Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Plant Straight Rows


In farming, as in medicine, focusing only on daily tasks may keep us from seeing the impact we have.

As I turned the corner into her nursing home room, I interrupted a sacred space. I hadn’t meant to, of course, but what was intended to be a quick “check in” visit with a patient in hospice care changed dramatically when I saw her husband, daughters, and grandchildren, and her pastor huddled around her bed. He was reading fervently from scripture and leading them all in prayer for peace and comfort. 


At first, I felt like an outsider. I was running behind schedule, and I felt the pull of a million other responsibilities. Eventually I would need to attend to my other patients, calls, results and countless other obligations. Despite this, I felt right here, right now was where I needed to be. Being present. Not rushing to the next room, not checking the next thing on my to-do list, not being more efficient. Focusing. Loving. Caring. 


Her husband was a retired farmer and they both had dedicated their life to that craft in northwest Iowa. The whole family loved to talk about the fruits of farm labor and the gifts of family growth and care for the land. I also came from the same background and found much common joy in this. 


In farming, planting straight rows of corn is hard to do. At least, it used to be. Before the advent of GPS and auto-steer, a mark made by the planter on the last pass, eyes fixated on the way ahead, and a steady hand on the steering wheel was what guided the tractor down the right path through the field. The result isn’t seen until tiny shoots break through the earth, slowly turning the seemingly lifeless dirt into (hopefully) neatly ordered rows of thriving green blades. It transforms the whole landscape from bleakness to beauty. 


In medicine, keeping our focus on being present for the patient is hard to do. Of course, it shouldn’t be. Before the advent of EMRs, quality metrics, insurance denials, and what seems like endless paperwork, medical knowledge, clinical acumen, and a caring presence was what guided the physician down the right path. These remain our greatest tools. The result isn’t seen for a time, until small acts of caring blossom into fulfilling relationships day. It transforms a whole practice from bleakness to beauty. 


With our attention pulled in many directions, it’s easy to become overwhelmed with all the noise and lose sight of the sacred calling of caring for patients. Consider the following to help plant straight rows: 


1. Follow the mark.

In planting, this is staying along the path laid out by the implement during the last pass or round. If you can trust that the last time through was straight, it would be best to stay consistent. I like to think of this as remembering why I decided to practice medicine in the first place–to give relief to those suffering the best I can. Many of us have a similar core reason for being where they are today. Follow it! 


2. Keep your eyes fixed ahead.

In planting, if you look just ahead of the tractor you’ll weave back and forth trying to keep the line perfect. The rows end up wavy. They end up straight if you can keep the focus farther ahead. I like to think of this as keeping our focus on the care of the patient in day-to-day tasks. Certainly, quality metrics, the EMR, and the like are part of the modern practice of medicine, but they cannot usurp the primary objective of giving excellent care. 


3. Keep a steady hand on the wheel.

In planting, this just makes good sense. In medicine, stay anchored to the patient at all times. Take a few moments to appreciate who the patient is and help them feel your presence. Focus. Love. Care. 


Plant straight rows. You’ll look back on the joys of this calling when you do so. 











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