In healthcare, small gestures provide big outcomes

Don Berwick, M.D. the former administrator for the Centers for Medicare and Medicaid Services (CMS) and former President of the Institute for Healthcare Improvement (IHI) delivered a moving commencement address to his daughter’s graduating class from Yale Medical School. The following passages triggered a flood of memories from my early days as a young physician.

“What is at stake here may seem a small thing in the face of the enormous health care world you have joined. It is as a nickel to the $2.6 trillion industry. But that small thing is what matters. I will tell you: it is all that matters. All that matters is the person. The person. The individual. The patient. The poet. The lover. The adventurer. The frightened soul. The wondering mind. The learned mind. The Husband. The Wife. The Son. The Daughter. In the moment.

“…In my first week of medical school, I was assigned a tutor: Dr. Edward Frank. He was a vascular surgeon, and he was to supervise me in my physical diagnosis course. I read what Harvard Medical School called ‘The Red Book.’ It was all about the history and physical exam. Hundreds of questions to ask – history, physical, chief complaint, review of systems, and on and on. I stayed up very late, studying all those questions; memorizing the ritual. I knew all the right questions, I thought. I met Dr. Frank the next afternoon, and he took me to see Mrs. Goldberg, who was in the hospital to have her gall bladder taken out. Dr. Frank brought me into Mrs. Goldberg’s room, into her presence, introduced me, and invited me to begin. My very first history and physical.

 “‘Tell me, Mrs. Goldberg,’ I said, ‘when did your pain begin?’ Dr. Frank, the surgeon, interrupted me. He gently put his hand on my shoulder, and he gave me a gift I will never, ever forget. And I will pass his gift to you. His gift was a question that The Red Book left out.

“‘Oh, Don,’ he said. ‘Before you ask that, let me tell you something very special. Did you know that Mrs. Goldberg has a brand new grandson?’”

Reading these words, I pondered my first two encounters with a patient named Jacob. I became acquainted with Jacob as I rounded in a nursing home during my first year of practice. The first time we met, Jacob yelled at me to leave the room. In my irritation, I viewed him as the “demented guy in room 200.” A month later, during our second encounter, Jacob peered at an upside down Chest X-ray as I entered. Looking up, he asked me what the X-ray was before yelling at me to leave. Though his behavior remained aggressive and loud, he no longer appeared to me as the “demented guy in room 200.” I learned that before developing Alzheimer’s Disease, Jacob practiced as an accomplished radiologist and his family provided him with the X-ray as a link to his past. During that second visit, my perspective changed.  I saw Jacob as the precious, loved family member. The radiologist. The son.

Subsequently, whenever I entered the room of an elderly patient who could not converse with me, I looked for family pictures and mementos which could help me connect with the person and their lived experience. The mother. The father. The grandparent. The son. The daughter. The professional. The teacher. The lover. The writer. Working in healthcare we are privileged to witness small things that matter. 

I encourage you to read Dr. Berwick’s full commencement address. Click here to view.

In addition, please feel free to comment. We encourage a free exchange of ideas but, as always, we reserve the right to remove comments that make personal criticisms or attacks on individuals or specific businesses.