our story begins on a beautiful
our story begins on a beautiful afternoon in Durban South Africa or not
our story begins our story just began
our story begins our story just began Rea ours our story begins on a beautiful
Rea ours our story begins on a beautiful
Rea ours our story begins on a beautiful afternoon in Durban morning in Durban
afternoon in Durban morning in Durban
afternoon in Durban morning in Durban South Africa my wife and I had just gone
South Africa my wife and I had just gone
South Africa my wife and I had just gone for a swim in the Indian Ocean I’ve had
for a swim in the Indian Ocean I’ve had
for a swim in the Indian Ocean I’ve had a wonderful breakfast and ordered my
a wonderful breakfast and ordered my
a wonderful breakfast and ordered my second cappuccino then I reached for the
second cappuccino then I reached for the
second cappuccino then I reached for the local newspaper it was the morning after
local newspaper it was the morning after
local newspaper it was the morning after the municipal elections and I saw this
the municipal elections and I saw this
the municipal elections and I saw this photo my heart sank to a dermatologist
photo my heart sank to a dermatologist
photo my heart sank to a dermatologist like myself this picture can mean only
like myself this picture can mean only
like myself this picture can mean only one thing
one thing
one thing a lethal form of malignant melanoma
a lethal form of malignant melanoma
a lethal form of malignant melanoma don’t take my word for it here’s a photo
don’t take my word for it here’s a photo
don’t take my word for it here’s a photo from a dermatology textbook what to do I
from a dermatology textbook what to do I
from a dermatology textbook what to do I went home rushed to the telephone and
went home rushed to the telephone and
went home rushed to the telephone and called a photo editor of the newspaper
called a photo editor of the newspaper
called a photo editor of the newspaper I said taro I hate to bother you I know
I said taro I hate to bother you I know
I said taro I hate to bother you I know this is really strange I’m professor of
this is really strange I’m professor of
this is really strange I’m professor of dermatology in the United States at Duke
dermatology in the United States at Duke
dermatology in the United States at Duke University I’ve written text books and
University I’ve written text books and
University I’ve written text books and articles and I’m most worried about the
articles and I’m most worried about the
articles and I’m most worried about the man in this photo I said this is a kind
man in this photo I said this is a kind
man in this photo I said this is a kind of melanoma this most common in skin of
of melanoma this most common in skin of
of melanoma this most common in skin of color and to emphasize my point I told
color and to emphasize my point I told
color and to emphasize my point I told her this is exactly the kind of melanoma
her this is exactly the kind of melanoma
her this is exactly the kind of melanoma that was lethal to Bob Marley she
that was lethal to Bob Marley she
that was lethal to Bob Marley she listened carefully to what I said and
listened carefully to what I said and
listened carefully to what I said and promised to call me back as soon as I
promised to call me back as soon as I
promised to call me back as soon as I found the man in the photo and brought
found the man in the photo and brought
found the man in the photo and brought him to medical attention I was relieved
him to medical attention I was relieved
him to medical attention I was relieved and satisfied to know she was doing this
and satisfied to know she was doing this
and satisfied to know she was doing this two minutes later the phone rang and it
two minutes later the phone rang and it
two minutes later the phone rang and it was her and she said the following she
was her and she said the following she
was her and she said the following she said professor prose yes is there any
said professor prose yes is there any
said professor prose yes is there any chance the man in the picture simply has
chance the man in the picture simply has
chance the man in the picture simply has the mark that each of us gets when we go
the mark that each of us gets when we go
the mark that each of us gets when we go to vote in South Africa
to vote in South Africa
to vote in South Africa to prevent us from voting a second time
to prevent us from voting a second time
to prevent us from voting a second time at that moment at that moment my
at that moment at that moment my
at that moment at that moment my mother-in-law entered the living room I
mother-in-law entered the living room I
mother-in-law entered the living room I had learned a lesson in cultural
had learned a lesson in cultural
had learned a lesson in cultural humility I also learned that it’s a very
humility I also learned that it’s a very
humility I also learned that it’s a very thin line between between being a
thin line between between being a
thin line between between being a humanitarian a brilliant physician and a
humanitarian a brilliant physician and a
humanitarian a brilliant physician and a complete nitwit
complete nitwit
complete nitwit in the next 10 minutes you’ll have an
in the next 10 minutes you’ll have an
in the next 10 minutes you’ll have an opportunity to draw your own conclusions
opportunity to draw your own conclusions
opportunity to draw your own conclusions when I teach seminars to doctors or
when I teach seminars to doctors or
when I teach seminars to doctors or residents medical students I always
residents medical students I always
residents medical students I always begin with the same metaphor I say
begin with the same metaphor I say
begin with the same metaphor I say imagine what it would take to be on
imagine what it would take to be on
imagine what it would take to be on opposite sides of the table from the
opposite sides of the table from the
opposite sides of the table from the patient with the problem in the middle
patient with the problem in the middle
patient with the problem in the middle and then I say what would it take to get
and then I say what would it take to get
and then I say what would it take to get on to the same side of the table looking
on to the same side of the table looking
on to the same side of the table looking at the problem together a wonderful
at the problem together a wonderful
at the problem together a wonderful friend of mine in South Africa
friend of mine in South Africa
friend of mine in South Africa Joseph Bhutto lazy who was steeped in
Joseph Bhutto lazy who was steeped in
Joseph Bhutto lazy who was steeped in Zulu culture once told me that when he
Zulu culture once told me that when he
Zulu culture once told me that when he goes to see the doctor he most likes the
goes to see the doctor he most likes the
goes to see the doctor he most likes the doctor who seems to really care about
doctor who seems to really care about
doctor who seems to really care about him he feels that he and his doctor are
him he feels that he and his doctor are
him he feels that he and his doctor are singing the same song of course now you
singing the same song of course now you
singing the same song of course now you know we’re going to talk about Leo
know we’re going to talk about Leo
know we’re going to talk about Leo Tolstoy and about this very particular
