Why I Prescribe the Love Drug

Pamela Wible lips

As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During med school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the corner while the younger one jumped all over the playroom despite his contracted and painful limbs. Why? The younger boy’s family kept hugging and kissing him. The older boy had no visitors.

People die without love.

My friend, Dr. Patch Adams, discovered that less than 3% of his patients have self-esteem. And less than 5% have any idea what a day-to-day vitality for life is about. The fact is most people are in pain. So what do we prescribe for pain? Painkillers, of course.

Recently, I attended a training on the safe use of opioid painkillers where I learned that the United States is 4.6% of the world’s population, yet we consume 80% of all opioids. But painkillers don’t seem to be killing our pain. Why?

In America, we overprescribe opioids while under-prescribing the most potent drug of all: love. And love IS a drug. How fabulous you feel with it. And how painful life is without it.  So why are we so stingy about prescribing love? 

The antidote for hate, neglect, apathy, misery, even sorrow is love. No prescription pad needed. No risk of overdose Love is my preferred potion. I give patients heart-shaped balloons. And hugs. Yes, I even tell patients, “I love you.” Some leave with my kiss on their forehead.

You don’t need a medical degree to say, “I love you.” Just three simple words can heal more wounds than all the doctors in the world.

—–> See my TED Talk on healing & vulnerability.

Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.

21 Comments

***

How to Save 90% on Medical Bills

Pamela Wible Rob

Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.

A few days later, I get this e-mail: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to a doctor for 5 minutes. No blood drawn, no stitches made, no X-rays, but I’m told the standard amount for the classification of my visit is $624. I called to complain and, of course, the person on the phone can’t do anything. Well, she could have sounded sympathetic. I didn’t even know that there’s a difference between an urgent care and an emergency room. Apparently, an urgent care would have been cheaper. Where is there an urgent care downtown?”

Urgent care is just 2 blocks from the ER. But why didn’t Rob just call me? He wasn’t sure. Why do so many patients like Rob end up in the emergency room with non-emergent conditions? Let’s think this through.

An emergency is a serious, unexpected, and often dangerous medical condition requiring immediate action such as a heart attack or gunshot wound. An urgent medical condition is a very important, but non-life-threatening situation that needs immediate attention such as a dislocated shoulder or kidney infection. A routine medical condition is neither urgent nor emergent such as high cholesterol or hemorrhoids.

Let’s say I’m your family doctor. It’s Saturday morning and your kitty bites you. Your hand is suddenly red, hot, and swollen.

Should you go to our 60-room, 44-bed, 30,000-square-foot emergency department and trauma center that includes a waiting area with a fireplace and a children’s playroom? Do you really need 2 psychiatric holding rooms, 2 trauma suites, and a decontamination room with a dedicated entrance for patients exposed to hazardous material? Upon arrival you may be treated by up to 4 doctors and 17 nurses, all emergency-trained and you’ll have 24-hour access to anesthesiologists, neurosurgeons, and all manner of specialists. In case you need to arrive by helicopter from the 8-county service area, expect to enter an extra wide mega-elevator that will enable your continuous care during transport from the hospital’s rooftop helipad. By the way, if you need this level of care, please call 911.

Or should you go to our 6-room, 3,000-square-foot urgent care that staffs one family doctor, a nurse, and a medical assistant? They do X-rays and labs and they’re open from 9:00 am until 9:00 pm every day with six locations in town.

Or should you call me? I work in a cozy 280-square-foot clinic. I have no staff. I handle urgent and routine conditions and perform minor surgeries. Once, I even removed metastatic lung cancer from a guy in my office. I work most afternoons, but I’m available 24/7 for urgent needs. Best part: my low overhead allows me to pass savings on to you. How can I do this? Watch my TEDx Talk.

Today Rob sends another e-mail: “In addition to my initial fee of $624 associated with my cat bite, I got a second bill for $194.70. It’s totally different looking and is from the Emergency Physicians. The bill references a nurse practitioner. I suppose I never actually saw a physician.”

The truth is: you could get treatment anywhere for your cat bite. The real question is: how much do you want to pay for it?

Emergency room: $818.70.

Urgent care: $99.

