Alan Blum
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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