Tolstoy and about this very particular
Tolstoy and about this very particular novel which is the death of Ivan Ilyich
novel which is the death of Ivan Ilyich
novel which is the death of Ivan Ilyich so in the death of Ivan Ilyich Tolstoy
so in the death of Ivan Ilyich Tolstoy
so in the death of Ivan Ilyich Tolstoy documents the remarkable story of a man
documents the remarkable story of a man
documents the remarkable story of a man who was dying of a serious illness alone
who was dying of a serious illness alone
who was dying of a serious illness alone frustrated and worried and in this late
frustrated and worried and in this late
frustrated and worried and in this late 19th century novel he describes a
19th century novel he describes a
19th century novel he describes a conversation between the the doctor and
conversation between the the doctor and
conversation between the the doctor and Ivan and it goes like this everything
Ivan and it goes like this everything
Ivan and it goes like this everything took place as Ivan had expected and as
took place as Ivan had expected and as
took place as Ivan had expected and as it always does there was the usual
it always does there was the usual
it always does there was the usual waiting and the important air assumed by
waiting and the important air assumed by
waiting and the important air assumed by the doctor with which he was so familiar
the doctor with which he was so familiar
the doctor with which he was so familiar so Ivan Ilyich only one question was
so Ivan Ilyich only one question was
so Ivan Ilyich only one question was important was this case serious or not
important was this case serious or not
important was this case serious or not but the doctor ignored that him
but the doctor ignored that him
but the doctor ignored that him inappropriate question from his point of
inappropriate question from his point of
inappropriate question from his point of view it was not the one under
view it was not the one under
view it was not the one under consideration the real question was to
consideration the real question was to
consideration the real question was to decide between a floating kidney
decide between a floating kidney
decide between a floating kidney Clinic guitar or appendicitis for the
Clinic guitar or appendicitis for the
Clinic guitar or appendicitis for the doctors summing up Ivan Elliott’s knew
doctors summing up Ivan Elliott’s knew
doctors summing up Ivan Elliott’s knew that things were bad but that for the
that things were bad but that for the
that things were bad but that for the doctor and for everybody else it was a
doctor and for everybody else it was a
doctor and for everybody else it was a matter of indifference we sick people
matter of indifference we sick people
matter of indifference we sick people probably often ask inappropriate
probably often ask inappropriate
probably often ask inappropriate questions said Ivan but tell me in
questions said Ivan but tell me in
questions said Ivan but tell me in general is this complaint dangerous or
general is this complaint dangerous or
general is this complaint dangerous or not the doctor looked at him sternly
not the doctor looked at him sternly
not the doctor looked at him sternly over his spectacles with one eye I have
over his spectacles with one eye I have
over his spectacles with one eye I have already told you what I consider
already told you what I consider
already told you what I consider necessary and proper the analysis may
necessary and proper the analysis may
necessary and proper the analysis may show something more and the doctor about
show something more and the doctor about
show something more and the doctor about what is important then in the
what is important then in the
what is important then in the doctor-patient conversation in the 21st
doctor-patient conversation in the 21st
doctor-patient conversation in the 21st century to me the thing that’s more
century to me the thing that’s more
century to me the thing that’s more important than all our other
important than all our other
important than all our other considerations and skills and ability is
considerations and skills and ability is
considerations and skills and ability is cultivating curiosity my favorite
cultivating curiosity my favorite
cultivating curiosity my favorite article in all the medical literature
article in all the medical literature
article in all the medical literature over many years is this one written by
over many years is this one written by
over many years is this one written by faith Fitzgerald a physician in San
faith Fitzgerald a physician in San
faith Fitzgerald a physician in San Francisco about the role of curiosity in
Francisco about the role of curiosity in
Francisco about the role of curiosity in medicine and in the story in the article
medicine and in the story in the article
medicine and in the story in the article she tells the following story she
she tells the following story she
she tells the following story she reached a point where she felt the
reached a point where she felt the
reached a point where she felt the interns and residents in her hospital
interns and residents in her hospital
interns and residents in her hospital had absolutely no interest in the
had absolutely no interest in the
had absolutely no interest in the stories of the patients and their
stories of the patients and their
stories of the patients and their families she said to the residents look
families she said to the residents look
families she said to the residents look she said take me to the bedside of your
she said take me to the bedside of your
she said take me to the bedside of your least interesting patient and I’ll prove
least interesting patient and I’ll prove
least interesting patient and I’ll prove to you one way or the other that that
to you one way or the other that that
to you one way or the other that that person is interested the residents took
person is interested the residents took
person is interested the residents took faith to the bedside of a little old
faith to the bedside of a little old
faith to the bedside of a little old lady who had very little to say answered
lady who had very little to say answered
lady who had very little to say answered every question with one or two words and
every question with one or two words and
every question with one or two words and faith was starting to worry she had
faith was starting to worry she had
faith was starting to worry she had finally met the uninteresting patient in
finally met the uninteresting patient in
finally met the uninteresting patient in desperation faith as this woman have
desperation faith as this woman have
desperation faith as this woman have have you ever been in the hospital
have you ever been in the hospital
have you ever been in the hospital before and the woman said yes and then
before and the woman said yes and then
before and the woman said yes and then faith asked oh she said what for and the
faith asked oh she said what for and the
faith asked oh she said what for and the woman said I broke my arm hmm they said
woman said I broke my arm hmm they said
woman said I broke my arm hmm they said well why did you how did you break your
well why did you how did you break your
well why did you how did you break your arm and the woman said well a steamer
arm and the woman said well a steamer
arm and the woman said well a steamer trunk fell on it and faith said well why
trunk fell on it and faith said well why
trunk fell on it and faith said well why did the where did the trunk fall and I
did the where did the trunk fall and I
did the where did the trunk fall and I said well shipler the ship
said well shipler the ship
said well shipler the ship and then face of all what why did the
and then face of all what why did the
and then face of all what why did the ship lurched the one who said well
ship lurched the one who said well
ship lurched the one who said well because it hit the iceberg this is a
because it hit the iceberg this is a
because it hit the iceberg this is a true story and faith pointed out that
true story and faith pointed out that
true story and faith pointed out that after this revelation this woman became
after this revelation this woman became
after this revelation this woman became interesting to all of the newspapers and
interesting to all of the newspapers and
interesting to all of the newspapers and TV stations in San Francisco and
TV stations in San Francisco and
TV stations in San Francisco and eventually to the interns and residents
eventually to the interns and residents
eventually to the interns and residents and I often think that if faith has
and I often think that if faith has
and I often think that if faith has spent a few more minutes asking more
spent a few more minutes asking more
spent a few more minutes asking more questions she might have found out what
questions she might have found out what
questions she might have found out what this woman was doing before the ship hit
this woman was doing before the ship hit
this woman was doing before the ship hit the iceberg in a conclusion of her
the iceberg in a conclusion of her
the iceberg in a conclusion of her article faith beautifully states I
article faith beautifully states I
article faith beautifully states I believe that it is curiosity that
believe that it is curiosity that
believe that it is curiosity that converts strangers into people we can
converts strangers into people we can
converts strangers into people we can empathize with I believe it is curiosity
empathize with I believe it is curiosity
empathize with I believe it is curiosity that converts strangers into people we
that converts strangers into people we
that converts strangers into people we can empathize with so the skills that I
can empathize with so the skills that I
can empathize with so the skills that I teach to young doctors are really
teach to young doctors are really
teach to young doctors are really valuable when when working with the
valuable when when working with the
valuable when when working with the paper with the patient with concerns and
paper with the patient with concerns and
paper with the patient with concerns and worries but but think as you hear these
worries but but think as you hear these
worries but but think as you hear these skills and ideas think about your own
skills and ideas think about your own
skills and ideas think about your own life imagine giving advice to a close
life imagine giving advice to a close
life imagine giving advice to a close friend who’s trying to deal with a
friend who’s trying to deal with a
friend who’s trying to deal with a really annoying boyfriend and what would
really annoying boyfriend and what would
really annoying boyfriend and what would be which of these skills and techniques
be which of these skills and techniques
be which of these skills and techniques might come in handy and I’ll point out a
might come in handy and I’ll point out a
might come in handy and I’ll point out a few as we go along first of all I
few as we go along first of all I
few as we go along first of all I encourage every doctor to put his hand
encourage every doctor to put his hand
encourage every doctor to put his hand his or her hand on the doorknob before
his or her hand on the doorknob before
his or her hand on the doorknob before entering the room and take a deep breath
entering the room and take a deep breath
entering the room and take a deep breath with the conscious decision to pay
with the conscious decision to pay
with the conscious decision to pay attention and then ask an open-ended
attention and then ask an open-ended
attention and then ask an open-ended question not a yes-or-no question ask
question not a yes-or-no question ask
question not a yes-or-no question ask for example what worries you most about
for example what worries you most about
for example what worries you most about your illness or how have you been since
your illness or how have you been since
your illness or how have you been since the last visit and then listen because
the last visit and then listen because
the last visit and then listen because the average doctor of interrupts in the
the average doctor of interrupts in the
the average doctor of interrupts in the first 17 seconds of the medical
first 17 seconds of the medical
first 17 seconds of the medical interview now the open-ended question is
interview now the open-ended question is
interview now the open-ended question is not the same all over the world I was in
not the same all over the world I was in
not the same all over the world I was in Botswana and learned from a wonderful
Botswana and learned from a wonderful
Botswana and learned from a wonderful pediatrician that when he sees an infant
pediatrician that when he sees an infant
pediatrician that when he sees an infant his first question to the mom is how is
his first question to the mom is how is
his first question to the mom is how is the soft spot the spot on the center of
the soft spot the spot on the center of
the soft spot the spot on the center of the head why because this is the spot
the head why because this is the spot
the head why because this is the spot that is focused upon by the traditional
that is focused upon by the traditional
that is focused upon by the traditional heal
heal
heal and only by asking the mom in this
and only by asking the mom in this
and only by asking the mom in this unthreatening sort of way can he be sure
unthreatening sort of way can he be sure
unthreatening sort of way can he be sure of the fact that the mom the mother has
of the fact that the mom the mother has
of the fact that the mom the mother has actually taken this child to see a
actually taken this child to see a
actually taken this child to see a healer in the Zulu language there is no
healer in the Zulu language there is no
healer in the Zulu language there is no single word for depression so if you’re
single word for depression so if you’re
single word for depression so if you’re going to ask a patient how are you
going to ask a patient how are you
going to ask a patient how are you feeling today you might have to imagine
feeling today you might have to imagine
feeling today you might have to imagine responses like boom or open C or sangala
responses like boom or open C or sangala
responses like boom or open C or sangala who issue lulululu
who issue lulululu
who issue lulululu as ways of expressing what we call in
as ways of expressing what we call in
as ways of expressing what we call in our culture depression then I strongly
our culture depression then I strongly
our culture depression then I strongly suggest to reflect back what you’ve
suggest to reflect back what you’ve
suggest to reflect back what you’ve heard which is simply to say to the
heard which is simply to say to the
heard which is simply to say to the patient so what you’re saying is or let
patient so what you’re saying is or let
patient so what you’re saying is or let me make sure if I have this right and
me make sure if I have this right and
me make sure if I have this right and this is a way of my making sure I was
this is a way of my making sure I was
this is a way of my making sure I was listening but more so a way of saying to
listening but more so a way of saying to
listening but more so a way of saying to the patient that I’ve heard what they
the patient that I’ve heard what they
the patient that I’ve heard what they had to say would it be okay if asking
had to say would it be okay if asking
had to say would it be okay if asking permission before giving advice would it
permission before giving advice would it
permission before giving advice would it be okay if I interrupt you to ask some
be okay if I interrupt you to ask some
be okay if I interrupt you to ask some specific questions would it be okay if I
specific questions would it be okay if I
specific questions would it be okay if I explained what I think went wrong what
explained what I think went wrong what
explained what I think went wrong what are they okay if I give you some advice
are they okay if I give you some advice
are they okay if I give you some advice about this health issue or on the other
about this health issue or on the other
about this health issue or on the other side would it be okay if I give you some
side would it be okay if I give you some
side would it be okay if I give you some advice about how to get rid of you’re
advice about how to get rid of you’re
advice about how to get rid of you’re useless you’re useless boyfriend
useless you’re useless boyfriend
useless you’re useless boyfriend the same technique there’s only one time
the same technique there’s only one time
the same technique there’s only one time I recommend not to use this technique of
I recommend not to use this technique of
I recommend not to use this technique of asking permission before giving advice
asking permission before giving advice
asking permission before giving advice it’s with your own teenage children
it’s with your own teenage children
it’s with your own teenage children these are the people who don’t want to
these are the people who don’t want to
these are the people who don’t want to hear your advice you’re going to give it
hear your advice you’re going to give it
hear your advice you’re going to give it anyway don’t damage your credibility a
anyway don’t damage your credibility a
anyway don’t damage your credibility a few other key phrases I wish we had
few other key phrases I wish we had
few other key phrases I wish we had better treatments instead of saying I’m
better treatments instead of saying I’m
better treatments instead of saying I’m sorry I think to say I wish and let’s
sorry I think to say I wish and let’s
sorry I think to say I wish and let’s decide together what to do next and
decide together what to do next and
decide together what to do next and finally at the end what other questions
finally at the end what other questions
finally at the end what other questions do you have not do you have questions
do you have not do you have questions
do you have not do you have questions but what questions do you have and being
but what questions do you have and being
but what questions do you have and being careful not to say this with your hand
careful not to say this with your hand
careful not to say this with your hand on the doorknob on the way out okay now
on the doorknob on the way out okay now
on the doorknob on the way out okay now we’re gonna go back to Tolstoy in a
we’re gonna go back to Tolstoy in a
we’re gonna go back to Tolstoy in a different sort of a way in the fall I
different sort of a way in the fall I
different sort of a way in the fall I teach a freshman focused course and we
teach a freshman focused course and we
teach a freshman focused course and we spend an entire semester talk about
spend an entire semester talk about
spend an entire semester talk about empathy curiosity and cultural humility
empathy curiosity and cultural humility
empathy curiosity and cultural humility the empathy and curiosity of my students
the empathy and curiosity of my students
the empathy and curiosity of my students inspires me in many ways toward the end
inspires me in many ways toward the end
inspires me in many ways toward the end of the semester each student is asked to
of the semester each student is asked to
of the semester each student is asked to write an additional short chapter to add
write an additional short chapter to add
write an additional short chapter to add to Tolstoy book what would happen if the
to Tolstoy book what would happen if the
to Tolstoy book what would happen if the empathic doctor arrived at Ivan’s
empathic doctor arrived at Ivan’s
empathic doctor arrived at Ivan’s bedside many of the student chapters are
bedside many of the student chapters are
bedside many of the student chapters are remarkable and I will read from just one
remarkable and I will read from just one
remarkable and I will read from just one by Gabi Zegers the doctor removed his
by Gabi Zegers the doctor removed his
by Gabi Zegers the doctor removed his coat and sat beside Ivan Ilyich resting
coat and sat beside Ivan Ilyich resting
coat and sat beside Ivan Ilyich resting his hand on his shoulder hello my name
his hand on his shoulder hello my name
his hand on his shoulder hello my name is dr. Viktor Viktorovich and I will do
is dr. Viktor Viktorovich and I will do
is dr. Viktor Viktorovich and I will do whatever I can to clarify it for you
whatever I can to clarify it for you
whatever I can to clarify it for you what is wrong and how we could fight
what is wrong and how we could fight
what is wrong and how we could fight this the doctors expression was more
this the doctors expression was more
this the doctors expression was more soothing to Ivan than any drug could
soothing to Ivan than any drug could
soothing to Ivan than any drug could ever be then as a special move from one
ever be then as a special move from one
ever be then as a special move from one of curiosity it’s one of compassion and
of curiosity it’s one of compassion and
of curiosity it’s one of compassion and after a caring and compassionate
after a caring and compassionate
after a caring and compassionate discussion carefully explaining Ivan
discussion carefully explaining Ivan
discussion carefully explaining Ivan symptoms in the gravity of his diagnosis
symptoms in the gravity of his diagnosis
symptoms in the gravity of his diagnosis dr. Viktorovich concluded
dr. Viktorovich concluded
dr. Viktorovich concluded please call upon me again if you have
please call upon me again if you have
please call upon me again if you have any questions or concerns or you simply
any questions or concerns or you simply
any questions or concerns or you simply need someone to talk to if I were in
need someone to talk to if I were in
need someone to talk to if I were in your place I would try to focus on the
your place I would try to focus on the
your place I would try to focus on the instances in your life which you feel
instances in your life which you feel
instances in your life which you feel best about the doctor said to his dying
best about the doctor said to his dying
best about the doctor said to his dying patient your life is not over yet