My office: $50.

Your choice.

Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.

13 Comments

***

Meet the Happiest Doctor in America

Most docs aren’t happy. I wasn’t either. Until I left assembly-line medicine.

In 2004, I held town hall meetings where I invited citizens to design their own ideal clinic. I collected 100 pages of testimony, adopted 90 percent of feedback, and we opened one month later. Now, my job description is written by patients, not administrators. I’m finally practicing medicine the way I had always imagined. And I’m happy. Here’s why:

Disintermediation: I “removed the middlemen” so now I enjoy direct relationships with clients in a cozy office with no staff. I’m 100% solo. I don’t miss the bureaucracy. Nor do patients who get uninterrupted 30–to–60-minute appointments.

Autonomy: No more committee meetings. If my patients and I want to change an office policy, we do it. I’m available 24/7. I even do housecalls! I control my schedule. That means I can take vacation whenever I want. Problem is last time I left town, I missed my patients.

Finances: Without a bloated bureaucracy, I have super-low overhead. I pass on the savings to patients. Care is VIP with no extra fees. Insured and uninsured are welcomed. Nobody is ever turned away for lack of money.

Authenticity: I dress casual, not corporate. Mostly Levis and clogs. Patients like me to be me. A recent thank-you card reads: “It’s so refreshing to meet a doctor who is a real person with a real personality.” Forget professional distance. Let’s be real. Professional closeness is what people want.

Fun: I’ve got a giant gift basket with prizes for patients who lose weight, quit smoking, or reach other goals. Other gifts award folks who bicycle or walk to the office. Plus Fridays are Patient Appreciation Days with balloons and dark-chocolate hearts for everyone!

Inspiration: The best part: I stopped complaining. If doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged. If we want happy, healthy patients, why not start by filling our clinics with happy, healthy doctors? By enjoying medicine, I inspired my colleagues to find joy too.

Oh, and patients are happier than ever! Happiness is contagious, ya know.

Pamela Wible, MD, is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. She hosts  biannual retreats to help doctors love being doctors again. Many have opened ideal clinics too! Photo by GeVe.

14 Comments

***

Patient Profiling: Are You a Victim?

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences. For the first time, people share their stories:

“I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

“In 1986 I was in a motorcycle accident. I tore up my face on the road. I was taken to the ER and treated like crap because I had no insurance. They cauterized my facial wounds rather than stitch me up, and then dumped me on the sidewalk with amnesia. I still have distinct black scars; people think they’re tattoos. I went into collections and it took years to pay that one off. Six weeks ago, I fell while trimming a tree. When the ER found the insurance card in my wallet, I was treated like gold.” ~ James Cummings

“I was pressured by our doctor from my son’s birth all the way through grade school. I kept telling him no vaccines whatsoever, zero, nada. I was hassled, shamed, talked down to, and more. Not a fun experience, whatsoever. I was profiled as a bad mother.” ~ Sheri Ricker

“As a teen, I fractured my nose. Many sinus issues later, I consulted an ENT specialist. He insisted that I damaged my sinus passages by using cocaine. His assumptions caused me pain, humiliation, confusion, and anger. I repeatedly assured him that I wasn’t a user. Two surgeries later, my septum was removed. Afterwards, he was so cruel as to continue his tirade about my cocaine use. As the gauze was being removed from my nose, I fainted. When I was roused, he insisted that I leave immediately showing no concern about whether I could even make it home safely.” ~ Lonnie Stoner

“It was 1975. I was 23 and I’d been on the pill for 4 years, but I became concerned about potential negative side effects of long-term hormonal manipulation.  So I researched other contraceptives and felt the diaphragm was the simplest and safest option for me. When I went to the county clinic to get fitted, I explained what I’d researched to the doctor. He scoffed at my concerns, urged me to stay on the pill, and disputed any potential negative consequences. He reminded me that taking a pill each day was SO much easier than having to be responsible for using the diaphragm properly. It was clear he thought I was too young and clueless to make this decision about my own reproductive health care. Although he tried to dissuade me from switching to a diaphragm, I insisted that’s what I wanted, and he finally fitted me for it. After he left the room, the nurse said, ‘Don’t worry, dear; it’s quite easy to use. I’ve been using one for years with no problems. It’s a good choice for you to make!’ It was clear she didn’t approve of his patronizing attitude either.” ~ Patsy Raney

