A Word on Words; 2930; Frank Boehm

Well, I'm John Seagunthal, and once again, welcome to a word on words. I guess, Frank Bohm, Dr. Frank Bohm, welcome to a word on words. And the book is Doctors Cry 2, essays from the Heart of the Physician. Doctors Cry 2, that, I mean, you and Tears, Frank, that does not fit my image of you. Doctors Cry 2, it's a book of essays. It's a book of essays based on columns you have written for newspapers. Why'd you do it? Well, I wanted to show the humanistic, compassionate, caring side of doctors that I have seen over the last 35 years. I'm working at Vanderbilt for at least the last 30 years. I've had the opportunity to participate in the training of some 3,000 medical students,

150 or more residents and obstetrics and gynecology and a host of fellows and nurses and midwives and private practitioners throughout the city and the country. And what I have learned from these dedicated men and women is that they care very much what happens to their patients and frequently they get very emotional about what happens. And sometimes the patients don't see that. They don't confront the doctor during those emotional times. The physician doesn't show that side that feels so deeply, that is so passionate about their health. And I wanted to say something about it. I wanted to highlight that in a book and so I put it together. Well, I should say to our audience before I go any further that I have read this book. I read it in Galleys. I might have even read it before it was in Galleys and indeed if you look very closely on that cover, my name is right at the bottom of the page I did write the forward. And I wrote it because I thought it gave an insight to a profession that quite frequently

takes a bum rap and I congratulate you and your peers should congratulate you and I noticed among your admirers is Dr. Ruth who says that you have really reached out in a way that other doctors haven't to touch the hearts of patients. I read that Dr. Art Yuleen said he cried too. And I guess as I read those accolades that have come to the book as a result of your writing it, I have to ask did you write it for patients or for doctors or for both or for the general public? Well initially I wrote it for myself. I mean I guess the general public is. I mean we all are patients at one time or another but go ahead you wrote it for yourself initially. When I was a young teenager I found that writing made me feel better. I'd get emotional about something I'd write it down and put it in a drawer.

It was a place I could put my thoughts and not take it out into the rest of the world. As I grew older I continued to do that and then started putting a lot of the words that came to my mind because of things that have happened at the hospital or in my own life. I put them down and started sending them to the Tennessean and it was that collection of essays that eventually became this book. People want to know about their doctor. They, you know in the old days we used to have house calls by physicians and the patient and the physician had a relationship that is different than today. Today it's a little bit more mechanical you're in, you're out. People want to be able to trust their doctor and in order to trust they've got to know a little bit about them. So a lot of the essays in doctors cry too tell a little bit about my life. The things that go on for me, a granddaughter being born, a son going off to college. A miscarriage.

A miscarriage meeting a young boy on a plane going to Israel to see my daughter be Bob Mitzford. There are all these kind of things that try to show the human side of me because in the end patients need to understand that despite the fact that doctors have a white suit on and come with a stethoscope around their neck they go home and have the same kind of problems. That the patient does. They have problems at home with their children with their spouses with money with all kinds of things. It's the same issues and as long as people put a human touch or to that they'll know that their doctors are like everyone else and quite frankly they feel just as intensely about things as anyone else. But also you include essays that touch with real directness, real candor on problems that affect the image of doctors. Talk about that a little bit. Well years ago when I started medical school in 1961 there was an attitude that physicians took a step back emotionally from the bedside, from the patient.

And I think there was a tendency to be a little aloof. I remember hearing if you're too involved with your patient Frank you'll get all messed up. Was that in medical school? And it was in residency. I didn't hear it a lot but I heard it enough to make an impression on me. But what I saw was different and there's one particular essay in there about this physician who I thought really didn't show his emotions ever when we had a situation where our patient died and her newly born child died all within about an hour. And we had to go out and tell the family who was expecting a healthy child and a mother recuperating, smiling and talking about the birth of her child, we had to tell this family that their loved ones were dead. I was devastated. I couldn't hold back the tears. I mean I was just so emotionally distraught. I couldn't stand it.

And afterwards I went back into the lounge and I thought I was alone and I heard somebody sobbing. And the next room where the beds were was this private practitioner, probably somewhere in his 50s, maybe early 60s, and he was just sobbing. And I realized then that I was not alone. I was my emotional feelings that came to the surface so frequently. We're shared by many doctors. And that's the profession I see. Well you know the interesting thing about the book is that that's not the way doctors are so often seen in today's environment. I mean, you know the story. You get there and you wait and then you wait and you wait. And there are a lot of old magazines to read and your mind is right where it should be on business in your own life, whether you have a job in an office or on a assembly line or whether you should be at home caring for the kiddies.

