Recently I’ve been making more of an effort to “personalize” my documentation to include names, rather than just descriptors, in my documentation. Rather than “The patient’s wife says he’s not falling so much…”, I think “Donna says he’s not falling so much” is far less clinically impersonal. Not a big thing, maybe, but it reminds me that these are PEOPLE and not just SUBJECTS. I’m finding, too, that I tend to both read and write my progress notes less like dry clinical data, and more like the stories that they are – stories of my patients’ lives, joys, sufferings, and challenges.

But why do I even need this reminder? I went into medicine to care for people, not numbers or lab rats, so why am I now needing a reminder of who they are? I think it is due in part to the medical short-hand of referring to diagnoses or room numbers, not names. How many times have we heard, or said ourselves, “the gall-bladder in room 16 is feeling better” or “the pneumonia in 202 is still short of breath.” Or perhaps just using the number, “Room 205 is ready to go home today.”

(Frankly, if “Room 205 goes home”, it will leave a big hole in the hospital hallway!)

The craziness of it is that the habit of referring to people by room numbers has at least partly to do with protecting their names! As we’ve become more sensitive to privacy concerns (and appropriately so!), using room numbers or bed numbers has become a convenient short-hand for identifying patients to our professional colleagues, without breaching their privacy to those in earshot who do not have a “need to know.”

So – we’ve tried to protect privacy, and in so doing removed a key reminder of our patients’ humanity!

What’s in a name? Many things – but most importantly a reminder of who each of us is as an individual. And while that needs to be protected to honor privacy, it also needs to be REMEMBERED as we document our thoughts and plan our care for our patients. Medicine is not just about clinical data, it’s about people – and perhaps the right use of names can help us remember that.

I’m a doer. I like being a doctor who can fix things, whether it is treating an ear infection, suturing a laceration, or managing a patient through DKA. But I don’t just like to “do” – I like to serve. I enjoy home visits. I enjoy going to the nursing home. And I particularly enjoy volunteering at our local free clinic for the uninsured. With the cost of healthcare in the USA steadily increasing, I enjoy being able to be a part of serving those who are left out.

I also like to be a thinker, and feel it is important for us as doctors to THINK about why we do what we do. So, when I’ve had the opportunity to speak about the opportunities and challenges in caring for the uninsured, I’ve been a bit flummoxed when listeners have told me they want more on “how to” and less on the ethics, principles, and ideas behind service and care for the poor. And, having had that feedback, I actually felt a bit vindicated to see the program for a recent conference on health care for the poor included a whole track on issues of service, professionalism, and the doctor’s identity. “At last!” I thought, “more recognition for the issues of identity, and not just ‘getting the job done!’”

However, I’ve also been reminded recently, that there is still more to medicine than thoughtful service – doctoring is more than just thinking and doing. Several encounters, with students, patients, and colleagues, both at home an abroad, have reminded me yet again of the foundational importance of the relationship. Medicine is nothing, if we lose the human, “I-thou”, person-to-person connection with our patients.

As doctors, it’s easy for us to see the need for our service. But for our service to make a difference, we also need to think carefully and reflectively about what we do. However, for our care to have VALUE, for it to be HUMAN medicine, we need to pay as much, or probably more, attention to the relationships with our patients and our colleagues.

Relating, thinking, and doing – each is a vital piece of medicine, and put together they make for even better doctoring.

This week and next, I have a change of pace from “work as usual.” I have the privilege to be teaching in a Family Medicine program in Rwanda, and though I’ve traveled and worked in Africa before, I’m reminded once again of the things that are strangely familiar in the midst of remarkable differences…

•     Mobile phones are ubiquitous, though diagnostics such as ECGs or Blood Gas analysis are hard or impossible to come by. It is just plain odd, to me, to be in an African hospital ward, many beds to a room, yet with nearly every patient having a mobile phone tucked carefully in by the pillow or stored nearby with belongings.

•     Despite the tendency to think of “all those odd tropical diseases” that they get “over there” (at least that’s what folks at home seem to think), the most common diagnoses this week are the same as bread-and-butter diagnoses at home – pneumonia, pelvic prolapse, hypertension, heard disease and the like.

•     On the non-medical front, while folks at home were concerned about what we’d have that was safe to eat, in actuality here we’ve had outstanding meals each night at local restaurants – definitely good enough to write home about – and I have!

•     I’ve gotten back into the routine of my usual morning run (which is much nicer here at about 65 F than the 30F temperatures back home!), and while I’m used to being accompanied at times in the morning, it’s not usually by workers pushing their ware-laden bikes UP the local hill!

•     Most of all, I’m struck (as each time I come to Africa) how with much less than we have in the “developed” USA, it is possible to practice good medicine and provide great care despite much less technology and much simpler surroundings. Sure, there are times that having more labs, and more testing options would be nice, but when you have much less, you make it work – and the results may well be just as good!

Far from home, things can seem very different, but underneath, there is often much that is the same – and most of all what is the same, is the importance of providing the best care possible, one life at a time.