Third, laughter is important. The best physicians that I've known have a sense of humor about themselves, their patients and the world around them. Voltaire, who ironically satirized the philosophy of optimism, said, "The art of medicine consists in amusing the patient while nature cures the disease."
Fourth, I've found listening is a skill you acquire with time and you can learn a great deal about the nature of human disease by listening. Your skill as a physician is often more revealed by the time you spend with patients trying to understanding their illnesses than by treating each laboratory abnormality. A studious physician can learn to fix an internal combustion engine; a smart physician can teach a Bushman how to fix an internal combustion engine; a smarter physician can learn from the Bushman how to survive in the Kalahari Desert.
Fifth, as trite as it may seem, disease is not just a collection of diagnoses that afflict us. Disease alters us physically and emotionally. "The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated." (Plato) Dr. Harvey Laub recently shared from his poignant journal his thoughts about having Stage 4 lung cancer. One line stood out to me: "Remember to help your patients with fear; it's as real and as harmful as the aforementioned medical diagnosis."
Last, what I have come to understand most is that patients are the ones with the disease. They have the right to place limits, great or small, on their care. Dialysis-dependent kidney failure is multi-organ damage, but it is equally as much daily limitations on diet and activity that can sap joy fromthe patient. Nephrologists focus as much on numbers as anyone, but focus too much and the patient is left with despair. I remember one patient who was losing weight and seemed depressed. When I spoke with him about the change, he expressed frustration that he could no longer eat what he enjoyed. You see, he was a "black man from the South, and he was raised on pinto beans and cornbread." So, I let him occasionally have pinto beans and cornbread. Yes, occasionally his serum phosphate was higher than the "target value," but he gained weight, felt better and had many years thereafter with his devoted family and friends. I think I'll write a book: Cornbread and Pinto Beans for the Soul.