Sublime

in identifying tone, subtle shifts of mood, themes, and recurring metaphors, we become better at diagnosing and treating our patients.

Lina’s hormone doctor told her that if people are denied certain parts of relationships they need as children, they hunt for these parts as adults.

Another aspect of family history that doctors rarely take into account is what I think of as the culture of illness in which a person grows up. I’ve had patients whose childhoods were overshadowed by their parents’ extreme anxiety about illness and others whose illnesses were ignored, sometimes to the point of neglect. These early experiences can’t

in 1816 a French physician was too embarrassed to put his ear up to a female patient’s chest to listen to her heart and lungs (as was the norm at the time) and instead rolled twenty-four sheets of paper into a cone to create some distance between them. I think this distance between physician and patient has only grown larger over time.

I can anticipate the counterarguments of my colleagues—indeed, I’ve made them myself: But there’s only so much time in a day. You have to triage. You have to maintain appropriate boundaries. All true, and yet this, too, is true: when I talk with my patients about issues not strictly medical, I feel most like a doctor.

transgression

I find the photographs cheering, reminders of my patients not as patients, but as people, of their lives beyond what I recorded in their medical charts.

Hippocrates and Osler: It is much more important to know what sort of patient has a disease than what sort of disease a patient has.

even at one of the world’s great academic medical centers you can easily declare yourself an expert in a condition that no one else wants to deal with.