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March 19, 2018

'Resist!' What a young MD learned from his 96 year-old patient—a Nobel recipient and renowned cardiologist

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on June 28, 2021.

    A young doctor found himself treating Bernard Lown, an emeritus professor of cardiology at Harvard University and recipient of a Nobel Prize—and discovered that his own medical practices reflected the shortcomings of a medical system that Lown had spent decades critiquing, Rich Joseph writes for the New York Times.

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    The Nobel recipient in the hospital bed

    Joseph was an intern at Brigham and Women's Hospital when the renowned Lown became his patient. Not only was Lown an acclaimed physician credited with pioneering cardiac medical devices, but he had accepted a Nobel Prize in 1985 on behalf of the International Physicians for the Prevention of Nuclear War, which he co-founded.

    Despite the young doctor's efforts to provide careful, empathetic care, Joseph soon found himself the target of Lown's ire: The hospital "tests every ache and treats every laboratory abnormality," Lown told Joseph, "but it does little to heal its patients."

    Reflecting on the experience later, Lown said, "Each day, one person on the medical team would say one thing in the morning, and by the afternoon the plan had changed." He added, "I always was the last to know what exactly was going on, and my opinion hardly mattered."

    Lown's experience was striking because Lown himself had long critiqued hospitals for exactly those shortcomings. In his 1996 book "The Lost Art of Healing," Lown wrote that in the modern medical system, "healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures."

    Later in his hospital stay, Lown developed difficulty swallowing. His feeding options became a subject for debate between a speech pathologist and the broader medical team—calling to mind Lown's diagnosis in "The Lost Art of Healing" that "doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning" organs.

    How can providers learn from Lown's experience?

    Struck by Lown's experience, Joseph remained in touch with the celebrated physician after his release from the hospital, hoping to learn how to provide better, more empathetic care in the future.

    And Lown was generous with his feedback. He advised that physicians must listen to "the patient behind the symptoms," Joseph writes, "carefully touching the patient during the physical exam to communicate caring; using words that affirm the patient's vitality; and attending to the stresses and situations of his life circumstances."

    Further, Lown advised that "doctors of conscience" must "resist the industrialization of their profession." This starts with doctors' training, Joseph argues: Medical education should be less concerned with biomedical sciences and old, rare diseases, and more focused on communication, interpersonal dynamics, and leadership.

    Joseph writes that hospitals need to "be a last resort, not the hallmark of the health care system," and that the majority of health care resources should go into homes and communities.

    "Doctors must partner with public health and community development efforts to create a culture of health and well-being in patients' daily lives," he concludes (Joseph, New York Times, 2/24; Broad, "Archives," New York Times, accessed 3/14).

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