Lesson 1

By Laura Willet, MD

Looking back, I learned more about how to be a doctor from my mother, who was a children’s librarian, than from any other person. She had enormous insight into the human condition, and I want to share the insights I gained from her with young doctors, and with my family.

 

Lesson 1. Don’t say “How are you,” or “Have a nice day.”

 

We didn’t have any idea, then, that I would be a doctor. The year was 1974. I was 16, and my mother was getting radiation treatments 5 times a week for several weeks following her mastectomy. At the time, this was the standard treatment for breast cancer that had spread to lymph nodes and was therefore likely to recur and cause death. Mother experienced extreme fatigue with her radiation treatments and was struggling to keep up with her responsibilities as a wife, mother, and elementary school librarian. She was usually a calm, sweet person, so I was surprised to see her very angry one day after returning from her radiation treatment. “I got so mad at that nurse,” I remember her yelling. “What did she do?” I asked, thinking it must have been something horrible. “Every day, she greets me by saying, ‘How are you?’.” My face must have shown my confusion about why that was a bad thing to do, so she continued. “She should know better! We’re all there because we’re lousy. Today, I lost my temper and told her exactly how I am – the skin on my chest is so painful, I feel SO tired, and I hate going there every day! The other nurse knows not to say something stupid like that. She will say something cheerful about the weather or something. Never ask a sick person how they are unless you really want to know.”

 

I had been in the habit of greeting everyone with this common phrase, and this interchange with Mother made me re-think this. When I became a medical student, I remembered her advice, and tried to start my patient interviews with a different question like “What brings you to the office today?” Years later, when I was a young doctor, my own experience made me really understand my mother’s outlook. I went through a few years during which my mother was dying slowly and painfully of recurrent breast cancer, and my husband and I were dealing with infertility. Emotionally, I was doing terribly, and I didn’t know how to deal with my co-workers’ breezy greetings of, “How are you?” Eventually, I landed on a diverting statement of “Nice to see you,” which had the benefit of being true and avoided a long painful discussion they weren’t interested in. Only once in all those years did a perceptive doctor stop in his tracks and say, “No, I really want to know how you are.” His example showed me how thoughtless I had been for years, asking people how they were when I didn’t have the time or interest to hear an honest response.

 

Mother believed in unflinching truthfulness, and felt that this needed to extend to all of our unthinking habitual actions.

 

Another phrase I have warned my students against is the habitual leave-taking, “Have a nice day.” One day, a fairly new medical student and I were taking leave of a 25-year-old patient with widely metastatic melanoma, who was having a lot of pain and was likely to die within a few weeks. I thanked the patient for spending time with us to help the student improve his physical examination skills. The student said, “Have a nice day,” on his way out the door, and did not observe how the patient’s face contorted in response to the unthinking irony of this remark. After we were away from the room, I asked the student not to use that phrase in such a setting. The student seemed annoyed at me for criticizing his use of this phrase, even after I explained that the patient was never again going to have a “nice day”, and that using such an expression was therefore cruel. Most students have been able to absorb this lesson, that the words we use are potent tools, and that even these rote expressions need to be examined carefully.

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