“I injured my back at work. I couldn’t get time off, so my family doc prescribed pain meds so I could get through the day and Xanax for sleep. I returned every six months for two years and he always accused me of taking more than I was prescribed. He got progressively more rude and angry. I brought my wife with me to see if I was imagining it. She witnessed it too, so we searched for another doctor. I asked my new doctor to taper me off of the pain meds and Xanax so I could try medical marijuana instead. He was skeptical. He told me to go to the pain clinic. I’d gone there once before and was treated like a criminal. I didn’t want to go there!  So he wrote up a contract that said I would agree to take pain meds and Xanax and I’d be drug tested monthly to make sure that I wasn’t using medical marijuana. When I told him I wouldn’t sign the contract, he told me to find another doctor. This was at a critical time when I needed real help and was worried about taking the meds for over two years.” ~ Carl Williams

I’ve been a doctor for 20 years. I thought I’d seen it all. Drug addicts have altered my prescriptions, even forged my name. Patients have lied to me. Many haven’t followed my treatment plans. Some have died as a result. Still, I try to treat everyone fairly and with respect. But now I’m wondering, “Have I ever profiled a patient?” I bet I have. So on behalf of my colleagues and myself, I’ve got a message for any patient who has ever been misjudged or mistreated:

Are you a doctor who has profiled a patient? Have you ever been profiled by your doctor? I’d love to hear your story.

Pamela Wible, M.D., is a family physician in Eugene, Oregon, where she founded the first ideal medical clinic designed entirely by patients. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. Contact her at idealmedicalcare.org. Photos by GeVe.

51 Comments

***

A Case of Racism-Induced Hypertension

Meet Damien, my Facebook friend, photographer, and IT guy.

This morning, he messages me: “I would like to make an appointment.”

I reply: “For?”

“High blood pressure :(.”

I offer to see him, but he never comes in. Weeks later, he writes, “I got busy Pam. How are you? High blood pressure pills keep making me sick. I am doing the best I can. On bad days it is like 208/118.”

Friends don’t let Facebook friends die. And 208/118 is incompatible with life. I’m a family doc–a sleuth. It’s my job to spy on people. On Damien’s page, I find a dozen photos of lynchings–his reaction to today’s Trayvon Martin verdict. A black boy murdered in a land where killers roam free. Trayvon died a senseless death, but Damien shouldn’t have to. I suspect today is a bad day for Damien’s arteries. So I call him up. “I’m worried about you, man. I’m coming over to check on you tonight.” An hour later, I’m in his living room.

Damien didn’t always have hypertension. As a child, he loved music, dancing, and cruising around the neighborhood on his red tricycle. He was peaceful, happy–until the day he saw two dark men on the hood of a police car. “The police were beating the crap out of them. I asked my dad why. He said, ‘Son, this is the way things are. You’re gonna have to get used to it.’”

I ask Damien about his family.

“There’s high blood pressure on both sides of my family. Mom was diagnosed at 13. I’m of Jamaican, African, and Native American descent. I didn’t know much about my ancestors until recently,” he explains. 

“In junior high, I was taught my people were slaves. After class, I asked my history teacher if Native Americans and Africans were anything more than just slaves. Did they do anything great? It was an innocent question. I was curious. Genuinely concerned, my teacher put his hand on my shoulder and said, ‘Damien, it’s unfortunate, but it’s true that white people are superior to black people and Indians. The only hope for your people to get out of the situation they are in is to get an education and buy property.’” Damien was shocked. He explains, “We are taught that we’re a slave race. It’s a psychological weapon. No doubt about it. The message I received in school: You guys are slaves. We kicked your ass. And here’s all the great things we’ve accomplished as a result. That’s American history.”

“So how did you end up in Oregon?”

