April Fool’s Joke: The Text Message

This is for April Fool’s comic relief! The author genuinely; the author truly believes in and has published on the exact opposite of the below silly piece. 

The other day, I received a text message from an unknown phone number and had an epiphany—getting to know patients as individuals is neither important or rewarding.

When I got my first smartphone many years ago, I gave out my number to all my patients and told them they could call or text message me any time they had a question or concern. This particular text message was clearly from a patient, but it was an unknown number that wasn’t in my phone’s contact list. The text had some medical history, listed some symptoms, and included the heart rate and blood pressure taken from a home device. The diagnosis was pretty obvious, and so I texted back some recommendations and ended with, “By the way, who is this? I don’t have your number in my contact list.”

Thus the epiphany. I not only don’t need to know the patient well. I don’t even need to know the patient.

That got me thinking.

Is getting to know patients as individuals important? Does it really matter if I know where people live, whether their home has one flight of stairs or two, what they do for a living, or if they have kids or grandkids? Let’s face it . . . it probably was never that important, and it’s getting less so. Medicine is a lot like banking, except years behind. The bank teller was taken out of the equation a long time ago. Heck, are there even bank tellers anymore? Medicine is transactional. All we really need is data. Just give me the symptoms, medical history, and some numbers, and I can do the rest. In fact, with some lab tests and a good machine, just show me an empty stool and I’ll grab a beer at the neighborhood retired bank teller bar.

So that brings me to the next part . . . is getting to know patients as individuals rewarding? Does it add meaning to my life as a clinician? Might it prevent burnout?

I remember one of my first patients as a third-year medical student, a woman in her eighties with advanced esophageal cancer. She’d never married and had no family. Every day before I went home, I stopped by her room and just sat and talked. She told me great stories and I got the sense that the time we spent together helped her. I remember one particular night she told me how unbelievably lonely she was and how much she loved talking to me. The next morning when I came to the hospital, I learned that she’d died. She was found unresponsive in a pool of blood in her bed, the cancer having eroded through the esophagus into her aorta. I felt grief-stricken and cried.

That type of scene has unfortunately repeated itself too many times in my career. Too many, because it takes a toll. Life is tough enough. Is it really rewarding to truly know your patients? Is that what adds meaning? Prevents burnout? Give me a break.

The other day, one of my patients came to see me for her annual follow-up visit. A woman in her late seventies, she reminded me that she had told me at her last visit about her first grandchild who had been born six months earlier. This time, she took out her cell phone to show me a video of her grandson—now 18 months old—and she made it seem like he was some kind of budding genius because he could point to his eyes, ears, nose, and tummy after his mommy called out each body part’s name. I mean, do I really have to sit there and listen to this when I have other patients to see? Talk about burnout.

So this is my text message to all the readers of CLOSLER on this 1^st day of April:

Don’t be a fool. IMHO, getting to know patients as individuals isn’t necessary. Is it rewarding? I’m ROFL.

This piece does not represent the views of any organization, including Johns Hopkins Medicine.