One Doctor Quotes

“Some people say doctors should keep their professional lives separate from their personal lives. Whoever says so either never practiced medicine or forgets what it’s like. Doctors don’t live two separate lives. It all comes together, whether we think that’s a good idea or not.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“How much harm patients experience as a result of these “doctor discontinuities” is poorly understood, but there can be no doubt that they add redundancy, expense, and “occasion for error” to our health care system.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“Unless you explicitly forbid it, you will leave this world the same way Ms. Dubois did: Doctors or ambulance personnel will pump on your chest, put a breathing tube down your throat, squeeze oxygen into your lungs, jab you with needles, and electrocute your heart.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“We can’t say for sure why Ms. Dubois died, but Brian needs to know that his hard work yesterday to obtain permission for the autopsy was worth the effort. Some mysteries in medicine remain unsolved even after you look under every rock. But if you don’t lift the rocks, you don’t learn. Maybe that clot did break off and kill Ms. Dubois. But we don’t know this any more certainly than we know whether Brian’s long day at work yesterday precipitated his appendicitis. Sometimes, the best we can say is: Could be. So often, as in this case, medicine is all about maybe. Biology isn’t physics. Medicine isn’t math.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“We generalists must know our own limitations . . . but we will remain vital in our efforts and proud of our work if we heed our patients’ plea: Be my doctor.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“Donald Seldin, a distinguished physician-scientist, in his widely publicized address titled “The Boundaries of Medicine”: Medicine is a very narrow discipline. Its goals may be defined as the relief of pain, the prevention of disability, and the postponement of death by the application . . . of medical science to individual patients. . . . A heritage which invests medicine with the priestly function of the counselor and comforter of the sick . . . has resulted [in] a tendency to construe all sorts of human problems as medical problems. This medicalization of human experience leads to enormous . . . frustration and disillusionment when medical intervention fails to eventuate in tranquility . . . and happiness. Human problems . . . are medical problems and medical illnesses only when they can be approached by the theories and techniques of biomedical science.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“If only there were a book of life, somewhere I could just look up the answers. The intimidating breadth of clinical skill and experience that primary care requires is humbling, but these “people things” were the hardest part. Some involved classic issues in medical ethics; these I could read about and consult with colleagues to help me. But so many others were judgment calls where there was no right or wrong answer, where I couldn’t be sure what was the best thing for my patient or what were the appropriate limits of my responsibility as their doctor. These ambiguities were part of the job. • • •”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“The word doctor is derived from the Latin root docere—to teach—but, in my experience so far, the patients had taught the doctor at least as much as the doctor taught them.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“This didn’t mean we were friends. I hadn’t let that happen. When friends wanted to become my patients, I talked them out of it. And when patients wanted to become my friends, I put them off. This was awkward, sometimes—and often I wished I didn’t have to refuse the dinner invitations or golf outings or theater tickets—but I didn’t see any other way. Professional objectivity was impossible when caring for a friend or a relative. Love and loyalty, or guilt and regret, just get in the way. But maintaining a distance was a personal defense, too. After all, the “doctor-patient relationship” is a relationship. And, like all relationships, it can get complicated.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“Primary care . . . provides person-focused (not disease-oriented) care over time . . . and coordinates or integrates care provided elsewhere or by others. . . . The long-term relationship that characterizes primary care will be difficult to sustain if either party is uncomfortable with their encounters. Because many problems that patients bring to primary care physicians are of uncertain cause or prognosis, the relationship must be strong enough to tolerate ambiguity. —Barbara Starfield, Primary Care (1998)”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“Visitors stream in and out of the rooms and corridors. There are families to see, questions to answer, a new admission from the ED. It’s one thing after another—randomly, it seems—bouncing from one story to the next. Mr. Gunther, headed for the NIH, leaves with his wife. She gives me a long look as they head toward the elevator. I wish her well; living with Pascal’s wager can’t be easy. Mr. Kinney, a dapper corporate attorney, is also getting out of here after a rough two weeks. His pancreas is totally destroyed, replaced by puddles of necrotic fluid, yet he refuses to accept the fact that his fondness for single-malt scotch is the reason why. His wife gives me a long look, too, then they’re gone. Jim, the Cardiology fellow, shows me the echocardiogram he just did on Mr. Warner, our guy with HIV. Nothing there, Jim says, no vegetation, no sign of endocarditis. We consider what this means, make a plan. Up on 10 Central, Mr. Mukaj’s bladder irrigation backs up painfully again but there’s nowhere else we can put him, no empty beds in the ICU or Step-Down Unit, no place where he can have his own nurse with him all the time. We bounce this around, too, decide to try this, then that, we’ll see. Mr. Harris, our patient with Marfan syndrome, a plastic aorta, and a septic hip joint, spikes a fever again. Not good. We make a plan. And so it goes, on into the evening. On days like this, doctoring feels like pinball: nonstop random events—intercepted here, altered there, prolonged or postponed by this or that, the bells and boinks sounding all around—and sometimes you can’t be sure whether you’re the guy pushing the buttons, manipulating the levers, and bumping the machine, or whether you’re inside the machine, whether you’re the pinball itself.”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

“Remarkably, doctors tend to trivialize the suffering of patients with panic attacks—and somatization in general. When it becomes clear that the patient is not having a heart attack—it’s “only” a panic attack—many doctors lose interest or, worse, blame the patient for wasting their time. (I did this myself many times before I learned better.) These dismissive attitudes and behaviors have deep roots in the medical profession: They go to the core of what medicine is for. For many doctors, the purpose of medicine is to cure disease. For these “curing” doctors, if you don’t have a definable disease—panic attacks are not a disease—then you’ve come to the wrong place. But, for other doctors, the purpose of medicine is the same today as it has been for centuries: to relieve human suffering—sometimes by curing disease (when we can) but always by empathizing with, understanding, and trying to comfort the sufferer. Doctors”
― Brendan Reilly, One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine