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Join us for a conversation with Fazlur Rahman, a hematology-oncology physician and author of Our Connected Lives. In this episode, we explore how Fazlur’s journey from physician to patient transformed his understanding of empathy. He reflects on the importance of personal connection in medicine, the impact of a lack of empathy on both doctors and patients, and the need for medical education to include the humanities to foster compassionate care. This episode dives deep into the role empathy plays in improving patient outcomes and doctor-patient relationships.
Fazlur Rahman is a hematology-oncology physician and author of Our Connected Lives.
He discusses the KevinMD article, “From doctor to patient: a life-changing lesson in empathy.”
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Fazlur Rahman. He’s a hematology oncology physician. His KevinMD article is an excerpt from his book Our Connected Lives. The excerpt is titled “From Doctor to Patient: A Life Changing Lesson in Empathy.” Fazlur, welcome to the show.
Fazlur Rahman: Thank you. Thank you for having me, Kevin.
Kevin Pho: So, before we talk about your book and article, just briefly share your story and journey.
Fazlur Rahman: Well, I was born in what is now Bangladesh, and, you know, I had all kinds of trouble, like so many other people at the time. I was trained in Dhaka, and then I came to New York 55 years ago as a young man and trained at Long Island Jewish Hospital and Queens General Hospital.
That’s where I did my internship. We did internships in those days, internship and junior residency. After that, I came to Baylor College of Medicine in Houston, where I completed my senior residency and fellowship. After the fellowship, I had to decide what to do in my life. Due to circumstances, I wanted to be in academics, so I came to West Texas. You could say it was either a choice or acquired fate, and it worked out well with the help of my wife, R.I.A.R.A.
Over the years, I practiced cancer medicine, hematology, and oncology for 35 years. In between, I wrote my views on what I saw as a physician and what I observed about medical ethics, bedside medicine, IVF, CPR, and some of the most significant papers in the world. These include The Guardian Weekly, The New York Times, The Wall Street Journal, Christian Science Monitor, and Newsweek, among others. I also wrote personal essays, like those in the Harvard Review.
These writings were to express my own feelings and what I learned from my patients, along with my experiences. All these things were done in between my practice. I wrote two books; this is the second one. The first one, The Temple Road: A Doctor’s Journey, is about my growing up. The second one is about the stories of my patients, what I learned from them, how they dealt with me, and how I dealt with them. Each patient in the book makes a point. That summarizes my life.
Kevin Pho: Your latest book is titled Our Connected Lives, and you shared an excerpt from it titled “From Doctor to Patient: A Life Changing Lesson in Empathy.” For those who haven’t read your excerpt, can you tell us what this particular story is about?
Fazlur Rahman: The story is about how, as an internist, you understand taking care of patients. One thing I like about your podcast is that many policy makers are not as patient-oriented but more business-oriented. You understand this.
After practicing for 35 years, I had a hiking accident and fractured my right ankle badly, requiring detailed surgery. I recall a paraphrased quote by Susan Sontag: when you are born, you are born with two citizenships—the citizenship of the well and the citizenship of the sick. Suddenly, I shifted from the citizenship of the well to that of the sick.
I thought I knew quite a bit about empathy after practicing for so many years and reading about it, but I did not fully understand it until I became a patient. I didn’t comprehend the depth of it—how essential it is to understand a patient’s anguish, difficulties, and inner struggles. That was the basis for writing the article, which is a chapter of my book titled “Empathy Matters in Medicine.”
Kevin Pho: You mentioned that when you became a patient and had to undergo a procedure to fix your ankle, you were surprised by how important empathy was, even though you are a cancer physician yourself. What exactly surprised you?
Fazlur Rahman: The point is that science is the basis of medicine, but science alone cannot solve everything. You can’t feel a person’s anguish or their difficulties through science alone. The surgeon who treated me saw me as a technical challenge, which he successfully addressed. But is that enough? That’s the point.
It felt impersonal, as though I was just a case of a fractured ankle and not a person with a fracture. That realization probably prompted me to write this piece. It was surprising that, while he addressed the technical aspects of my care, there was a disconnect in recognizing the human being attached to that ankle.
Kevin Pho: What would you have liked to see from a patient’s standpoint? In an ideal world, what would you have liked from your orthopedic surgeon?
Fazlur Rahman: I would have liked the doctor to touch me, to touch my ankle, and to engage with me and listen to my concerns in detail. Even after surgery, a little more detailed follow-up would have been appreciated. I understand that no one has an endless amount of time; I was a busy physician too. But listening doesn’t take a lot of time. I would have liked him to spend a bit more time listening to my concerns.
The word “empathy” is often used now, but I’ve been writing about it for a long time, even before it became so prominent. I tell medical students and residents to read Ward No. 6, one of the best short stories I’ve encountered, about a doctor who becomes a patient in the same hospital ward and realizes how insensitive he was to his patients.
Fazlur Rahman: In Ward No. 6, the doctor, who was initially insensitive to his patients, ends up being treated the same way when he becomes a patient. While he’s on his deathbed, he reflects on how he ignored the needs of his patients for 20 years and wonders why he didn’t realize it sooner. It might sound philosophical, but the essence is this: taking time and showing genuine interest in the person, not just the disease, is crucial.
Kevin Pho: Why do you think doctors today are less empathetic compared to before? You’ve practiced for decades. Do you feel it’s more challenging for doctors now to show empathy to their patients?
