Has the Relationship Between Physician and Patient Changed?

The Doctor Stories

I have long been fascinated by books written by physicians that describe their lives, their training, and their practice. In that genre, a book I would highly recommend is The Doctor Stories, written by William Carlos Williams and edited by Robert Cole, MD. A series of essays, short stories, and poems, The Doctor Stories is a window into the life and practice of Dr. Williams, a generalist and pediatrician who practiced for over forty years in Northern New Jersey. He writes with robust clarity and directness of the patients for whom he cared, speaking in the vernacular of his patients, a diverse, multiethnic, and generally blue-collar population, often immigrants, in a way that rings through with honesty and uncompromising, even unsentimental, compassion.

As I mentioned, The Doctor Stories is a collection of essays, short stories, and even some autobiography mixed in giving the reader an intimate view of a doctor’s life in the first half of the twentieth century. All the selections are worth reading; some are uncomfortable; all are unblinkingly honest. Two of his essays stand out for me. In Old Doc Rivers we are confronted with the slow deterioration of a brilliant and trusted physician through substance abuse. Sadly, this is a story with which most of us are familiar. In A Night in June Williams describes delivering a baby by forceps one night when he was a young physician, a baby that died in childbirth, and the relationship he forged with the mother over the years that followed as he continued to deliver her babies over the years that followed.

In his writing, the reader becomes a witness to medical practice as it was at the time. With little in the way of technology or formulary, the essence of what Williams did, and that we do, is the relationship between doctor and patient. This is one of the things I find most compelling about Williams’ writing: in the end, what we all do can be distilled down to the relationship we have with the patients for whom we care.

This is essentially what I tell my residents. “What goes on between a doctor and patient – be it at the bedside, in clinic,  or on a video visit - none of that – the intimacy, the trust, the fear and anxiety, the power of healing and caring – has changed.” 

More about Williams Carlos Williams, MD  – Physician, Poet, Writer

What I didn’t know about Williams when I first read this book, but learned later, was that he was also a gifted poet and writer. Born in 1883 to an English father and a Puerto Rican mother in Rutherford, New Jersey, Williams grew up in an eclectic household. He received a public school education that culminated in attending the Horace Mann School in New York City, a rigorous school that emphasized math and science in the curriculum. Upon having passed a “special examination” he was accepted from Horace Mann directly into medical school at the University of Pennsylvania in 1902 and graduated in 1906. He completed successive internships in two New York hospitals, and on completion traveled to Leipzig for advanced studies in pediatrics before he returned to Rutherford in 1909 to take up the practice of medicine.

Although Williams clearly had a gift for math and science, culminating in his acceptance into a prestigious medical school at the age of 19, he clearly also had a passion for literature and, in particular, poetry. He fell into a circle of literary/artistic friends during his first years of college that included the poets Ezra Pound and Hilda Doolittle and painter Charles Demuth, all of whom became lifelong friends. Williams became most closely identified with the Imagist movement in poetry and painting, a movement that emphasized the use of precise images to clarify expression. The poets he most admired and drew inspiration from were John Keats and Walt Whitman, poets of very different styles. As his poetry matured, he became known as an inventor, an innovator, and a revolutionary, and he in turn became one of the poets most admired by the 1960’s Beat Generation.

Williams was something of an enigma, however. While his poetry was sometimes radically innovative, he lived a conventional lifestyle. He married, raised two sons with his wife, and practiced medicine in the same location for over forty years. I would imagine that few of his patients even knew that he was also a writer and poet of some note!

William J. “John” Yost, MD, FACP is a member of the AIAMC Programming Committee. In his “day job” John is a practicing general internist and the Chief Academic Officer and Vice President, Medical Education and Research at UnityPoint Health in Des Moines, Iowa.