Beyond superficiality

“So many faces in and out of my life  

Some will last, some will just be now and then.  

Life is a series of hellos and goodbyes, I’m afraid it’s time for goodbye again.”  

So go the lyrics by Billy Joel to “Say Goodbye to Hollywood.” The words speak to the endings and beginnings of the sometimes-fleeting intersections our lives have with others.  

In medicine, encounters are too often brief, rushed, and even impersonal. Our patients come to us with their concerns, symptoms, and worries. They may unfurl painstakingly written lists of issues, often to our (hopefully hidden) cringing chagrin. We’re too often distracted by the electronic health record, the need to check boxes to document our interactions and interventions, and by the ever-present clock—urging us on to the patient in the next room and the task list waiting to be completed. Lost in such encounters are the nuances of a patient’s visit, causing us to squander the opportunity to explore what’s really behind our patients’ concerns. No patient is an isolated symptom, test result, or diagnosis. Rather, they’re the sum of all that’s come before, ferrying them to this intersection with us. What’s for us a routine day may be the start of some of the worst days of our patients’ lives . . . or a remarkable triumph waiting for us to share.  

I was recently reminded of the too-frequent superficiality of our interactions when I was walking our dog. I’d often seen our neighbors, a husband and wife, walking separately in the neighborhood. I’d always say hello to whoever I’d happen to encounter. Small talk: “Good morning!” “Glad it’s getting warmer out,” “Your dog is adorable.” Nothing deep or memorable. On one of my canine-accompanied forays, I noticed that the husband had lost weight; a good thing in my mind, because I’d always noticed his Type 2 diabetes/sleep apnea phenotype.  

Then, a few weeks ago, his wife stopped me on my walk. She asked if I knew her husband had died recently, just a year after receiving a diagnosis of lymphoma.  

I had no idea, no clue. I didn’t know he was ill, that he’d then transitioned to hospice, or that he’d died. I realized that I didn’t even know his name until his wife told me he was gone. I shared my condolences, barely hiding my embarrassment. I hoped our brief talk would have some small meaning for her.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.