Ladies in hats
Tuscaloosa, Alabama, United States
I was encouraging an overweight patient in patent leather shoes with two-inch heels to start wearing sneakers instead, when she calmly reached into her totebag and pulled out a pair of Nikes. The pumps, she explained, were her “comin’-to-the-doctor shoes.” Her finest footwear was a sign of respect.
Hats, too, are a way of dressing up for the occasion, and we can return this respect by writing “well-dressed” in the medical record. Besides, taking such note of the patient’s attire is preferable to the hackneyed phrase “well-developed, well-nourished, in no acute distress” that should only ever be used to refer to infants in the newborn nursery.
As a medical student at Emory, I began adding sketches and snippets of dialogue to my charts as a way to spend more time with each patient, to focus more closely on the patient’s expression, and to try to capture the essence of our encounter. I do not use the term “chief complaint,” instead looking and listening for the patient’s main concerns, worries, and fears. Until reluctantly adopting the electronic medical record 25 years ago, I had made nearly 5,000 sketches. All were unplanned and completed in ballpoint pen on whatever scrap of paper I happened to have, from prescription pads to paper towels. I learned the importance of empathy and listening closely to patients from my late father, Leon Blum, MD, a general practitioner in Rockaway Beach, New York for nearly 40 years. His office was in our home, where every afternoon the living room became the waiting room. I never thought of his countless devoted patients as other than our houseguests. I cherish their memory, as I do that of the patients whom I have been privileged to care for.
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ALAN BLUM, MD, is Professor and Endowed Chair in Family Medicine at the University of Alabama, Tuscaloosa, where he founded and directs the Center for the Study of Tobacco and Society. His sketches and stories of patients have appeared in numerous publications including the Journal of the American Medical Association, the Canadian Medical Association Journal, Literature and Medicine The Pharos, Pulse, and The Color Atlas of Family Medicine. A self-taught artist, he has had invited solo exhibitions at Houston Community College; the University of Texas Health Sciences Center; the Texas Medical Center Library; the Kentuck Museum and Gallery in Northport, Alabama, and several medical schools and hospitals. Dr. Blum has been invited to share his stories and sketches at dozens of conferences, courses in the medical humanities, and medical school and residency graduations. He has produced three artbooks of sketches and stories: Ladies in Waiting, Gentle Men, and Seeing Patients: The Sketchiest Details. View his artwork at https://sketchiestdetails.com/.