Editor’s Corner: Two Ears, One Mouth

Joseph R. Mikhael, MD, MEd
Professor, Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer Center and Chief Medical Officer, International Myeloma Foundation

I consider myself blessed to come from a medical family. My parents were physicians who were sweethearts in medical school in Egypt. They had a rough road, with many years of training on four continents. They were incredible role models of resilience in the face of discrimination and patience in the midst of persecution, and they were determined to make a better life for their children. My brother, who is also a physician, and I owe them an incalculable debt.

My father started practicing medicine more than 50 years ago, and he had tremendous insight into the field, matched by his compassion for his patients. I can recall numerous times and ways he served as a role model physician to me, but I’d like to share two pieces of advice he gave me on the day I was accepted to medical school. I can still hear his words nearly 30 years on – and they ring true perhaps at no time more than the present.

“Joey,” he said (and don’t even think of calling me that now), “First, treat nurses like the professionals they are.”

My father practiced medicine at a time when the team model of care was still being developed, but he had already realized the importance of respecting everyone on the health-care team. Long before the concept of a “multidisciplinary team” and its subsequent iterations were commonplace, he had already embraced these ideas.

From his example, I knew his advice was not just empty words. As a child, I often had the privilege of accompanying my dad to the hospital on Saturday mornings when he did rounds. I saw him interact with nurses, pharmacists, physical therapists, and even the hospital janitors. He was the quintessential gentleman and genuinely wanted their input. A nurse took me aside one morning and told me that my dad was special – that he listened to the nurses’ opinions, and that most other doctors didn’t.

My dad had a mixed academic and community practice, but he never believed in the hierarchical, “lone ranger” model of the doctor at the top of the team. It was not just the structure of the team that mattered to him; the attitude was equally important. He was completely committed to the team concept and it served him, his patients, and indeed his colleagues well.

Dad wasn’t done with his words of wisdom. “Second,” he said, “God made you with two ears and one mouth for a reason. Listen to your patients more than you talk.”

This anatomical lesson is equally pertinent. To be clear, he was a urologist – respectfully, I am not too sure how well-known they are for listening (can they even hear down there?) – but nonetheless he treated the physician-patient relationship as sacred.

This was long before the notion of active listening had permeated medicine. With all the time pressures of medicine today, further exacerbated by the COVID-19 pandemic and the challenges of telemedicine, we need to take time to listen to our patients. Sometimes we can literally “mute” our patients and not hear them, perhaps because we have predetermined what we think they have or need.

We all understand the value of communication with the patient, yet so often our behavior does not fully reflect it. One of the most important studies in this arena was conducted by Ethan Basch, MD, MSc, and colleagues at Memorial Sloan Kettering Cancer Center in 2016.1 Patients with solid tumors were randomized either to receive an iPad to report ongoing symptoms or to the standard symptom-monitoring method (the patient calls and leaves a message and someone eventually calls them back). The intent was to find ways to enhance communication to improve patients’ quality of life. Not only did symptom self-reporting with the tablet improve health-related quality of life, it also was associated with prolonged survival.

In my field of myeloma, where we seem to have a new drug approved every month, we would do well to use all the tools we have – including the ones conveniently attached to our faces.

I miss my father every day. It has been nearly 10 years since cancer claimed his life. He may be gone, but his progressive advice has profoundly affected me and my daily practice. In an age of technology and social distancing, his sage words remind us of the value of the humanity in medicine and the need for a cohesive team to serve our patients.

Joseph Mikhael, MD, MEd
Associate Editor

Reference

  1. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34:557-565.