTANDS THAT IT’S A BENIGN
NON-SERIOUS CONDITION THEY
DECIDE TO LIVE WITH IT. >> I TRIED TO COMMIT SUICIDE
HAD A THREE-DAY STAY AT A PSYCHE WARD, ONCE I LEFT, I WAS
TOLD I HAD TO WAIT THREE AND A HALF MONTHS TO SEE A
PSYCHIATRIST. THIS SEEMS UNETHICAL TO ME AS A
PATIENT TO NOT HAVE ACCESS TO PROPER CARE IN A TIMELY MANNER.
I AGREE. COMMENT? >> ONE WONDERS HOW THIS AROSE.
HOW COULD THIS HAPPEN? >> YOU KNOW, YOU NEED — THE
PERSON WHO IS IN THAT SCENARIO
NEEDS TO SEE THE DOCTOR SOONER. I WOULD SAY FIND A PRIMARY CARE
DOCTOR BECAUSE OFTENTIMES PRIMARY CARE DOCTOR IS THE
PSYCHIATRIST FOR MANY PEOPLE AND HAVING A KINDLYIER
PERSPECTIVE AND CAN DO JUST
WHAT A PSYCHIATRIST — COMMENT? WHAT DOES THE MEDICAL SCHOOL IN
SOUTH DAKOTA DO TO INCLUDE THE
HUMANITIES IN ITS CURRICULUM? DO MOST MEDICAL SCHOOLS INCLUDE
HUMANITIES? JERRY? >> MANY MEDICAL SCHOOLS ARE
STARTING TO INCLUDE THEM MORE. I MENTIONED THE CLASS THAT WE
HAVE AT OUR MEDICAL SCHOOL OF
MEDICINE AND HUMANITIES, SPECIFICALLY, BUT I HAVE TO SAY
THAT EVEN IN THE FIRST YEAR, IN
THE FIRST THREE OR FOUR MONTHS, THERE IS AN EFFORT TO BRING
HUMANITIES IN. WHEN I GIVE A LECTURE TO THE
FIRST-YEAR STUDENTS, I ALWAYS HAVE A CLASSIC PAINTING OF
SOMETHING, USUALLY SOMETHING
MEDICAL. I TRY TO BRING IN SOME POETRY,
SOMETIMES QUOTE SHORT STORIES. I THINK BRINGING HUMANITIES IN
IS VERY IMPORTANT. >> SO
IMPORTANT. >> AND WE SHOULD HAVE IT PUSHED
IN COLLEGE. OUR MISSION — WE’VE GOT 30
SECONDS EACH. OUR MISSION EXPERIENCES
PROMOTED FOR HELP STUDENTS TO
TEACH EMPATHY? I THINK THEY ARE. I THINK
THAT’S WHAT MISSION STATEMENT
— EFFORTS ARE ALL ABOUT. >> THE P.D.A. GROUP, OUR
PRAIRIE DOC ASSISTANCE HAVE BEEN DOING SOME MISSION WORK
AND THAT’S BEEN WONDERFUL. FROM THE NEUROLOGY PERSPECTIVE,
DO YOU THINK ADHD IS BECOMING MORE COMMON AMONG CHILDREN OR
JUST BETTER DIAGNOSED? >> I THINK IT’S BETTER
DIAGNOSED. >> AND IT’S BETTER DIAGNOSED,
YOU THINK, IT’S APPROPRIATES.
>> YEAH. >> WHAT DO YOU PERCEIVE AS THE
FIVE MOST IMPORTANT CHARACTERISTICS OF AN ETHICAL
PRACTITIONER OR PHYSICIAN? NELS? >> WELL, I THINK YOU OUTLINED
THEM PRETTY WELL IN YOUR BOOK,
RICK. FIRST OF ALL, TRUTH-TELLING IS
EXTREMELY IMPORTANT. EMPATHY. WOULD BE A SECOND TO ME OR
MAYBE EVEN THE FIRST. A WILLINGNESS TO SHARE YOUR
LIFE AND EXPERIENCES WITH YOUR
PATIENT. TRYING TO REACH THE POINT THAT
WE’RE ALL IN THIS TOGETHER. THIS IS NOT JUST THE PROBLEM
YOU’RE HAVING SHE IT’S A PROBLEM I’VE HAD AND OTHER
PEOPLE HAVE HAD AND KIND OF
WORK THROUGH THIS TOGETHER. AND JUST A GENERAL OVERALL
ENJOYMENT OF BEING ABLE TO VISIT ONE ON ONE WITH ANOTHER
HUMAN BEING AND TO SHOW A
LITTLE EMPATHY AND COMPASSION. >> RIGHT. >> I’M IMPRESSED.
