Faculty Bibliography

When doctors tolerate a culture of disrespect, we aren't just being insensitive, or obtuse, or lazy, or enabling. We're in fact violating the first commandment of medicine

"When we read or hear a poem that's truly effective," says [Rafael Campo], "we feel what the speaker is feeling. We experience an entire immersion of ourselves in another's consciousness." So opens Campo's prize-winning poem, "Morbidity and Mortality Rounds." It's an immersion into the maw of death. I've read textbooks and articles about facing death, but they don't capture the essence of the experience the way these few lines do. Every doctor and nurse will recognize "when I look at you, I see myself laid bare." It's the fierce existential tie between caregiver and patient. Campo's newest book of poetry, "Alternative Medicine," will be published this fall. "A good poem engulfs us," says Campo, "takes hold of us physically. Its concision and urgency demand the participation of another in order to achieve completeness, to attain full meaning. In these ways, it's not so different from providing the best, most compassionate care to our patients."

Countless times it is only during physical exams that patients have brought up their true concerns - domestic violence, suicidal ideation, job loss, eating disorders, sexual concerns - things that seemed awkward during the computer-dominated Q&A of the first half of the visit. Even if the physical exam may have less diagnostic utility as in years past - though this is certainly a debatable point - it still plays a critical role in medicine

The trick to surviving was to shuttle patients to another area of the hospital as quickly as possible. This patient was a perfect candidate for the intermediate care unit, a holding station for patients with no active medical issues who were awaiting discharge. First we just had to rule out any treatable medical conditions -- get the labs, head CT scan and chest X-ray. But the docs at the intermediate ward left at 5 p.m. and it was 4:45. I quickly scanned through the labs, called the ward's doctor and ran through the case -- demented patient, still demented, return to nursing home tomorrow. I remember the doctor's voice so clearly: "You're sure the labs and everything are normal?" Yes, yes, I said, everything is fine. She hesitated, then said O.K. The intern and I high-fived each other, and bolted back to our other admissions. Much attention has been paid to reducing medical errors. Electronic prescriptions avoid penmanship mistakes. Bar codes on wristbands ensure that medications go to the right patient. Checklists and timeouts before surgeries help prevent common oversights. But we can stop only the errors we know about. There remains a black hole of near misses, of uncharted errors -- a black hole of shame that prevents caregivers from coming forward