Fazlur Rahman: Yes, absolutely. I’m retired now, but I can share my perspective. Back in our time, bedside medicine was very important. Today, while technology has improved patient care and quality of life, surveys still show that patients feel dissatisfied. About 70 percent of patients indicate that doctors don’t show personal touch as much anymore.
This change is partly our fault as doctors. We accepted every new demand placed on us without pushing back. During my time, hospital or clinic administrators worked with physicians for the sake of patient care. Now, many of my younger colleagues and friends face a different reality. Administrators run the show, setting quotas for the number of patients that must be seen and measuring productivity. These metrics can be manipulated to appear as if quality care is provided when it isn’t necessarily so.
Administrators push for high production and incentives. One of your recent guests talked about rewarding doctors who save money while delivering good care. While that idea has merit, it’s more complicated in practice because quality care criteria can be misrepresented to fit a particular narrative. The health care system has become very bureaucratic and administration-heavy, whether for-profit or nonprofit.
There was an article in The New York Times last year about a large hospital chain where the CEO was making a 1.2 million dollar salary while patients’ appointments and treatments were being cut due to outstanding bills. The profit motive has become a big issue, and it’s challenging to maintain a balance. Health care isn’t like Walmart; while some profit is necessary for growth and sustainability, excessive profit can be harmful. That excess profit motive has caused many of these issues.
Kevin Pho: You wrote in your excerpt that including humanities in medical education can nurture empathy. Can you elaborate on how the humanities can foster compassionate care?
Fazlur Rahman: Absolutely. While science is vital—you need CAT scans, MRIs, PET scans, and now AI—science alone won’t make you understand the patient’s emotional struggles. Humanities provide a different perspective. Reading stories like Ward No. 6 or poems like Raymond Carver’s What the Doctor Said can be eye-opening.
The humanities can make you realize that you, too, could be in the patient’s position. Arts, literature, and even visual arts can reveal what science cannot. With the current demands in medical school focusing on science, the inclusion of medical humanities is even more crucial. I worry that as technology and AI continue to advance, we may lose that human connection in medicine. Humanities can help maintain that connection.
One medical school I advise, the University of Texas at San Antonio Medical School, incorporates medical humanities effectively. Many medical schools are now including these aspects, but it should be more integral to the curriculum.
Kevin Pho: With the advent of technology, AI, and time constraints, how can doctors maintain empathy amid all these pressures? What are specific ways they can sustain empathetic care in today’s world?
Fazlur Rahman: That’s an excellent question, and there isn’t a simple answer. To start, we need legislative changes that address systemic issues in medicine. This can help provide doctors with more time to spend with their patients. Hospital administrators and policy makers need to understand that while this might sound idealistic, it’s essential for better patient care.
Medicine is still a noble profession where you can make a decent living while helping people. Few careers allow you to do this consistently. However, young medical students who enter the field are influenced by the hospital culture that prioritizes profits and productivity, which can shift their mindset.
Selecting the right kind of medical students who enter the field not just for prestige or money, but out of genuine care, is vital. Medicine, to me, was always a calling, not just a profession. I mention this in my book, Our Connected Lives, which details caring for cancer patients in rural Texas. Even though the patients were in rural areas, their suffering was the same as anyone else’s, only differing in the support they had.
Administrators and legislators need to rethink their approach, not solely relying on policies but also changing the mindset of the entire health care system. Training also plays an essential role. Good mentors and teachers can significantly impact medical students and residents. My mentor at Dhaka Medical College, Professor S. M. Bob, exemplified this. He believed that healing starts with a reassuring presence at the patient’s bedside and genuine empathy. While I didn’t always succeed in embodying this, it’s crucial for teachers to instill this mindset in future doctors.
Kevin Pho: You mentioned that you wrote for the Houston Chronicle addressing some of these issues years ago. Can you tell us more about that?
Fazlur Rahman: Yes, I wrote articles about these systemic issues, including one for the Houston Chronicle when the ACA debate was prominent. I’ve always believed that we need to train doctors properly, integrate the humanities, and reevaluate policies to ensure we prioritize patient care.
Fazlur Rahman: Training doctors with the right mindset is crucial. Including humanities in medical education, as I mentioned earlier, helps bridge the gap between medical science and the human experience. We need to remember that technology, AI, and bureaucracy should serve one purpose only: patient care. If we lose sight of that, we risk becoming disconnected from the very people we aim to help.
Kevin Pho: We’re talking to Fazlur Rahman, a hematology oncology physician and author of Our Connected Lives. We’re discussing an excerpt titled “From Doctor to Patient: A Life Changing Lesson in Empathy.” Fazlur, let’s end with some take-home messages for the KevinMD audience.
Fazlur Rahman: Thank you, Kevin. My take-home message for doctors, especially new ones and medical students, is to remember why you entered this profession. I encourage them to read Ward No. 6 and Raymond Carver’s poem What the Doctor Said to gain a deeper understanding of patients’ experiences. Always remember that all the technology, AI, and advancements we have are tools meant to serve patient care.
If you’re a patient, especially a cancer patient, try to go to your doctor’s appointment with your most pressing concerns written down—three key questions, for example. This helps focus the conversation, especially since doctors often have limited time. And for caregivers, please remember to take care of yourselves. You can’t help your loved ones effectively if you’re not well yourself.
Lastly, doctors should learn about end-of-life care. With the 85-plus age group being the fastest-growing demographic, we will increasingly need to understand and address end-of-life issues compassionately.
Kevin Pho: Fazlur, thank you so much for sharing your insight and perspective. Thanks again for coming on the show.
Fazlur Rahman: Thank you, Kevin. It was a pleasure.