And you think here I am and where is he and where am I on the list and how am I going to get in here. And then you see him and you're in and you're out in 15 minutes or 10 or sometimes 5 and then you get the bill. And that is, it is to that image I think that you're writing and for all those reasons it seems to me the book touches a chord that needs to be touched. Well it's an irritant to sit and wait for anybody, a doctor, an accountant, get your car fixed. In fact, one of the essays deals with the process of waiting. And I tried very hard to keep people from waiting, eventually however, if you show a compassionate side of yourself and if you spend the quality time once the patient gets into the room, it makes up a lot for the deficiencies in the waiting room. But quite frankly the good doctors, the ones that patients flock to because they do show that they care are the ones you have to wait the longest for.

And what patients frequently don't know, or maybe they do, but nobody's told them, is that the physician feels very badly about keeping his or her patient waiting. I used to feel guilty. I told my secretary, you cannot book anymore because I can't see this number of patients in the time a lot of it. But then somebody would call a special friend, a relative, a relative of a relative, a friend of a friend. And before you knew it, you were trying so hard to do the right thing for as many people as you can, it becomes a problem. And so I think when patients sit in the waiting room, as long as they know that when they get in there, their time will be quality time. It will be thorough. It will be quality. And that is what happens, and that's why you're waiting because the physician is taking them. I think that's what that essay says. It's a message to the doctor, they're out there, and they're waiting on you. And they don't like it, and you better wake up to the idea that when they're in here, you've got to connect with them.

Well, I come out in the waiting room sometimes and say, I'm sorry, I'm running behind, I'm working as best I can, I'm really apologized. It also says, I think, to the patient, that you can't have it both ways. I mean, he can't give you both time, he can give you time only if you have to wait. Because everybody who comes in there has to get a touch of compassion, if he's going to be seen as a human being. I tell people who are in the hospital, for example, stop looking at the clock, look at the calendar. If they say they're going to draw you a blood on the 12th of June at 10 o'clock in the morning, be happy if it's drawn before the 13th comes. Medicine has to take its time. It's a complicated process. We're not dealing with a car that can be brought back and fixed. We're talking about life and death matters. So it's a very serious issue. And if you take shortcuts, if you're pushed too much, you start making mistakes because we're just humans.

And I think that the patients need to feel trust. Trust is the glue that holds our relationship together. You know, when you sit in an airplane, you strap yourself in, you don't even know who the pilot is. You can't even see the pilot. You don't know their background, anything. You strap yourself in and let this individual or two or three individuals take you 35,000 feet above the earth, fly you two or 3,000 miles away and then land you. And you really don't give another thought to it because you trust that pilot. Now, a lot of that trust comes because you know the pilot is just as anxious about landing and flying properly because his or her life is involved as well. Well, with physicians, that same feeling of trust is what we tried to inculcate in our patients. But we can't just do it without showing a little bit of ourselves because we don't have the same investment. We're not going to go down with the plane if a patient dies during an operation. One of the things I was reminded of when I read the book and thought about it, is that doctors get sick too.

They do. Yeah. And talk a little bit about... Well, I got sick. I've been sick a number of times, obviously, I'm a human being, but one particular time that I wrote about was when I severed my Achilles tendon, the appropriate title. And that whole process of being on crutches and in a wheelchair and having casts and surgery really made me aware of the problems with the handicapped. I really understood bathrooms big enough to get into and out of. I understood ramps. And everything seemed, when you're in crutches, everything seemed like looking at binoculars from the other end. What was once a little small few steps to my office became this huge effort. And I realized that being ill really changed how people talk to you and looked at you. It was a whole new culture that made me empathetic. There's a difference between empathy and sympathy. You can be sympathetic.

But until it's happened to you, you don't really get that empathy feeling. And when doctors do get sick and lots of them do, obviously, they become more empathetic and I think perhaps even better physicians. Let me ask just as an aside there, do doctors... Do you have an advantage over me in picking who's going to wait on you? And is it a problem for your physician when you're sick? Do you try to second guess the diagnosis? Sure. One of the nice things about being a doctor is that we sort of know when something hurts here, all the organs that that could involve. We're the first to make diagnoses on ourselves. We do have a heads up and we call doctors, I call my doctor and say, this is what I think I've got. And it's always something terrible because that's just the nature of the beast for me anyway. When I was in med school, I had every illness that I read about. I had heart attacks, cancer, leukemia, everything. And still alive and still healthy. But go, the first symptom would spark your...

