Last week, a young woman dear to my heart graduated from medical school. My pride, even now, spikes tears in my eyes.
Bethany brings such gifts & graces to the medical profession, including depth of years – she started med school in her early thirties. She started after NOT getting accepted on her first try, strengthened areas of perceived weakness & made the cut. The time from first learning she was considering becoming a doctor to the day, less than a week ago, when she really & truly did was a period of indescribable adventure for me, getting bits & pieces via Facebook & her parents’ letters.
She came to mind today, reading a NY Times article pondering the ethics around a physician giving gifts to patients, “…whether it be a stuffed animal, a small amount of money or an old winter coat.”
The writer, a 3re –year resident at Brigham & Women’s Hospital, Boston, first recalled when she was a med student, finding herself in the hospital gift shop, thinking about an elderly patient who was about to be discharged to home hospice. The woman’s metastatic cancer was incurable & she’d reached the limits of medicine.
There was nothing her doctors, let alone a medical student, could do to cure her body, but the young woman’s instinct, “ingrained in me from my Italian-Jewish family,” suggested that maybe a stuffed animal – a plush black puppy – could lift her spirits.
It is to weep, thinking of how the woman must have felt, the feel of the stuffie’s “fur” in her hands, the knowledge that someone had thought of her, had also held that wee small dog – powerful medicine for a happy heart, if you ask me.
A fellow medical student rebuked her for the gift – “You can’t get a patient a present,” it would set a “bad precedent” & start her down a “slippery slope.” She gave it anyway, excusing it as okay for a medical student, that she’d create “appropriate” boundaries, rules once she became a “real doctor.”
There is apparently a good bit of discussion in the medical community about if & when it is okay for physicians to accept presents. Talks about doctors gifting patients? Not so much.
One doctor who gave a patient money to fill a prescription received a formal rebuke after being reported by a resident who was shadowing him. Dr. Gordon Schiff, also of Brigham and Women’s Hospital, used the reprimand – for “unprofessional boundary-crossing behavior” – as a teachable moment, writing a fairly blistering editorial piece for the Journal of American Medical Association. He acknowledged the need for certain boundaries, but reminded his fellow physicians that they should be judicious & not be used as barriers to providing HUMANE (my caps) care, that taken to extremes “risks encouraging detached, uncaring, arms-length relationships.”
Personally, I can think of a lot of situations where a prescription for a stuffie would do a world of good for a patient. But then, I am a long-time believer in the healing power of stuffies. When Mom was in the hospital for a mastectomy, we brought in Benita to keep her company – a plush grey hippopotamus. It seemed like the hospital staff loved her as much as Mom did – they’d come in & stroke her or play with her.
Guess what happened when she became Dr. DeFilippis? She still gave some patients presents. A word search book for a man tethered to his hospital bed & chair. A plush heart after a young woman’s transplant, weeks after waiting in the hospital for a viable organ. She had me at, “I believe that alleviating suffering involves providing comfort, solace and coziness, even if that takes the shape of a fluffy golden teddy bear.”
Dr. DeFilippis wonders if she gave that elderly woman the plush puppy as a way of facing her own sadness over medicine being only able to go so far. She wonders if her giving them a small token of “I see you” might help them feel more connected to life. Or maybe a way to express hope & best wishes for the future. As she prepares to start a fellowship in cardiovascular medicine at New York Presbyterian Hospital-Columbia University Medical Center, she still hasn’t created those boundaries her med school self imagined. “Boundaries serve a few purposes – they avoid improper expectations, legal liability and confusion of personal and professional relationships. But they also can disconnect us from the patient experience, from the human experience.”
Or, to quote Dr. Schiff – “In weighing such risks, however, we need to be clear whose risks we are considering. Many of these risks are actually more risks to physicians, rather than to patients. … While there is nothing inherently wrong with protecting caregivers against overwhelming time demands or burnout, let’s not pretend we are imposing limits for patients rather than for our own best interests.”
My own thoughts, had I been asked to share them last Friday at the Sanford Pavilion, as the Class of 2018 graduated from The University of South Dakota Sanford School of Medicine, would have focused on the softer side of medicine, the human side. I’d remind them that a baseball might do a powerful amount of good for the patient facing a medical crisis, a fluffy golden bear could provide comfort at 3:00 a.m., a Sudoku book could stimulate the mind of the bed bound. That they might not be the sort to equate actual gifts to quality patient care – would they give the gift of an extra moment of their time? Would they ask a question that would give a personal response? Is their instinct to see the patient or stay detached? Would boundaries do they consider inappropriate? And how might they feel if they were the patient? If it was their parents partner child?
I’d ask them to consider, as they sat there, freshly minted doctors, and throughout their practice – – What is their version of that small black plush puppy?