our story begins on a beautiful afternoon in Durban South Africa or not
our story begins our story just began
our story begins our story just began Rea ours our story begins on a beautiful
Rea ours our story begins on a beautiful
Rea ours our story begins on a beautiful afternoon in Durban morning in Durban
afternoon in Durban morning in Durban
afternoon in Durban morning in Durban South Africa my wife and I had just gone
South Africa my wife and I had just gone
South Africa my wife and I had just gone for a swim in the Indian Ocean I’ve had
for a swim in the Indian Ocean I’ve had
for a swim in the Indian Ocean I’ve had a wonderful breakfast and ordered my
a wonderful breakfast and ordered my
a wonderful breakfast and ordered my second cappuccino then I reached for the
second cappuccino then I reached for the
second cappuccino then I reached for the local newspaper it was the morning after
local newspaper it was the morning after
local newspaper it was the morning after the municipal elections and I saw this
the municipal elections and I saw this
the municipal elections and I saw this photo my heart sank to a dermatologist
photo my heart sank to a dermatologist
photo my heart sank to a dermatologist like myself this picture can mean only
like myself this picture can mean only
like myself this picture can mean only one thing
one thing
one thing a lethal form of malignant melanoma
a lethal form of malignant melanoma
a lethal form of malignant melanoma don’t take my word for it here’s a photo
don’t take my word for it here’s a photo
don’t take my word for it here’s a photo from a dermatology textbook what to do I
from a dermatology textbook what to do I
from a dermatology textbook what to do I went home rushed to the telephone and
went home rushed to the telephone and
went home rushed to the telephone and called a photo editor of the newspaper
called a photo editor of the newspaper
called a photo editor of the newspaper I said taro I hate to bother you I know
I said taro I hate to bother you I know
I said taro I hate to bother you I know this is really strange I’m professor of
this is really strange I’m professor of
this is really strange I’m professor of dermatology in the United States at Duke
dermatology in the United States at Duke
dermatology in the United States at Duke University I’ve written text books and
University I’ve written text books and
University I’ve written text books and articles and I’m most worried about the
articles and I’m most worried about the
articles and I’m most worried about the man in this photo I said this is a kind
man in this photo I said this is a kind
man in this photo I said this is a kind of melanoma this most common in skin of
of melanoma this most common in skin of
of melanoma this most common in skin of color and to emphasize my point I told
color and to emphasize my point I told
color and to emphasize my point I told her this is exactly the kind of melanoma
her this is exactly the kind of melanoma
her this is exactly the kind of melanoma that was lethal to Bob Marley she
that was lethal to Bob Marley she
that was lethal to Bob Marley she listened carefully to what I said and
listened carefully to what I said and
listened carefully to what I said and promised to call me back as soon as I
promised to call me back as soon as I
promised to call me back as soon as I found the man in the photo and brought
found the man in the photo and brought
found the man in the photo and brought him to medical attention I was relieved
him to medical attention I was relieved
him to medical attention I was relieved and satisfied to know she was doing this
and satisfied to know she was doing this
and satisfied to know she was doing this two minutes later the phone rang and it
two minutes later the phone rang and it
two minutes later the phone rang and it was her and she said the following she
was her and she said the following she
was her and she said the following she said professor prose yes is there any
said professor prose yes is there any
said professor prose yes is there any chance the man in the picture simply has
chance the man in the picture simply has
chance the man in the picture simply has the mark that each of us gets when we go
the mark that each of us gets when we go
the mark that each of us gets when we go to vote in South Africa
to vote in South Africa
to vote in South Africa to prevent us from voting a second time
to prevent us from voting a second time
to prevent us from voting a second time at that moment at that moment my
at that moment at that moment my
at that moment at that moment my mother-in-law entered the living room I
mother-in-law entered the living room I
mother-in-law entered the living room I had learned a lesson in cultural
had learned a lesson in cultural
had learned a lesson in cultural humility I also learned that it’s a very
humility I also learned that it’s a very
humility I also learned that it’s a very thin line between between being a
thin line between between being a
thin line between between being a humanitarian a brilliant physician and a
humanitarian a brilliant physician and a
humanitarian a brilliant physician and a complete nitwit
complete nitwit
complete nitwit in the next 10 minutes you’ll have an
in the next 10 minutes you’ll have an
in the next 10 minutes you’ll have an opportunity to draw your own conclusions
opportunity to draw your own conclusions
opportunity to draw your own conclusions when I teach seminars to doctors or
when I teach seminars to doctors or
when I teach seminars to doctors or residents medical students I always
residents medical students I always
residents medical students I always begin with the same metaphor I say
begin with the same metaphor I say
begin with the same metaphor I say imagine what it would take to be on
imagine what it would take to be on
imagine what it would take to be on opposite sides of the table from the
opposite sides of the table from the
opposite sides of the table from the patient with the problem in the middle
patient with the problem in the middle
patient with the problem in the middle and then I say what would it take to get
and then I say what would it take to get
and then I say what would it take to get on to the same side of the table looking
on to the same side of the table looking
on to the same side of the table looking at the problem together a wonderful
at the problem together a wonderful
at the problem together a wonderful friend of mine in South Africa
friend of mine in South Africa
friend of mine in South Africa Joseph Bhutto lazy who was steeped in
Joseph Bhutto lazy who was steeped in
Joseph Bhutto lazy who was steeped in Zulu culture once told me that when he
Zulu culture once told me that when he
Zulu culture once told me that when he goes to see the doctor he most likes the
goes to see the doctor he most likes the
goes to see the doctor he most likes the doctor who seems to really care about
doctor who seems to really care about
doctor who seems to really care about him he feels that he and his doctor are
him he feels that he and his doctor are
him he feels that he and his doctor are singing the same song of course now you
singing the same song of course now you
singing the same song of course now you know we’re going to talk about Leo
know we’re going to talk about Leo
know we’re going to talk about Leo Tolstoy and about this very particular
Tolstoy and about this very particular