Well, read a book and look at the symptoms. It's usually two or three paragraphs and surely one of my symptoms was in that paragraph. That's why the Merck Manual and PDRs and things like that are dangerous for the layperson because you can have everything. I should tell for those of you who are tuning in just now, we're talking with Dr. Frank Bowman about his book, Doctor's Cry 2, and it's a book for doctors and for patients. And indeed, if you've never been to the doctor, you should read it because someday you're going to have to go and you should know the man on the other side of the stuff spoke is a human being. Do you have a favorite of these essays? Well, they become sort of like your little children, I think. I've heard this before and it certainly rings true here. I think we all have, all writers have favorite things that they've written. There are a number of them. The more personal ones about my mother dying or a walk on the beach with my dad, I was very close to my family and at college, my daughter going off to college, some of those

sort of ring true, I think what patients really like is to read about things that happened to their doctor. In the case to me, we, in medical school, we have courses now that teach young men and women how to show the caring side of themselves, how to tell people bad news. I mean, up until recently, medical schools did not teach these young physicians how to break bad news to people. And when you go sit through these classes, one of the things we emphasize is there is a proper way, there is an etiquette, turn your beeper off, stay focused, the words have to be graduate, gradually more intense, you don't start off with the worst news right away. There are ways to handle all these issues, but if that person can be someone that the patient knows, not some stranger that has maybe shared in some of the feelings that the doctor has, then the patient can feel better about the whole process.

Most patients feel very put off by doctors who they don't know coming in and giving some bad news. So, I find that I have found in my own practice that when I'm with patients, I like to tell them a little bit about what happened to me. Y'all, my wife and I, we just went to Florida, we did this, my daughter just graduated. Let me show you a picture of my granddaughter. They want to know about me. It's that process that eventually bonds the patient and the physician. And once you've got that bond, a lot of things get better. Things frequently feel better about the care they're getting, and therefore they can heal quicker. I mean, in the book, I've listed a number of emotions and attitudes that occur for people that actually are healing. Things like forgiveness and humor and love and joy and happiness and forgiveness. Those kind of things are important, and the physician is the one to help patients get to those issues.

You said earlier you started this as a project, which you wrote for yourself because it made you feel better. And then you began to write and submit the articles to the Tennessean. My successor, editor of the Tennessean Frank Sullivan, had the good judgment to publish your columns, which only validates what I've said about him. He's a better editor than I ever was. And you're a testament to that, Frank. But talk about how doctors deal with the issue of terminal illness, because it comes up, it does come up in the essays, and it's the ultimate fear we all have when we go to the doctor. Well, there's an entire section on death and dying. That's right. Because remember, when you start medical school, most of the kids are, they're kids, they're 21 years old. And frequently, they have not been exposed to death. Maybe they've had a parent who died or a grandparent. But to see it, to be a part of it, is brand new.

And it's very painful at first. It's a process that most young students have to get comfortable with. It doesn't happen overnight. And patients, just like doctors, are a little bit afraid of death. We may know that we're going to die, but what are the circumstances and when? Are we going to be in pain and what is it all about? Intrigues us, both as doctors and as patients. So it's the doctor that has to frequently take the patient by the hand and walk them through that process. If the doctor doesn't understand all the issues that a patient faces, then the patient doesn't go through the right kind of process and is left frequently with a very bad ending. So we do try to teach that to doctors. Other courses all over the country, they're 125 medical schools, and I think all of them deal with these issues of how do you first learn about death? How do you feel about death? Talk about your feelings. Then you can go out and deal with patients who are dying.

You know, practicing medicine today is quite different than it was three decades ago, a quarter of a century ago. The issue of sexuality and the openness with which we address every form of illness. I mean, you know, you now can see on television commercials that tell you about hemorrhoids and menstrual period and even mind as it was revenge and how to deal with it, but it also today's society forces us to look at controversies that were not around open in the open a quarter of a century ago. Abortion is part of that, euthanasia is another. I mean, from the cradle of grave is not really a cliche for the doctor who has to deal with

everything from abortion to the issue of death with dignity. And you deal with both of those subjects in the book as well. Well, medicine has changed so much, it's hard to recognize it, even for myself who started in 1961, it has changed dramatically and the changes are going to continue and all of them are going to be technological advances with a genome project and things like that. So we're going to have to work harder to maintain that personal image that doctors care, that we're just not a group of individuals who are mechanics. We care for the soul for the heart of patients and that's what I really try to do in the book to highlight that. You know, it's interesting, people think that doctors get upset when bad things happen because they're afraid of a lawsuit. My experience is not that at all. They don't even think about that. What they think about is the pain and anguish that they have been a part of and they start