THOSE ARE VERY GOOD. THERE WAS AN OLD PHYSICIAN
PERCY WHO SAID THE SECRET TO CARING FOR A PATIENT IS TO CARE
FOR THE PATIENT. TO CARE ABOUT
HIM. >> TO CARE ABOUT THE PATIENT.
TALK ABOUT ETHICS OF HEALTH CARE COSTS, WE’RE GOING TO HAVE
A SHOW ON THAT COMING UP BUT IT IS, I THINK, WHEN YOU SEE THE
PHARMACEUTICAL INDUSTRY BEING DRIVEN BY FINANCES AND NOT
ETHICS, THAT IS UNETHICAL. HOW DO YOU LIVE THE GOLDEN RULE
AS HEALTH CARE PROFESSIONALS? >> WELL, I WOULD COME BACK TO
WHERE I STARTED WITH, KINDNESS. IF ALL OF US RELISH KINDNESS
AND IF WE TREAT EACH OTHER, OUR
CO-WORKERS, PATIENTS, FAMILIES, KINDLY, I THINK WE’RE
APPROACHING WHAT SHE’S TALKING
ABOUT, ASKING ABOUT. >> ALL RIGHT. >> AND NOW FOR
THE WINNER OF TONIGHT’S PRAIRIE
DOC QUIZ QUESTION. VERACITY IS A TERM IN ETHICS
THAT MEANS WHAT? A: HOW FAST MEDICAL ATTENTION
IS APPLIED IN A SITUATION. B: THE DIFFERENCE BETWEEN URBAN
AND RURAL MEDICINE. C: A HEALTH PROFESSIONAL SHOULD
BE HONEST, GIVE FULL DISCLOSURE
TO PATIENT WITHOUT MISREPRESENTATION OF THE FACTS.
AND THE ANSWER IS “C,” TRUTH IN
PRACTICE. IT’S BASICALLY TRUTH-TELLING
AND IT’S A SEARCH FOR THE TRUTH
WHICH IS BY DEFINITION SCIENCE. IT WAS ROD HINES FROM STURGIS.
ROD, THANK YOU FOR ANSWERING
THE QUESTION CORRECTLY. A BOOK WILL BE IN THE MAIL TO
YOU SOON. WE’LL BE RIGHT BACK
AFTER THIS. >> HAVE YOU HEARD, THE PRAIRIE
DOC HAS A RADIO SHOW? LISTEN TO YOUR LOCAL SOUTH
DAKOTA RADIO STATION FOR
PRAIRIE DOC CONVERSATIONS. THIS PROGRAM FEATURES
PHYSICIANS AND OTHER HEALTH PROFESSIONALS DISCUSSING
VARIOUS MEDICAL TOPICS IMPORTANT TO YOU AND YOUR
FAMILY. ASK YOUR LOCAL RADIO STATION IF
THEY BROADCAST PRAIRIE DOC
CONVERSATIONS. >> THANK YOU FOR LISTENING.