Tolstoy and about this very particular novel which is the death of Ivan Ilyich
novel which is the death of Ivan Ilyich
novel which is the death of Ivan Ilyich so in the death of Ivan Ilyich Tolstoy
so in the death of Ivan Ilyich Tolstoy
so in the death of Ivan Ilyich Tolstoy documents the remarkable story of a man
documents the remarkable story of a man
documents the remarkable story of a man who was dying of a serious illness alone
who was dying of a serious illness alone
who was dying of a serious illness alone frustrated and worried and in this late
frustrated and worried and in this late
frustrated and worried and in this late 19th century novel he describes a
19th century novel he describes a
19th century novel he describes a conversation between the the doctor and
conversation between the the doctor and
conversation between the the doctor and Ivan and it goes like this everything
Ivan and it goes like this everything
Ivan and it goes like this everything took place as Ivan had expected and as
took place as Ivan had expected and as
took place as Ivan had expected and as it always does there was the usual
it always does there was the usual
it always does there was the usual waiting and the important air assumed by
waiting and the important air assumed by
waiting and the important air assumed by the doctor with which he was so familiar
the doctor with which he was so familiar
the doctor with which he was so familiar so Ivan Ilyich only one question was
so Ivan Ilyich only one question was
so Ivan Ilyich only one question was important was this case serious or not
important was this case serious or not
important was this case serious or not but the doctor ignored that him
but the doctor ignored that him
but the doctor ignored that him inappropriate question from his point of
inappropriate question from his point of
inappropriate question from his point of view it was not the one under
view it was not the one under
view it was not the one under consideration the real question was to
consideration the real question was to
consideration the real question was to decide between a floating kidney
decide between a floating kidney
decide between a floating kidney Clinic guitar or appendicitis for the
Clinic guitar or appendicitis for the
Clinic guitar or appendicitis for the doctors summing up Ivan Elliott’s knew
doctors summing up Ivan Elliott’s knew
doctors summing up Ivan Elliott’s knew that things were bad but that for the
that things were bad but that for the
that things were bad but that for the doctor and for everybody else it was a
doctor and for everybody else it was a
doctor and for everybody else it was a matter of indifference we sick people
matter of indifference we sick people
matter of indifference we sick people probably often ask inappropriate
probably often ask inappropriate
probably often ask inappropriate questions said Ivan but tell me in
questions said Ivan but tell me in
questions said Ivan but tell me in general is this complaint dangerous or
general is this complaint dangerous or
general is this complaint dangerous or not the doctor looked at him sternly
not the doctor looked at him sternly
not the doctor looked at him sternly over his spectacles with one eye I have
over his spectacles with one eye I have
over his spectacles with one eye I have already told you what I consider
already told you what I consider
already told you what I consider necessary and proper the analysis may
necessary and proper the analysis may
necessary and proper the analysis may show something more and the doctor about
show something more and the doctor about
show something more and the doctor about what is important then in the
what is important then in the
what is important then in the doctor-patient conversation in the 21st
doctor-patient conversation in the 21st
doctor-patient conversation in the 21st century to me the thing that’s more
century to me the thing that’s more
century to me the thing that’s more important than all our other
important than all our other
important than all our other considerations and skills and ability is
considerations and skills and ability is
considerations and skills and ability is cultivating curiosity my favorite
cultivating curiosity my favorite
cultivating curiosity my favorite article in all the medical literature
article in all the medical literature
article in all the medical literature over many years is this one written by
over many years is this one written by
over many years is this one written by faith Fitzgerald a physician in San
faith Fitzgerald a physician in San
faith Fitzgerald a physician in San Francisco about the role of curiosity in
Francisco about the role of curiosity in
Francisco about the role of curiosity in medicine and in the story in the article
medicine and in the story in the article
medicine and in the story in the article she tells the following story she
she tells the following story she
she tells the following story she reached a point where she felt the
reached a point where she felt the
reached a point where she felt the interns and residents in her hospital
interns and residents in her hospital
interns and residents in her hospital had absolutely no interest in the
had absolutely no interest in the
had absolutely no interest in the stories of the patients and their
stories of the patients and their
stories of the patients and their families she said to the residents look
families she said to the residents look
families she said to the residents look she said take me to the bedside of your
she said take me to the bedside of your
she said take me to the bedside of your least interesting patient and I’ll prove
least interesting patient and I’ll prove
least interesting patient and I’ll prove to you one way or the other that that
to you one way or the other that that
to you one way or the other that that person is interested the residents took
person is interested the residents took
person is interested the residents took faith to the bedside of a little old
faith to the bedside of a little old
faith to the bedside of a little old lady who had very little to say answered
lady who had very little to say answered
lady who had very little to say answered every question with one or two words and
every question with one or two words and
every question with one or two words and faith was starting to worry she had
faith was starting to worry she had
faith was starting to worry she had finally met the uninteresting patient in
finally met the uninteresting patient in
finally met the uninteresting patient in desperation faith as this woman have
desperation faith as this woman have
desperation faith as this woman have have you ever been in the hospital
have you ever been in the hospital
have you ever been in the hospital before and the woman said yes and then
before and the woman said yes and then
before and the woman said yes and then faith asked oh she said what for and the
faith asked oh she said what for and the
faith asked oh she said what for and the woman said I broke my arm hmm they said
woman said I broke my arm hmm they said
woman said I broke my arm hmm they said well why did you how did you break your
well why did you how did you break your
well why did you how did you break your arm and the woman said well a steamer
arm and the woman said well a steamer
arm and the woman said well a steamer trunk fell on it and faith said well why
trunk fell on it and faith said well why