“Los Angeles is a dangerous place to be black. I’ve lost a lot of friends to violence. I’ve seen people get shot. I’ve watched them die. Back home, when a black man calls for help, police show up to harass him. I’ve been denied jobs, even hotel rooms, because I am black. Back home, I always dress nice. Yet a white woman will look at me with a frightened expression, grab her purse, and move away from me like I’m going to mug her. I am a friendly guy. I’m here because I got sick of being shut down.”

“Mind if I check your blood pressure?” Damien sits on the sofa, takes a deep breath, and offers me his right arm. “Wow. It’s 150/89–better than I thought. Let’s check the other side”

Suddenly, there’s a knock on the window. A flashlight shines into his living room. Before I understand what’s happening, Damien’s hands are up in the air. A police officer tells him to come outside. We learn that the cop is searching for a lady who’s driving recklessly through the neighborhood.

I’m relieved that nobody is hurt, but Damien is agitated. He’s pacing. His post-police blood pressure: 205/109.

He sits down. He stands up. He sits down. I check him again: 189/105.

He stands up. He calls his daughter. “Hey sweetie, I need you to get down if you hear anything. I love you.” She’s visiting his mom in L.A., where drive-by shootings are the norm. “My mom jumps in the bathtub when she hears gunshots,” he tells me.

I recheck his blood pressure: 167/98.

“Hey Damien, can you tell me what medicine your doctor has you on?”

“I’ve been on so many pills. Most recently Lisinopril. But my pressure went up. My heart was racing. I got anxiety. Doctors have been giving me experimental drugs for years. White men’s medicine doesn’t work for me.”

Maybe taking white men’s medicine–drugs developed by one’s oppressors–raises blood pressure. I never thought about that before, but it makes sense now. Could be the anti-placebo effect.

“Why don’t you lie down, relax? I’ll make you some tea.”

In Damien’s cupboard, I find hibiscus. “Hey, do you know hibiscus is native to Jamaica? It even has blood pressure lowering effects.”

As he sips his tea, I help Damien understand what’s going on. “Emotional distress clamps down your arteries and causes you to retain sodium. When you raise your blood pressure, you are beating yourself up inside–punching your heart, brain, kidneys with each heartbeat. Try to let go of your fear and anger, Damien. Don’t internalize the racial oppression, man. Please . . .” I lead him through a meditation to release his inner torment. Thirty minutes later, my friend’s blood pressure is 136/72.

People with hypertension die prematurely of heart disease, stroke, kidney failure. I think I know why Damien developed such high blood pressure. I consult Harrison’s Textbook of Internal Medicine and confirm the sad statistics: urban blacks have twice the prevalence of hypertension as whites and more than four times the hypertension-induced illnesses. A chart lists risk factors for bad outcomes in hypertensives. The top three: black race, youth, male sex.

Maybe Damien is carrying the pain of his ancestors who were kidnapped, shackled, brought here against their will. Maybe his arteries clamp down when he sees cops because so many of his friends were harassed, rather than protected, by them. Maybe his body is responding normally to the daily stress of being a black man in America.

Damien’s is 45. Since his early 30s, doctors have diagnosed him with essential hypertension, a form of high blood pressure for which no cause can be identified. Essential hypertension is a cop-out, a trashcan diagnosis. Why? The majority (95%) of hypertensives are dumped into this category. We tell them to lose weight, stop smoking, avoid salt. But Damien isn’t obese. He doesn’t smoke cigarettes. He rarely drinks alcohol. He eats mostly lentils and rice. The guy drinks lemon water.

“Essential” means absolutely necessary, vitally important. To treat essential hypertension, it’s absolutely necessary and vitally important to understand why a human being would develop blood pressure incompatible with human life. For Damien, the “unidentified” cause is racism.

“Unimportant” is the opposite of “essential.” To be satisfied with the diagnosis of essential hypertension is to declare the real cause unimportant–and that’s exactly how racism makes people feel.

 

Pamela Wible, M.D., is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind and the founder of the first community-designed ideal medical clinic in America. Contact her at idealmedicalcare.org. Photos courtesy of GeVe.


7 Comments

***

Surprise! It’s Patient Appreciation Day

Bill and Carol enjoy Patient Appreciation Day.