UNTIL NEXT TIME, STAY HEALTHY
OUT THERE, PEOPLE. >> AFTER 40 YEARS AS A DOCTOR
INTERACTING WITH PATIENTS, IN THE LAST TWO AND A HALF YEARS,
THE TABLES HAVE TURNED AND I’VE
BECOME THE PATIENT. ALTHOUGH MOST ARE GOOD, I’VE
FOUND SOME DOCTORS ARE DETACHED, SOME ARE TOO QUICK,
SOME WOULD RATHER BE SOMEWHERE
ELSE, SOME ARE EVEN ANGRY. BUT, WHEN A PHYSICIAN WHO CARES
WALKS INTO THE ROOM, AND I’M NOT EXAGGERATING, THE DAY
BECOMES BETTER, THE PAIN BECOMES LESS AND HOPE FILLS MY
HEART. SCIENTIFIC KNOWLEDGE IS
IMPORTANT, BUT THE ABILITY TO CONVEY HONEST CONCERN, HUMAN
THOUGHTFULNESS AND COMPASSION IS EQUAL IN IMPORTANCE IN THIS
HEALING PROFESSION. SO, HOW DO WE SELECT PRE-MED
STUDENTS FOR THAT, OR TEACH
COMPASSION IN MEDICAL SCHOOL? THERE ARE STUDIES THAT SHOW
THOSE INTERESTED IN HUMANITIES OR TAUGHT DISCIPLINES THAT
EXPLORE HOW PEOPLE TICK DO BETTER IN THE COMPASSION
DEPARTMENT. THESE DISCIPLINES INCLUDE
HISTORY, LITERATURE, RELIGION,
ETHICS, ANTHROPOLOGY, PSYCHOLOGY, CULTURAL STUDIES
AND THE ARTS OF THEATER, FILM,
PAINTING AND POETRY. SOME EXPLAIN THAT THE
HUMANITIES GIVE US THE VERY REASON TO LEARN SCIENCE AND
MATHEMATICS. SEVERAL STUDIES SUPPORT THE
VALUE OF HUMANITIES IN MEDICINE. SEVEN HUNDRED MEDICAL STUDENTS
WERE SURVEYED ABOUT THEIR LIFETIME EXPOSURE TO THE
HUMANITIES, AND THE RESULTS INDICATED THAT THOSE WHO HAD
MORE HUMANITIES KNOWLEDGE HAD MORE EMPATHY, TOLERANCE TO
AMBIGUITY, RESOURCEFULNESS, EMOTIONAL INTELLIGENCE, AND
LESS BURNOUT. ANOTHER STUDY FOUND THAT A MED
STUDENT’S ABILITY TO RECOGNIZE DIAGNOSTIC CLUES INCREASED BY
MORE THAN 35% AFTER TAKING A
VISUAL ARTS CLASS. ANOTHER STUDY FOUND PRACTICING
IMPROV THEATER HELPED MED STUDENTS LEARN TO PREPARE FOR
UNEXPECTED QUESTIONS AND
CONVERSATIONS. A FOURTH STUDY SHOWED HOW
WRITING EXERCISES HELPED MED STUDENTS HAVE FORESIGHT INTO
WHAT A PATIENT MAY BE
EXPERIENCING. CLEARLY, AN EXPOSURE TO THE
HUMANITIES MAKES A BETTER
DOCTOR. I BELIEVE THAT CARE PROVIDERS
WHO HAVE HAD A WELL-ROUNDED HUMANITIES EDUCATION HAVE A
BETTER CHANCE OF UNDERSTANDING ABOUT HOW IT FEELS TO FACE
PAIN, NAUSEA, LOSS OF BODILY FUNCTIONS OR EVEN A CANCER
DIAGNOSIS. THOSE STEEPED IN GOOD
LITERATURE OR ART HAVE A BETTER OPPORTUNITY TO TAP CREATIVE
JUICES TO PROBLEM SOLVE AND TOLERATE A LIFE THAT CAN BE
AMBIGUOUS AND UNPREDICTABLE. THOSE WHO ARE KNOWLEDGEABLE OF
HISTORY, ETHICS, CULTURAL WAYS WILL FIND IT EASIER TO KNOW
WHEN IT IS TIME TO STOP AGGRESSIVE CARE AND MOVE TOWARD
COMFORT. THIS IS A CALL FOR ALL STUDENTS
TO BECOME READERS, TO FIND TIME TO ENJOY THE HUMANITIES, TO
EXERCISE YOUR CARING AND COMPASSION MUSCLES SO WHEN YOU
COME INTO THE ROOM OF A PERSON SUFFERING, IT MAKES THEIR PAIN
LESS AND THEIR DAY BETTER.

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