This week a patient, for whom I served as the primary care physician for over many years, died after an extended illness. I had the privilege of visiting her two days before her death, as she weakened and drew closer to her last breath. It was an opportunity to tell her good-bye. We were close. She was very smart. She had an engaging sense of humor. She loved college basketball. She pulled for UNC, and I for Duke, which, if you understand North Carolina, you appreciate the push and pull of all that. She was a retired teacher, and she taught me much during her life and with her death. And her last lesson was in her obituary. It was published the evening after her death. I saw my name, and my care over the years was noted and appreciated by the family. I was genuinely touched by the acknowledgment. Over my nearly 40 years of practice, whenever this happens, it is special. It brings back memories with not only the patient, but with their extended family. After all, in a small-town practice, multigenerational care is the norm, not the exception. It always makes me even more appreciative of the doctor-patient relationship. It reminds me of their secrets, our jokes, those minor illnesses, and those major ones too. Sometimes it feels unnecessary. It is most always unexpected. But it is never unappreciated. So yes, I do have a confession. I do read obituaries, those of my patients, those of people I have known, and those of people I never knew. I think many, if not most, doctors peruse them too, especially we “older” ones. These days, of course, you have to find them online. I think obituaries matter. They can convey much about the person and their family, their nicknames, their passions, and their appreciation of friends and others considered special. Often, I see mentioned the names of caregivers or nurses closely involved with the person in their last weeks or months. I see this, and I applaud it and understand it. After all, my own daughter is a hospice nurse, and I know what she does. Those providing care at the end are hard to forget and are truly special. But I have wondered: Why is the primary care doctor not mentioned more often in obituaries, as I was? Did the patient not have one? Did something negative happen? Were those present in those last weeks or days considered “more important” than the primary care doctor who provided care long before death? Was the obituary hurriedly written and the doctor of so many years forgotten? Was the obituary truncated by cost or a limited word count? The truth is, I suspect families are dealing with so many issues and arrangements they simply do not give it much thought. A simple innocent omission. I understand. I have been there with the death of my own parents. Nevertheless, I bet many, if not most, patients do have a long-term relationship with a primary care doctor, who has been with them through many ups and downs, who has guided them through crises, who has provided advice, who has been their advocate, who has encouraged prevention and early detection, who has served as a confidant and a listening ear, who has even completed those forms and prior authorizations that none of their specialists “had time” to do. Not always heroic. Difficult to always measure, but indispensable and immensely valuable. Not to say we primary care doctors are not thanked in many other ways. Meaningful handshakes. Hugs. Kind words. Thank you cards. Holiday cards. Vegetables in the summer. Pies and cakes and cookies. Handmade crafts and woodwork. I certainly do not want to minimize the genuineness and thoughtfulness of such gestures and expressions of love. Those are the never-forgotten joys of practice. And so are the loyalty and trust we receive, the privilege to listen, and the opportunity to solve problems, all true gifts themselves. At my age of 66, and after nearly 38 years of practicing family medicine, I have had more than my share of expressions of appreciation. But to be honest, I would like to see primary care doctors mentioned more often in obituaries. Not as a perfunctory duty. Not as a matter of routine. But when it applies, when it captures a special relationship, when it seems like the right thing to do, when it fits. Not because we “deserve” it. But because, honestly, I think we doctors sometimes need it. We are human too. You see, I was genuinely touched by that obituary this week. It helped provide closure, as did the funeral, to a many-year relationship with a special person and family. It made me proud to do what I do. It was my patient telling me good-bye, and that she was grateful, and a reminder that gratitude, after all, is an important lesson to learn and express. So when I die, I hope my obituary adequately thanks my primary care doctor, among others who have cared for me, recently and in the past. And I hope my doctor reads it and knows they were appreciated, just as I experienced this week. Regardless of who they pull for during basketball season. To show I learned my lesson and show my gratitude to my patient and her family, I decided to wear a Carolina Blue tie to her funeral today. Yes, that was hard. But that’s what we primary care doctors do. And had it been my funeral, she would have worn a darker shade of blue to honor me. I know that. Because that is what gratitude looks like. Thomas Rhyne White is a family physician. Source
