Why We Walk The Wire: A Doctor’s Day Reflection

Today is National Doctors’ Day, one more holiday on a crowded calendar. In my 30 years of practice, I was almost embarrassed to see it celebrated and certainly never observed it myself. Surely there are many professions deserving of recognition.

Going from full engagement in patient care to an administrative position triggered a wealth of complex emotion and reflection, and I now have a different appreciation for what clinicians actually do. The first thing I became aware of when I stopped seeing patients was a surprising feeling of immense relief.

Day in, day out, I was left wondering if I had done enough or too much, if I had done the right thing for my patients.  There were many patients who presented overwhelming pictures I could not recognize, a set of social and emotional entanglements presenting in unison with a set of diverse and disconnected physical symptoms, which could be something or could be nothing.  My patients and I always faced a decision together about how much uncertainty we were willing to tolerate, and balanced that against the risks of further testing or empirical treatment.

But this is only one kind of uncertainty doctors face on a daily basis. Change is a constant in medicine, with a continuous cycle of doctors trying to figure out how to use the new science and technology of the day in the relief of suffering.

The stethoscope changed the way doctors tried to sort out what was going on inside their patients, and changed the choreography of a visit to the doctor. At the dawn of the 20th century, X-rays changed our ability to look inside patients without having to literally cut them open to see what was happening. Today, computers at the point of care are allowing us to know, in real time, how often we are achieving our goals and how consistently and reliably we are applying the knowledge we have in service of our patients.

Certainly the profession is under an enormous amount of stress and transformation. The rapid pace of change in medical knowledge increases the burden on doctors to keep up even as it increases expectations from patients that surely their problem can be solved. And there is always uncertainty:  the high wire artist Karl Wallenda once said “Life is on the wire; the rest is just waiting.” One of the bravest things doctors do is to go out on that wire with their patients, knowing they can’t be sure of a good result, but knowing that they are using all their knowledge and skill to get one.  That work really is different, and we are all really lucky that doctors do it.

The repeated willingness to get on that wire with my patients led to deep relationships of mutual knowledge and trust. I had the privilege, as so many colleagues do, of caring for many generations of the same family, of watching patients I had cared for as teenagers become themselves parents of teenagers.  And as they would come back year after year and I would still be there, we never remarked on what a gift that was, and I never realized how anchoring and reassuring my commitment and continuing presence was to my patients – and theirs was to me.

I knew my patient’s ex-husband with the drug problem, had visited them in the hospital at the birth of each of their daughters.  I remembered the Vietnam vet, and how he told me how angry he was when I first told him to quit smoking, and how grateful he was when he finally did. And when patients of many years might say “You haven’t changed at all,” I didn’t realize how much it meant that I was a doctor they knew and could come back to and how centering that was for both of us.

Now that I myself have gotten to a phase of my career where I am relying on younger doctors to take care of me, I realize my younger colleagues may not appreciate the gift they are giving. I know they will carry the burden of uncertainty, but I know I can depend on my doctor to walk this wire with me.

This is why celebrating today matters: Because in reflecting on what these relationships meant to me, I realized that doctors every day do something heroic for people with complex needs and even more complex lives.