August 09, 2021

A Role Model for Humanizing the Practice of Medicine: My Love Letter to Dr. Nema

Janis prince innissBy Janis Prince Inniss

Last October, I took my 90-year-old mother to her doctor's office for the seasonal flu shot. That shot is not given by the doctor, of course, but he came into the patient room to see her with great excitement! She was thrilled to see him, and there was no mistaking her grin beneath her mask. Dr. Nema (a pseudonym) told Mum how good she looked, complimented my pants, and when he saw my Saint Leo University mask, told me about some family members attending school there. Then, he invited my mother and me to return to the office the next month to have a physically distanced lunch with him.

Does this interaction with a physician seem typical to you? Do you have interactions like this with your doctor? How does this interaction square with what doctors are taught? Is Dr. Nema following prescribed physician-patient norms? Most of you, like me, find Dr. Nema’s behavior unusual among physicians regarding these questions. However, as a recipient of this style of practicing medicine, I can vouch for the benefits that this kind of behavior from a doctor can mean to a patient and the patient's family!

As her sociologist daughter in possession of a doctorate, I lectured my mother on bureaucracies. At least once a year, after accompanying her to a doctor’s visit and witnessing her chatting up her doctor, I would tell her that the physicians were not her friends and that there was a specific way of interacting in this context that differs from personal interactions. None of these conversations seemed to have any impact on my mother. She just kept treating her doctors like her chums.

On the other side of the equation, have you ever considered how doctors learn to behave like doctors? We know that physicians learn technical information in their many years in medical school and residency, but here I am referring to professional socialization—learning the values of the profession. Medical students learn how they should behave with their patients, talk with them, and feel and act in the presence of their patients—that is, they learn medical norms. In The Sociology of Health, Illness, and Health Care: A Critical Approach, sociologist Rose Weitz notes that medical students learn that the norms of greatest importance for their profession are:

  • emotional detachment
  • trusting their clinical experience over scientific research
  • concealing their uncertainty so that they are seen as competent
  • seeing the body as analogous to a machine in need of repair
  • valuing medical interventions over other measures such as diet
  • having a preference for rare illnesses over more garden variety ones

The first in this list—emotional detachment—is the norm that I often tried to explain to Mum. She behaved as though her doctors really cared about her—and I tried to explain that they do not, well, except in the most generic ways. Can you think of any reasons that emotional detachment is a norm among physicians? Consider the number of illnesses and deaths they witness—perhaps this is one way to manage their emotions. Maybe the idea is that having no personal attachments to patients will help keep them calm in a crisis. However, this norm makes doctors seem cold and devoid of all human emotion—and this lack of empathy occurs when it is most needed. It also prevents physicians from connecting with their patients in ways that allow them to learn about the social factors that will influence their patient’s health. (Dr. Nema had avoided that; he called me when there was significant medical news about Mum, and as her primary caretaker, that was critical for her well-being.)

Culture also encompasses patient-doctor relationships—as it does just about all others. In other words, what does the larger culture say about these relationships? Did you wonder about Dr. Nema’s culture? Based on what I recall from reading a newspaper article on his office wall, Dr. Nema grew up in Honduras. I think both his father and grandfather were physicians who made home visits to their patients. Dr. Nema was raised in a more traditional culture where doctors are far less emotionally removed from their patients than is typical in the U.S., and he aimed to repeat aspects of this style of medical practice in the U.S. He even makes house calls!

Based on his warmth and genuine concern for her, Dr. Nema was the only medical professional I believed I could trust when my mother was hospitalized for weeks two years ago. He served as my unofficial advisor when the emotionally detached doctors at the hospital appeared to be motivated by profit rather than by my mother's well-being: Brain surgery on an 89-year-old?! Sure! A couple days after another procedure? Sure! She's going to recover really quickly!! During that ordeal, in response to my call seeking direction, Dr. Nema gave me his cell phone number, taking my calls—even when he was out with his family on Father's Day! His emotional connection to my mother did not compromise my mother’s medical care; it enhanced it deeply.

In the end, Mum was right. Dr. Nema went to her apartment to share lunch with us on her 91st birthday.  The day before, I realized that we had not taken him up on his lunch invitation and called his office, mentioning that her birthday would be a good time to take him up on that offer. His assistant said he would join us at noon, but I didn’t tell Mum for fear of disappointing her, in case his schedule changed.  At one minute past noon, when there was a knock at her door, I knew who it was. Dr. Nema spent two hours dining, toasting, talking, teasing, and viewing a photo book with my mother. And when he heard me mention to someone on the phone that Mum’s doctor was visiting, he said, “Doctor and friend.”



I have a different opinion on this topic, but I still enjoyed reading this article and learning about the author's perspective.

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