Reflections on 40 years of clinical practice 

By Joseph Carrese, MD, MPH, Johns Hopkins Medicine 

I recently retired from clinical practice, decades after completing my residency in general internal medicine. I was a primary care doctor and followed many of my patients for over 20 years. During my last year, I made a point of telling each patient I was retiring, so I could say goodbye and let them know the plan regarding their transition to a new PCP. Their responses were kind and generous, and I think instructive. They told me how much they appreciated me and that they would really miss having me as their doctor. They especially appreciated that I was very thorough. Over the years, when I apologized to them for routinely running late in clinic, the vast majority of patients indicated that was ok because of the trade-off: once I got to them, I was thorough, careful, and spent the time they needed. They also greatly appreciated that I kept my promises; for example, getting back to them in a timely manner about test results. They appreciated that I went the extra mile, and that I showed up for them in a variety of ways. One way I showed up, they told me, was by being a steady presence throughout the various twists and turns of their respective medical journeys.  

“Hanging in there” with patients in the face of uncertainty, adversity, and conditions that are difficult to diagnose or treat is challenging for us but so appreciated by patients. Knowing they have a companion and advocate for whatever is going on and whatever lies ahead is reassuring and comforting. In so many words, they told me I had earned their trust, and they worried about being able to trust another doctor the same way. In a 1927 article entitled “The Care of the Patient,” Francis Weld Peabody wrote the following simple, but profound, sentence: “The secret of the care of the patient is caring for the patient.” This oft-quoted passage makes the point that being genuinely interested in and actually caring about the people in our charge matters. Also, I’ve learned, it is noticed by them.  

What I realized after spending a year saying goodbye to my patients is that all along they were paying careful attention to me and what I was doing, and they greatly valued the dedication and effort on their behalf. Even a few of my more disagreeable patients, who I could never seem to please, made a point of thanking me at their last visit – they also noticed and were appreciative. A few weeks ago, just after the Thanksgiving holiday, my cell phone rang, and on the other end was one of my longstanding patients. He used to call me pretty regularly, sometimes from the ED, sometimes from his home, asking questions and seeking advice. This time he was calling to see how my retirement was going, to wish me happy holidays, and to let me know how much he missed me and how much he appreciated all I did for him over the years. It was the best holiday gift I could have received. 

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