On random Fridays, clients are showered with extra affection to celebrate “Patient Appreciation Day.” I surprise the unsuspecting visitors with dark-chocolate hearts and Mylar heart-shaped balloons as they enter the office. This is in addition to the gifts many receive for meeting their health goals. Sitting on the couch next to her balloon, treats piled high in her lap, a woman bursts out, “This is like going to Grandma’s!”

Kids and adults alike enjoy the unexpected attention and gifts. It’s especially exciting to surprise new patients, the ones who choose me at random from a preferred provider list given to them by their health insurance company. After receiving a door prize and an initial hour-long appointment, one woman exclaims, “I feel like I hit the lottery!”

Actually, I’m the one who hit the lottery. After all, I couldn’t be a doctor without such awesome patients! Here are a few of the people I appreciated and celebrated this week:

Mariah loves her balloons!

Benjamin and his balloons

Kimmy takes a balloon for her son.

Dick and Sheri share a loving moment before the end of their visit.

Emily and Jayson celebrate the end of a long day with balloons from their doctor.

Pamela Wible, M.D. is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.

3 Comments

***

Should You Be Intimate with Your Doctor?

Pamela Wible, M.D.

A new patient calls for an appointment. I ask, “What would you like to come in for?”

“Depression. Two weeks ago my doctor put me on antidepressants.”

“Why don’t you see your current doctor?” I ask.

“I feel weird discussing my emotions with someone who doesn’t have any.”

When doctors are fully present, vulnerable—even emotional, patients are more likely to be honest, transparent, and open. Sexual intimacy is, of course, inappropriate between patients and physicians, but emotional intimacy is essential in any healing relationship.

What patients really need is a human being who is being human, a whole person who sees the patient as a whole person. On her way out, a new patient says, “I feel like I just got a physical, met with a marriage counselor, and had a spiritual awakening.” We could all have comprehensive, personalized care, but here’s the paradox: We resist what we most desire: Intimacy. Intimacy means “in-to-me-see.” It’s when we see so deeply into another, that we find our own reflections and discover ourselves.

Beatrice, an elderly woman calls for a Prozac refill. I remind her of my office policy: no refills between appointments. She screams, “None of my other doctors made me come in. What’s wrong with you?” Upon arrival for her appointment, she’s fuming. After thirty minutes, Beatrice breaks down and shares how difficult it has been since her husband died last month. She feels isolated and scared. With tears in her eyes, she hugs me and then thanks me for getting her out of the house.

It’s Friday night when Christie calls for an antidepressant. I pick up on the second ring. “Hello, how can I help you?”

“This is the doctor? It’s almost midnight and you answered the phone!” Frazzled, Christie tries to explain herself. “Things are kind of tough right now, Pamela. I was just calling so you could prescribe me some antidepressants.”

We talk about her mother’s death and the challenges of raising her autistic child.

“Christie, I’m happy to see you Saturday morning.”

“I just can’t believe you answered the phone. I’m so excited, I don’t feel depressed anymore.”

Being emotionally available and accessible is healing. Sometimes I think maybe I am the antidepressant.

Pamela Wible, M.D. is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.  Photo credit: GeVe

7 Comments

***

How to Eat a Triple Bacon Cheeseburger with Your Doctor

Joe just had open-heart surgery. A triple bypass. When he left the hospital last month, he promised he’d follow a healthy diet and quit smoking for good. I call to review his cholesterol results. He picks up on the second ring.

“Hold on a minute,” he says.

The reception is poor, but I can make out a few people talking. I hear the muffled voice of a woman.

“Okay, so you want a combo meal, sir? That’s a BK Bacon Triple Cheeseburger, large fries, and a large Coke. Anything else, sir?”

“Can you change that to a Diet Coke?”

“Okay. That will be $7.29 at the window.”

“Sorry, who is this again?” he asks.

“It’s Dr. Wible.”

“Oh my God. Oh no. Oh no. Oh my God. I can’t believe it. I promise this is the first burger since the bypass. It’s just a treat. It’s the first time, I promise. I’ve been eating more salads. I was even vegetarian for a few days. I can’t believe it’s you. I can’t believe you’re calling now. Oh my God.”

“Joe, your cholesterol is still high. You better stay on your statin. In fact, let’s triple the dose. You know, the drive-thru is just a shortcut to the Pearly Gates.”

