Rachel Paneth-Pollak: David O. Hough, MD Endowed Memorial Award Essay

by Rachel Paneth-Pollak

“No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.” -- Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science

For the surgeon Atul Gawande, the spirit of healing extends beyond the acquisition of technical skills to encompass a persistent determination to take on the complicated challenges of an inherently imperfect science. Such a spirit is vital to the family physician working at the nexus of preventive medicine and primary care.

The true healing physician does not see herself merely as a solution to, or as a fixer of illness, but also as a supporter and enabler of good health. A good family physician listens to patients carefully, understanding their illness and health in the context of their families, their communities, and their social stresses, and helps them to make the best decisions for their care. In my view, a good physician heals not only through clinical encounters, but also through efforts to promote wider community health. For example, the family physician supports healing by seeking to increase access to quality health services in schools, community centers, workplaces, and mobile clinics. Family doctors engage in population management of their patient panels, tracking outcomes over time, striving to produce thoughtful quality improvement measures enabling system-wide improvements that lead to better individual health. They support legislation that enables health and healing, and they advocate for their patients. Ideally, such public health activities will occur in conjunction with patient care. For me, the public health dimension of family practice is inextricable from the healing of individual patients.

As the specialty most anchored in the community and social aspects of health, family medicine is uniquely poised to successfully blend population health and clinical medicine in the tireless pursuit of healing. Gawande recognizes that there is more than preparation and skill in the making of a good physician; for no matter how well-trained or competent, physicians are human, and patients exist in a complex and imperfect world. As healers, we must be willing to persist in spite of the intricacies of our patients and the limitations of our common humanity. The spirit of the healer is this persistence, the genuine desire and earnest effort, to do right by the patients in our communities, inside and outside of our direct encounters, and regardless of complication and faltering along the way.