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toms of depression to their physi- quences, particularly for vulnera- But as a group, doctors can advo-
cians in the first place. ble employees. Notably, wellness cate for policies that protect pa-
Incursions on the doctor– programs can save money for em- tients, the medical profession,
patient relationship could be jus- ployers even if employee health and the relationship between the
tified if they produced sufficient does not improve, simply by shift- two. In the absence of compelling
benefits to patients or to society ing more health care costs to less evidence that incentive-based well-
at large. In theory, wellness pro- healthy employees. Since low- ness programs improve employee
grams use financial penalties not income employees are more likely health, I would urge physicians
to punish unhealthy employees to have the conditions that well- to oppose arrangements in which
but to encourage them to adopt ness programs target, these pro- the penalty for poor health is re-
behaviors that will improve their grams may increase insurance duced access to health care.
health — behaviors many em- costs for the people who can least Disclosure forms provided by the author
ployees may want to adopt but afford them. are available at NEJM.org.
in the emergency department be- Once I opened the door, though, could not find in the evidence-
cause her family found her to be I found Ms. W.’s family entirely based medicine we practiced. I
drowsy. A CT scan of her brain supportive and understanding of found that the question that I’d
showed a severe bleed. She spent the care we’d provided. They asked been carrying around since my
a few days in the ICU and then about my training and my plans first day of residency could work
was moved to hospice. and we talked about their kids, another type of transformation:
Before Ms. W. died, I went to while my patient, their mom, it helped my patients see the per-
visit her. As a trainee, I had viewed rested under a pink-and-white son behind the white coat.
It is easy to lose sight of your-
self during residency, as you en-
It led to a transformation I did not dure the countless hours spent in
windowless rooms entering data in
fully appreciate at the time: there was electronic medical records or com-
an actual person behind that pleting administrative tasks or jug-
gling a dozen other competing
hospital-issued gown. priorities. But if I may offer one
piece of advice to my new col-
leagues who don a long white coat
hospice as medicine’s kryptonite: checkered blanket in the bed be- for the first time each July: Make
our powers were no good there. side us. sure to get the name of the dog.
I stood outside her room having I stepped out of that room
Names and identifying characteristics
a staring contest with the closed and took a breath — something have been changed to protect the privacy of
wooden door, unable to command I realized I hadn’t done since I patients and dogs.
my hand to grasp the doorknob. first scrolled through Ms. W.’s Disclosure forms provided by the author
are available at NEJM.org.
What would her family think of CT images. Hospice provided
the decisions we’d made? What some comfort to her family that From Baylor University Medical Center, Dallas.
did I think of them myself, given I had not thought possible, and DOI: 10.1056/NEJMp1806388
how things had worked out? they provided me a comfort I Copyright © 2018 Massachusetts Medical Society.
The Name of the Dog