This is PART 2. Read PART 1.

Chapter 79  from Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.   ** R.I.P. Joe 12/10/13 **

 

Leave a comment

***

How to Smoke a Cigarette with Your Doctor

Joe has smoked two packs per day since his teens. He knows better. I don’t need to lecture him on the dangers of smoking.

“I was a respiratory therapist back in Brooklyn,” Joe says in his thick New York accent.

“And you smoked?”

“Yep. All the respiratory therapists smoked, Doc.”

“Reminds me of cardiologists who order bacon and eggs in the hospital cafeteria, but then tell patients to eat low-cholesterol diets.”

Joe continues, “It’s my anxiety. That’s why I smoke. I moved to Oregon a few years ago for the quiet life. I’m gonna turn my life around. You’ll see, Doc.”

Today we’re celebrating. Joe hasn’t had a cigarette since he went into the hospital last month with pneumonia.

“I feel terrific!” he says. “I’ve turned the corner, Doc.”

The next day I’m bicycling through town. I turn at the corner of Sixth Avenue. To my right, I see a man smoking a cigarette. I have a feeling it’s Joe. He’s standing next to an apartment complex. I get closer. Oblivious, he has headphones on and he’s tapping his left hand on his thigh. So I speed up and then stop suddenly right in front of his face. The high-pitched squeal from my brake pads startles him.

He does a tough guy pose and tries to stare me down. “What’s your problem?” he says.

I lean my bicycle against the door to his apartment.

“Who are you?” he demands as he closes in on me.

We’re in a standoff. He takes off his headphones. I take off my bike helmet. He removes the cigarette from his mouth. I remove the sunglasses from my face.

Then he slinks back against the building and almost cries, “Oh my God. Oh no. Oh no. Oh my God. I can’t believe it. I promise this is the first cigarette. I just picked it up just now. It’s the first one. I mean the last one. I promise I’m going to quit, Doc. I’ll quit now, tonight, as soon as you leave. It’s the last one. I promise. I can’t believe it’s you. What is this? Why are you here? What are you, an angel?”

I put my hand on top of Joe’s balding head, look straight into his eyes, and I bless him: “Your life has been spared one more day.”

Then I ride off into the sunset.

This is PART 1. Read PART 2.

Chapter 78 from Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.   ** R.I.P. Joe 12/10/13 **

3 Comments

***

Why I Kiss My Patients

I started kissing patients in med school. And I haven’t stopped.

During my third year pediatric rotation, I used to stay up late at night in the hospital, holding sick and dying children. I’d lift them from their cribs, kiss them, and sing to them, rocking them back and forth until they fell asleep. One day the head of the department pulled me aside. He said that I was a doctor when my patients needed a doctor and a mother when they needed a mother.

Twenty years later, I’m still mothering my patients.

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. They worried that big government would kill the small-town physician. But I love being a family doctor. And I love my patients. I hug them and kiss them, and I do housecalls. And most patients call me Pamela or sweetie, or honey. They all have my home phone number. I’m on call 24/7, but I never feel like I’m working.

I’m not good with boundaries. I’m never sure when work ends and play begins. It all feels the same to me. Many of my patients are friends. I do their physicals and eat over at their homes for dinner.

I’m not a fan of professional distance. But I’ve been trained to maintain distance from patients. How can I remain distant when I’m looking deep inside people in places nobody has been before? How can I remain detached when delivering a mother’s first baby, saving a brother’s sister, or helping a child’s grandfather die?

Apparently, maintaining a safe distance from patients will help my objectivity, limit favoritism, maintain clear sexual boundaries, and prevent exploitation. But patients today don’t want professional distance; they want professional closeness with a doctor who has a big heart and a great love for people and service in a clinic where people feel warm, nurtured, loved and important.

And I want to be that kind of doctor.

The truth is: I can’t always stop patients with heart attacks from eating bacon double cheeseburgers. I can’t always stop smokers from smoking. I can’t always stop little kids from dying.

I can’t always cure, but I can always care—and kiss my patients.

Pamela Wible, M.D. is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.

8 Comments

***