This is Why Doctor’s Day Truly Means Something

Walking to Lowell General Hospital this morning, I was greeted by a sign that read, “Happy Doctor’s Day! Honor, Trust, Knowledge.” Now, of course, the cynical will see such a day as another “Hallmark Holiday,” along with Administrative Assistant’s Day, Bosses’ Day, and the like. But it’s always nice to be appreciated, so the sign, as well as my wife’s greeting of “Happy Doctor’s Day” this morning, brought a smile to my face.

Honor, Trust, Knowledge

I contemplated the “Honor, Trust, Knowledge” aspect of the sign. The word “trust” stuck with me. Yesterday, I saw one of my cancer patients on whom I had just performed a large neck dissection surgery along with my otolaryngology residents. It was a long procedure, and he was in the hospital for a few days. Now he was sitting in my office for his first outpatient visit. He had previously had chemotherapy and radiation for his throat cancer, and he has had significant trouble swallowing.

He seemed to be turning the corner and having some improvement, but then we found cancer again in his neck, prompting the neck surgery. The surgery led to some swelling in his throat, upsetting the delicate balance that is the swallowing mechanism, and he needed a feeding tube placed a few days after the neck surgery. Now, here he was sitting in my office, going over his current status.

He informed me that he seemed to be having some improvement in swallowing. Usually, we proceed with a series of swallowing tests to make sure liquids and foods of various consistencies are not going down the wrong pipe (the trachea) before giving the green light to resuming a normal diet. But he told me that he had very sparingly been trying various consistencies, and he wanted my approval.

I told him that he could try certain foods and liquids that were least likely to cause problems, but that needless to say, if he had any issues he would need to stop and strictly rely on the feeding tube. He said that he would watch for any signs of aspiration (foods or liquids entering the trachea). He then said to me, “Do you trust me?” I laughed and said, “Of course, I trust you. You just trusted me to make a huge incision in your neck and take out your cancer. I think we trust each other.”

Trust Lies Between Honor and Knowledge

Trust is an amazing thing. In fact, I love the fact that on the Happy Doctor’s Day sign, it lies in the middle of Honor and Knowledge. You may honor me because I am a doctor, with the assumption that I have put in years of dedicated work to hone my craft. You may expect that I have the knowledge of general medicine as well as the specific area in which I specialize. But the trust is what makes it all work. You, as a patient put your faith in me. At the risk of being dramatic, you literally put your life in my hands.

And with that in mind, I see Doctor’s Day not as a time when I expect gratitude, but instead, as a time when I am grateful to my patients as well as my colleagues. The true honor lies in the fact that people trust me to take care of them when they may be most vulnerable, that they trust my knowledge to choose the best course for them and to make the best decisions with them regarding their care.

I am never too proud to be truly awestruck when patients come to me and put their trust in me. I meet people on a daily basis who are referred from other doctors, from other patients, or simply because they called my office and asked for an appointment with whichever doctor had the next appointment. There are many people I meet who enter the room having never met me before, and then, approximately fifteen minutes later, they are leaving my office ready to set up surgery with me. In that short period, we have bonded, and they have placed their trust in me to perform surgery on them, or in many cases, on one of their children. I have been a doctor for a long time, but this phenomenal trust never ceases to amaze me.

Trust Beyond Medicine

Now, of course, this trust is not unique to medicine. There are many times when we put trust in someone who really is, at least initially, a complete stranger to us. Parents send their children to school, where a teacher whom they may not know will be the central person in their children’s lives for a large portion of the day. True, by the end of the school year, that teacher is well-known to you, but that is not always the case the first day of school. This is also true when you drop your child off for soccer practice with a new coach or violin lessons with a new instructor.

Let me give you a more adult example. Think about flying, hopping on a plane to travel for business or pleasure. Think about how many people fear flying. Often, when someone says he or she fears flying, there will be the retort that more people die in car accidents than in plane crashes each year. Now, besides the fact that plane crashes seem to make headlines more quickly, in part because of the number of casualties in a given event, I believe the real issue here is our loss of control. When I get into a car, even if I am not the driver, I understand how that car works. I can see potential threats on the road ahead of me. I know the speed limit. I can interpret the gauges.

When I am on a plane, I relinquish that control. Not only am I not flying the plane or sitting next to the person who is, but I also would have no idea what was going on even if I were sitting in the cockpit. And, in spite of the number of times I have seen those diagrams of the cross-section of an airplane wing and how air flowing over the wing and then back under it keeps the plane up in the air, I still don’t get it. Yes, by flying, even with trepidation, we get to our destination, because we trust the pilot, the copilot, and the crew. We have faith that they are dedicated to flying the plane, and knowledgeable enough to get us safely to our destination.

A Sacred Trust

This flying analogy brings me back to my career as a surgeon, and the trust people place in me. Although there is so much medical information on the Internet, the reality is that, when people roll into the operating room on a stretcher and are transferred to the operating room bed, ready for surgery, they are relinquishing control. They are entering a world that may be very foreign to them. They will soon be asleep — in some of my cases, for eight to twelve hours if it is cancer resection and reconstruction. During that time, they are completely in my team’s hands. It is trust that allows them, even if they are extremely fearful, to make that leap of faith that is required to place their lives in our hands.

Given that faith, the onus is on me, and on my team, to deserve that trust, and to show the true definition of being trustworthy. I need to constantly be worthy of that trust. I need to perform to the best of my ability. I need to keep my knowledge and skills up to date. I need to know my limitations and recognize when I need assistance. And I need to be honest, whether the outcome is good or bad. When I read reports of surgeons acting in a dishonest or unethical fashion, such as those reports we see in the news regarding billing fraud, concurrent surgeries, or falsified results, I am appalled at the dark shadow these acts cast on the trust people have in our field. This trust is sacred and cannot be violated.

Perhaps this is why I see broken trust in other walks of life as so egregious. Molestation of children by coaches or clergy, scams and schemes that financially devastate retirees, workplace accidents due to corporate neglect of safety standards – these are all occurrences that leave us shaken, not only because of the acts themselves, but because they destroy our trust in others, sometimes even in revered institutions, and they shatter our faith.

So, on this Doctor’s Day, I want to thank those who have trusted in me and in my profession. I will continue to work hard to be worthy of that trust because trust and faith in each other provide a strong foundation for the community and society in which I believe we all want to live.

 

Arthur M. Lauretano, MD, MS, FACS

3/30/17