blaming themselves frequently. What did I do wrong? Could I have done something different? We spend hours in conferences when there are adverse effects of medication or surgery. And frequently my residents and even attendings will actually sob. I mean, they'll be, you can see the feeling and then those that don't express their feelings that easily and don't cry, you can tell they're distraught, they want to quit medicine, they want to go home. They're not thinking about the lawsuit. That is not what drives doctors. Doctors are driven by a sincere passion to bring health to patients. A doctor named Kaworkin has brought to the front the moral dilemma about death with dignity. And in some ways, he has almost become a caricature of himself, but he, I think, has brought into the open a dilemma that can't be ignored and has to be dealt with and you do deal with

it. I do some. You're now getting close to maybe my second book this book, but you know, I get the sense. I get the thread is here and it's a question that's on everybody's mind now. Well, patients want to die without being a burden on their family. They don't want a lot of pain, but very few people actually take the route that Kaworkin offered, the physician assisted suicide, Oregon being the only state that's legalized that has had only a few dozen patients in the last couple of years take up the offer. They like the idea that they have it available, but very few take it. It's a very complicated issue and dying, the ones that I picked, the essays that I picked, tried to put a feeling attached to it. The way we die is so important because death is just part of life until you're finally

pronounced dead, you're still alive and that whole process is an important process. I tell a story about my mother who literally died of grief, but she died at home. So here were two issues, dying of grief, which there's nothing on the death certificate that allows you to put down or dying at home, which is only a third of our senior citizens are able to do that and yet this is a very nice comfortable place to end one's life. And the wonderful things that you sometimes see at the time of death. For example, my beloved mother-in-law, Dorothy, had this incredible 36 to 48 hours where she just suddenly woke up from a coma and started saying goodbye to me. And you write about that? I was so impressed. It was like somebody who picks up a car because their child is trapped and they've never picked anything heavier than a 50 pound weight. Human spirit is an enormously complicated instrument and doctors need to understand that and

the more they understand, the better they are to help people handle death and dying without having to go to the extremes of them taking their own lives. You talked about doctors not thinking about medical mile practice suits when they begin and which reminds me that there are myths about all of our businesses and our professions. I remember when I was a journalist, people said, well, he's only writing for the headline or he's only writing to sell papers. And I never wrote a story in my life for a newspaper that it occurred to me how many people would buy the papers result of that story. In my own mind, it's a myth, it's a very real perception to people there and the perception of defensive medicine is also there, talk a little bit about, expand on that just a little bit.

Well, if you sit around the table where doctors have lunch or they're in their doctors lounge and surgical lounges and things like that, you have to be an inner member of the group to hear the conversation, obviously, and I've been privy to that conversation. And the conversation that I hear I've heard over the years did, for a while, focus on malpractice. Those lawyers, they're always nipping at my heel and I've got this lawsuit and that was the topic. Today that topic has changed. Today the topic is manage care and how it's coming between the patient and the physician. So doctors talk very little bit about malpractice, they're not that concerned. What they do is they try to practice a brand of medicine that won't be criticized, not from the lawyer, but from the patient and most important from themselves. Doctors are the hardest on themselves. They drive home, I have driven home, hundreds of times, could I have done this better? What if I'd gone left instead of right?

What if I'd have taken to the operating room at 9 o'clock in the morning instead of three in the afternoon? What if I would have brought in this consultant and we second guess ourselves all the time? And the lawsuits may sound like they're a big deal and they are when you get sued because doctors who get sued go through the same processes that the Kublai Ross wrote about in death and dying, the anger, the disbelief, the depression, the bargaining, and finally the acceptance. We have to go through that and it's an emotional event, but it certainly is not what drives us in trying to take good care of people. We've only had about 15 seconds left, are you going to write another book? Absolutely. Are you in it now? Well, I'm formulating it and I'm thinking about a title, something like Trust Me, I'm a doctor. Trust me, trust me, I'm a reporter. What I'd like for people to understand is that their doctors is like them in many ways and different in other ways and to see the professionalism that I see on a day-to-day basis makes me proud to know these men and women that call themselves doctors and makes

me proud of the profession. So we've been talking to Dr. Frank Bohn about his new book, Doctors Cry2. Thanks so much, Frank, for joining us. Thank all of you for joining us. For a word on words, I'm John Seaganthaler, keep reading. Thank you. Thank you.