1. Harpham, Wendy S. MD

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An outstanding pre-med student had asked to meet again about his career plans. As it turned out, this time he wasn't looking for advice. First a jumble of stories spilled out about his experiences while shadowing clinicians and working in a research lab. Then his earnest affirmation about wanting to help as many people as possible led to his triumphant reveal: "I can't be just a practitioner. I'm pursuing an MD-PhD."

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD. WENDY S. HARPHAM, MD, is an internist, cancer survivor, and author. Her books include

Ten different responses gridlocked my brain, each jostling to be the first out of my open mouth. The seconds of silence belied my confidence that his new career plan suited him perfectly-and how happy I felt for him and for future patients. To properly celebrate the moment, I suppressed my one nitpicky comment.


In the days that followed, however, I kept coming back to his four-letter word that had jumped out and stung me: just. "Just" is one of those nuanced words that stymie adults learning English. As an adjective, the link to its Latin origin-justus (law; right)-imparts overtones of morality and fairness, such as when we talk of a just decision or a just punishment.


As an adverb, "just" can portray a variety of concepts. Precision, as in This is just what I need. Near-immediacy, as in He's just arriving. Barely or narrowly, as in There's just enough room. No more than, as in Addjust a teaspoonful. Only, as in They sell just vanilla.


In addition, "just" can connote disappointing ordinariness, such as someone saying a painting is "just a print" or a singer is "just an understudy." Here, whether consciously or not, "just" adds a value judgment of inferior status.


Rationally I knew the pre-med student was simply saying that to do research, and in keeping with his goal of helping as many people as possible, he needed to become a clinical researcher. He couldn't do research if he was just-only-a practitioner. He was not disparaging practitioners.


Here's my problem: I heard a value judgment, too, and still wince at the unwitting subliminal snub. My emotional reaction (okay, my overreaction) has nothing to do with that student and everything to do with my great respect for today's practitioners and loyalty to my chosen career that I left behind.


When I opened my solo practice in 1983 I was finally living my dream of providing hands-on care in the privacy of my office, expecting to be a practitioner until I turned 80. Less than 10 years later illness forced me to hang up my white coat.


Writing about survivorship has offered me meaningful, patient-centered work. But it's nothing like practicing medicine. The fact that I've been able to write despite physical and cognitive limitations attests to how much easier it is for me. Any struggles I've faced as a writer have been a walk in the park compared with the routine challenges I faced as a practitioner.


The contrast between my two careers explains why an unexpected award prompted me to seek counseling years ago. "Rabbi, I'm not comfortable with this. If anyone should receive this honor for work in the health field, it's my doctors. They work harder and make greater sacrifices. I'm just a writer."


Someone else might dismiss my angst as humblebrag. Not my rabbi, who nodded. Blending philosophy and Biblical verse, he focused on the danger of comparisons, in general, and specifically the error of assigning value according to the demands of the job. All beneficial work merits honor, from collecting garbage to curing cancer.


Ancient wisdom teaches that the yardstick of a life well-lived is "how." It is not how many, how quickly, how far or how much...but how. How did you live your life? With purpose? With loving-kindness? With honor? With quiet acts of courage and fortitude?


Through my experiences as a patient and patient advocate, I've come to know and admire many of today's practitioners. Out of the public eye, these dedicated men and women strive to provide the best care possible to each of their patients, bobbing and weaving with all the changes in medicine. How do they do it?


* With discipline they make thousands of decisions, aware that a misstep with even minor decisions can lead to disaster.


* With equanimity they manage uncertainty.


* With composure they deal with patients (or family members) who are rude, inappropriate, demanding, or exasperating in some other way.


* With courage they care about each new patient and, if there is hope, find hope.


* With generosity they sacrifice sleep and comfort and family time.



Practitioners do all this-and much, much more-while racing the clock, burdened by a 40-pound backpack filled with frustrating, boring, time-consuming, independence-sapping administrative duties.


Sitting here in my quiet study, I'm thinking about practitioners on the front lines of medicine and remembering how my doctors saved my life, literally and figuratively. Other people might envision dramatic rescues from life-threatening illnesses or injuries, such as those regularly portrayed in the media. For me, what comes to mind first are the acts of care and caring that usually remain invisible to all but the patients.


My extraordinary admiration of practitioners arises from my first-hand knowledge of their unsung efforts to address patients' minor complaints and subtle changes before they become life-threatening; to persevere when dealing with patients' atypical presentations, resistant diseases, and risky behaviors; and to bring expertise, energy, and empathy to all the problems that threaten patients' quality of life.


That's hard work. That's heroic work. That's why I could never say they are "just" practitioners.