trunk fell on it and faith said well why did the where did the trunk fall and I
did the where did the trunk fall and I
did the where did the trunk fall and I said well shipler the ship
said well shipler the ship
said well shipler the ship and then face of all what why did the
and then face of all what why did the
and then face of all what why did the ship lurched the one who said well
ship lurched the one who said well
ship lurched the one who said well because it hit the iceberg this is a
because it hit the iceberg this is a
because it hit the iceberg this is a true story and faith pointed out that
true story and faith pointed out that
true story and faith pointed out that after this revelation this woman became
after this revelation this woman became
after this revelation this woman became interesting to all of the newspapers and
interesting to all of the newspapers and
interesting to all of the newspapers and TV stations in San Francisco and
TV stations in San Francisco and
TV stations in San Francisco and eventually to the interns and residents
eventually to the interns and residents
eventually to the interns and residents and I often think that if faith has
and I often think that if faith has
and I often think that if faith has spent a few more minutes asking more
spent a few more minutes asking more
spent a few more minutes asking more questions she might have found out what
questions she might have found out what
questions she might have found out what this woman was doing before the ship hit
this woman was doing before the ship hit
this woman was doing before the ship hit the iceberg in a conclusion of her
the iceberg in a conclusion of her
the iceberg in a conclusion of her article faith beautifully states I
article faith beautifully states I
article faith beautifully states I believe that it is curiosity that
believe that it is curiosity that
believe that it is curiosity that converts strangers into people we can
converts strangers into people we can
converts strangers into people we can empathize with I believe it is curiosity
empathize with I believe it is curiosity
empathize with I believe it is curiosity that converts strangers into people we
that converts strangers into people we
that converts strangers into people we can empathize with so the skills that I
can empathize with so the skills that I
can empathize with so the skills that I teach to young doctors are really
teach to young doctors are really
teach to young doctors are really valuable when when working with the
valuable when when working with the
valuable when when working with the paper with the patient with concerns and
paper with the patient with concerns and
paper with the patient with concerns and worries but but think as you hear these
worries but but think as you hear these
worries but but think as you hear these skills and ideas think about your own
skills and ideas think about your own
skills and ideas think about your own life imagine giving advice to a close
life imagine giving advice to a close
life imagine giving advice to a close friend who’s trying to deal with a
friend who’s trying to deal with a
friend who’s trying to deal with a really annoying boyfriend and what would
really annoying boyfriend and what would
really annoying boyfriend and what would be which of these skills and techniques
be which of these skills and techniques
be which of these skills and techniques might come in handy and I’ll point out a
might come in handy and I’ll point out a
might come in handy and I’ll point out a few as we go along first of all I
few as we go along first of all I
few as we go along first of all I encourage every doctor to put his hand
encourage every doctor to put his hand
encourage every doctor to put his hand his or her hand on the doorknob before
his or her hand on the doorknob before
his or her hand on the doorknob before entering the room and take a deep breath
entering the room and take a deep breath
entering the room and take a deep breath with the conscious decision to pay
with the conscious decision to pay
with the conscious decision to pay attention and then ask an open-ended
attention and then ask an open-ended
attention and then ask an open-ended question not a yes-or-no question ask
question not a yes-or-no question ask
question not a yes-or-no question ask for example what worries you most about
for example what worries you most about
for example what worries you most about your illness or how have you been since
your illness or how have you been since
your illness or how have you been since the last visit and then listen because
the last visit and then listen because
the last visit and then listen because the average doctor of interrupts in the
the average doctor of interrupts in the
the average doctor of interrupts in the first 17 seconds of the medical
first 17 seconds of the medical
first 17 seconds of the medical interview now the open-ended question is
interview now the open-ended question is
interview now the open-ended question is not the same all over the world I was in
not the same all over the world I was in
not the same all over the world I was in Botswana and learned from a wonderful
Botswana and learned from a wonderful
Botswana and learned from a wonderful pediatrician that when he sees an infant
pediatrician that when he sees an infant
pediatrician that when he sees an infant his first question to the mom is how is
his first question to the mom is how is
his first question to the mom is how is the soft spot the spot on the center of
the soft spot the spot on the center of
the soft spot the spot on the center of the head why because this is the spot
the head why because this is the spot
the head why because this is the spot that is focused upon by the traditional
that is focused upon by the traditional
that is focused upon by the traditional heal
heal
heal and only by asking the mom in this
and only by asking the mom in this
and only by asking the mom in this unthreatening sort of way can he be sure
unthreatening sort of way can he be sure
unthreatening sort of way can he be sure of the fact that the mom the mother has
of the fact that the mom the mother has
of the fact that the mom the mother has actually taken this child to see a
actually taken this child to see a
actually taken this child to see a healer in the Zulu language there is no
healer in the Zulu language there is no
healer in the Zulu language there is no single word for depression so if you’re
single word for depression so if you’re
single word for depression so if you’re going to ask a patient how are you
going to ask a patient how are you
going to ask a patient how are you feeling today you might have to imagine
feeling today you might have to imagine
feeling today you might have to imagine responses like boom or open C or sangala
responses like boom or open C or sangala
responses like boom or open C or sangala who issue lulululu
who issue lulululu
who issue lulululu as ways of expressing what we call in
as ways of expressing what we call in
as ways of expressing what we call in our culture depression then I strongly
our culture depression then I strongly
our culture depression then I strongly suggest to reflect back what you’ve
suggest to reflect back what you’ve
suggest to reflect back what you’ve heard which is simply to say to the
heard which is simply to say to the
heard which is simply to say to the patient so what you’re saying is or let
