President's Message - Service

Thomas G. Peters, M.D.

Webster's Seventh New Collegiate Dictionary defines service, in part, as contribution to the welfare of others, a helpful act, useful labor that does not produce a tangible commodity, and providing maintenance and repair. Service is a word which has, I believe, probably become more widespread in the last several decades. It is common to hear the term: service industry. The word is used as a verb: to service (as in automobile maintenance). But I learned service in medical school, and that story follows.

In 1969, my third year at the University of Cincinnati College of Medicine, the surgery rotation included a four-week stint at Holmes Hospital, the faculty private practice venue. Along with a second year surgical resident, two junior medical students managed the inpatient service (there is that word!). We were expected to do the usual patient history and physical examination (hand written), routine ward (all private rooms) tasks, and daily rounds, as well as to assist in the operating room. All physicians can recall their lot as a medical student, and part of the package is the gruff, older, unapproachable attending - especially if a surgeon. Most of my fellow students thought that Dr. Vinton "Hoppy" Siler was such a man. A superbly trained general surgeon, with a hobby of hand surgery, he used to say such things as, "The hand is the most important organ in the body. Are you with me or against me?" Daunting for a medical student who didn't know the man. I did know him, because he had operated upon me for a neck mass a year before. Therefore, I had seen Dr. Siler in the context of the doctor-patient relationship. I was neither frightened nor in awe of him. I did not like his seemingly endless surgical procedures, but must look back as a now mature surgeon and surmise that his meticulous technique surely led to better outcomes.

One morning, the usual medical student and house officer duties having been completed, Dr. Siler notified the surgical resident that he wanted to make rounds. The other student and I were instructed to tag along, and we came to the first room. The patient was a woman with diverticulitis of the colon which had required several operations, all done by Dr. Siler. He knew this patient well, and we all paused outside the door. He looked up at the resident (Dr. Siler was of short and somewhat rotund stature) and said, "Doctor, do you know what it is to give service?" Silence. Looking directly at the resident, Dr. Siler simply said, "You come into this room with me. I'm going to care for this patient. I'm going to show you what service is."

Unbelievable! I truly did not know what to think. This stunning moment on an otherwise ordinary weekday morning was baffling in several ways. We had already made rounds before Dr. Siler came to the ward. The patient's needs were largely attended to, or so I thought. She was actually doing well, and my sense was that the surgical resident would have said so to Dr. Siler if given a chance. I could not have been prepared for what thereafter transpired, even having been cared for as a surgical patient by Dr. Siler.

On entering the patient room, Dr. Siler's demeanor was fully professional, positive, cheerful, and reassuring. After pleasant small talk, Dr. Siler indicated that he wanted to inspect the surgical wound. As I recall, we had already changed the dressing, and there was nothing in particular notable about the healing process in this case. Nonetheless, maintaining suitable respect for the patient's modesty and comfort at all times, Dr. Siler gently removed the dressing we had placed earlier. Looking at the wound and touching gently he explained to the patient what was going on just beneath those black silk sutures. No doubt, he had given this layman's lesson in wound healing many times, but the patient was not only attentive but clearly appreciative for this information. Then, using appropriate dressings and other materials, Dr. Siler placed a small amount of liquid soap on a swab and cleansed the wound, thereafter gently rinsing with a moist sterile swab then placing a new dressing and tape. He then asked the patient, "Are your needs being met?" She indicated that her needs were being met and that she believed that all was progressing nicely. Final courtesies were exchanged and we left the room.

Hoppy Siler looked up at the surgical resident and at both of us students. "That's how you give service, and don't you forget it," he said.

In many ways, service is what we do each day. We are not a service industry. We do not manufacture, market, and sell a service. What doctors do is give service in the course of day-to-day patient care. They may "serve" in so many other capacities in the office, hospital, and community. But giving service, like Hoppy Siler did, is tending to the patient and inquiring about unmet needs. It is what we do, and a finer task may not fall to any. And, as with most gifts, rendering service comes back to us many fold. There are days that Hoppy Siler's lesson about giving service keeps me going. I suspect it's the same for other doctors, too.

June/July, 2002/ Jacksonville Medicine