No, I am not "The Patient"

There's a good reflection piece posted (free) today on-line at JAMA: “The Patient” by Katie Thure. It starts:

Mrs T was a 58-year-old female admitted to the intensive care unit (ICU) for respiratory distress secondary to pneumonia. On her 10th day of hospitalization, she developed septic shock. Despite escalations in care, it became clear Mrs T would not survive. After a goals-of-care conversation with her husband, her 2 adult children, living outside of the state, were called to come to say their goodbyes. With both children at bedside, a woman wearing scrubs and a long white coat walked into the room and announced, “I’m Dr A, an ICU resident.” She explained the medical data and summarized to the family that “the patient has no chance of survival.” Although this statement was objectively correct, it failed to acknowledge that “the patient” was also a community advocate for equitable education, a wife of 40 years, a lover of mischief, and my mom. . . .

I was not surprised to hear about her poor prognosis. But I was surprised at Dr A’s choice to call my mom the patient. Is this how everyone is told their best friend was going to die? How could my mom be just the patient if her fingernails were still painted with Christmas trees and snowflakes?

There's more to savor and learn from this short essay. It's about the dehumanizing effect of the language of medical encounters. "Dr. Jones" becomes simply "the resident," and Dr. Smith is "the attending." "Mrs. Thure" is stripped of personhood and is "the patient." As the author writes: "When we choose not to use someone’s name, we are choosing to reduce them. We are indirectly saying, 'You are no more than the one-word descriptor I have given you.' The patient is not a human but just a pathology needing to be addressed." 

Ms. Thure (Class of 2024 in UCLA's medical school) doesn't oversimplify: 

Years later as a medical student, I was taught to think about patients both holistically and also to reduce them to a one-liner. There is clinical significance to having an accurate, concise depiction of a patient’s history and current medical needs. There is also equal clinical significance to remembering the person behind the one-liner.

What defines the distance between these two descriptions? Empathy. Or maybe simply circumstances:

Over the years, I have spent a fair amount of time trying to figure out how my mom became the patient. Maybe Dr A was at the end of a long and difficult shift, maybe that was not the first bad news she had delivered that evening, maybe she was never trained to be empathetic, maybe it is just the culture of medicine. Or maybe there was no reason at all.

Tomorrow is the last meeting of this semester's edition of "Law, Literature & Medicine." It's a seminar for 4th-year med students (UT-Southwestern) and 3rd-year law students (SMU/Dedman) that I have taught for decades, since 2017 with my valued friend and co-teacher, Dr. Reeni Abraham. I will propose that we email the class a PDF of Ms. Thure's essay and discuss whether it should be included in the first day's reading assignment when we offer the course again in 2025. The course is about the language we professionals use, identity (our patients' and clients' and our own), narratives, and empathy. And it's all here in this wonderful little essay.