patient so what you’re saying is or let
patient so what you’re saying is or let me make sure if I have this right and
me make sure if I have this right and
me make sure if I have this right and this is a way of my making sure I was
this is a way of my making sure I was
this is a way of my making sure I was listening but more so a way of saying to
listening but more so a way of saying to
listening but more so a way of saying to the patient that I’ve heard what they
the patient that I’ve heard what they
the patient that I’ve heard what they had to say would it be okay if asking
had to say would it be okay if asking
had to say would it be okay if asking permission before giving advice would it
permission before giving advice would it
permission before giving advice would it be okay if I interrupt you to ask some
be okay if I interrupt you to ask some
be okay if I interrupt you to ask some specific questions would it be okay if I
specific questions would it be okay if I
specific questions would it be okay if I explained what I think went wrong what
explained what I think went wrong what
explained what I think went wrong what are they okay if I give you some advice
are they okay if I give you some advice
are they okay if I give you some advice about this health issue or on the other
about this health issue or on the other
about this health issue or on the other side would it be okay if I give you some
side would it be okay if I give you some
side would it be okay if I give you some advice about how to get rid of you’re
advice about how to get rid of you’re
advice about how to get rid of you’re useless you’re useless boyfriend
useless you’re useless boyfriend
useless you’re useless boyfriend the same technique there’s only one time
the same technique there’s only one time
the same technique there’s only one time I recommend not to use this technique of
I recommend not to use this technique of
I recommend not to use this technique of asking permission before giving advice
asking permission before giving advice
asking permission before giving advice it’s with your own teenage children
it’s with your own teenage children
it’s with your own teenage children these are the people who don’t want to
these are the people who don’t want to
these are the people who don’t want to hear your advice you’re going to give it
hear your advice you’re going to give it
hear your advice you’re going to give it anyway don’t damage your credibility a
anyway don’t damage your credibility a
anyway don’t damage your credibility a few other key phrases I wish we had
few other key phrases I wish we had
few other key phrases I wish we had better treatments instead of saying I’m
better treatments instead of saying I’m
better treatments instead of saying I’m sorry I think to say I wish and let’s
sorry I think to say I wish and let’s
sorry I think to say I wish and let’s decide together what to do next and
decide together what to do next and
decide together what to do next and finally at the end what other questions
finally at the end what other questions
finally at the end what other questions do you have not do you have questions
do you have not do you have questions
do you have not do you have questions but what questions do you have and being
but what questions do you have and being
but what questions do you have and being careful not to say this with your hand
careful not to say this with your hand
careful not to say this with your hand on the doorknob on the way out okay now
on the doorknob on the way out okay now
on the doorknob on the way out okay now we’re gonna go back to Tolstoy in a
we’re gonna go back to Tolstoy in a
we’re gonna go back to Tolstoy in a different sort of a way in the fall I
different sort of a way in the fall I
different sort of a way in the fall I teach a freshman focused course and we
teach a freshman focused course and we
teach a freshman focused course and we spend an entire semester talk about
spend an entire semester talk about
spend an entire semester talk about empathy curiosity and cultural humility
empathy curiosity and cultural humility
empathy curiosity and cultural humility the empathy and curiosity of my students
the empathy and curiosity of my students
the empathy and curiosity of my students inspires me in many ways toward the end
inspires me in many ways toward the end
inspires me in many ways toward the end of the semester each student is asked to
of the semester each student is asked to
of the semester each student is asked to write an additional short chapter to add
write an additional short chapter to add
write an additional short chapter to add to Tolstoy book what would happen if the
to Tolstoy book what would happen if the
to Tolstoy book what would happen if the empathic doctor arrived at Ivan’s
empathic doctor arrived at Ivan’s
empathic doctor arrived at Ivan’s bedside many of the student chapters are
bedside many of the student chapters are
bedside many of the student chapters are remarkable and I will read from just one
remarkable and I will read from just one
remarkable and I will read from just one by Gabi Zegers the doctor removed his
by Gabi Zegers the doctor removed his
by Gabi Zegers the doctor removed his coat and sat beside Ivan Ilyich resting
coat and sat beside Ivan Ilyich resting
coat and sat beside Ivan Ilyich resting his hand on his shoulder hello my name
his hand on his shoulder hello my name
his hand on his shoulder hello my name is dr. Viktor Viktorovich and I will do
is dr. Viktor Viktorovich and I will do
is dr. Viktor Viktorovich and I will do whatever I can to clarify it for you
whatever I can to clarify it for you
whatever I can to clarify it for you what is wrong and how we could fight
what is wrong and how we could fight
what is wrong and how we could fight this the doctors expression was more
this the doctors expression was more
this the doctors expression was more soothing to Ivan than any drug could
soothing to Ivan than any drug could
soothing to Ivan than any drug could ever be then as a special move from one
ever be then as a special move from one
ever be then as a special move from one of curiosity it’s one of compassion and
of curiosity it’s one of compassion and
of curiosity it’s one of compassion and after a caring and compassionate
after a caring and compassionate
after a caring and compassionate discussion carefully explaining Ivan
discussion carefully explaining Ivan
discussion carefully explaining Ivan symptoms in the gravity of his diagnosis
symptoms in the gravity of his diagnosis
symptoms in the gravity of his diagnosis dr. Viktorovich concluded
dr. Viktorovich concluded
dr. Viktorovich concluded please call upon me again if you have
please call upon me again if you have
please call upon me again if you have any questions or concerns or you simply
any questions or concerns or you simply
any questions or concerns or you simply need someone to talk to if I were in
need someone to talk to if I were in
need someone to talk to if I were in your place I would try to focus on the
your place I would try to focus on the
your place I would try to focus on the instances in your life which you feel
instances in your life which you feel
instances in your life which you feel best about the doctor said to his dying
best about the doctor said to his dying
best about the doctor said to his dying patient your life is not over yet
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