A Life’s Work in Electrophysiology: An Interview with Blair P. Grubb, MD

Dr. Blair Grubb is the Director of Electro-physiology Services at The University of Toledo Medical Center in Ohio. In this special feature, we talk with Dr. Grubb about his career in EP. You’ve been writing about your experiences with patients for some time now in the Musings section of PACE. What patient has had the most profound effect on you thus far? Tell us about that patient. The first piece I wrote, entitled “It Should Once Again See Light,” was published in 1996 for the Annals of Internal Medicine. This case had a very profound effect on me. In the story I describe how I had helped collaborate with physicians in France on the care of a child there who developed one of the autonomic syndromes in my areas of expertise. With treatment, the child ultimately got better, and when I later traveled to France in 1996 for the Cardiostim meeting, I visited the grandparents of the child who I had helped treat. After dinner with them, the child’s grandmother, learning I was Jewish, presented me with a gift — it was a menorah that she had rescued during the Holocaust. This profoundly affected me. Indeed to this day I truly have trouble telling this story. What prompted you to begin to write? Knowing I often had trouble telling that particular story, one day my wife said to me, “Why don’t you write it down?” So I did, and I sent that first story to the Annals of Internal Medicine. Usually it takes awhile to hear something back from them, but the editors there called within the week and told me they wanted to publish my story! They timed publication of the story so that it came out the first night of Hanukkah in 1996. Next I wrote a piece called “Awakening,” about my experiences with a patient who had been one of the lawyers for the Nuremberg trials. This was published as well in the Annals of Internal Medicine. I later entered a writing contest and won a trip to England. Around that time, a colleague asked me if I’d like to head a section in PACE that was similar to JAMA’s “A Piece of My Mind” section or “On Being a Doctor” in the Annals of Internal Medicine. I thought to myself, “I could do that; I could be an editor and read other people’s work. It shouldn’t be too hard.” He said, “Well actually, there is nobody sending anything in, so you’re going to have to fill it up!” I began to worry what I was going to write about. Well, in rapid sequence, many personal hardships began happening in my life, so I knew I’d have plenty to write about! In your story “A Blessing on the Moon,” you write of your own experience as a cardiac patient. You are one of the few people who have been able to see things from the opposite perspective. What can you tell us about your experience? I believe physicians are in a unique position in American society today in that they have become the new priesthood in a way, in the priesthood of health. There is perhaps no profession now where you interact more profoundly in the lives of people — maybe psychology as well, but not in the same way — because while the clergy has possibly diminished in its importance, medicine has continued to increase in importance. However, these days we don’t train healers, we train biomedical technicians. When interacting with patients, doctors more often treat the illness, not the patient. One can take issue with that statement, but I’ve been on the other side of that, as a patient, several times due to personal health issues. I’ve experienced both sides of the care continuum, and while I’ve met some very compassionate physicians, I’ve also met some physicians who were basically just technicians with no personal interactive skills. It’s odd, because even though we can accomplish more in medicine today than we’ve ever done, patient satisfaction is progressively declining. It is estimated that the average doctor spends only 7 minutes with a patient — I find that horrifying and refuse to do it. When you’re that rushed, not only does the patient lose out, but the physician loses out too. One of the most worthwhile aspects of my career has been my ability to interact with other people and my ability to share in their lives. I’m not advocating being touchy-feely at the expense of being technically competent. Rather, while we don’t want to surrender medicine’s newfound ability to treat patients, at the same time I don’t think we should lose some of the traditional aspects of medicine and the traditional aspects of a healer. In the past, physicians managed to help people get better, and much of it was their attitude toward patients and the trust their patients had in them. I try to communicate what it can be like if you allow yourself this patient encounter. What are your suggestions for instilling a healthy and open patient/doctor relationship? Listen to what your patients have to say. Studies show doctors interrupt patients every 2 minutes. A physician will start to talk because they just want to get done and get to the next patient. If I have to do that, I’ll get another career. You have to realize the patients I see are the ones that no one else in the country likes to see — the people who are refractory. I have found that people always want to tell their story — the story is an essential unit of all of our lives. What is the history of the present illness? It’s the story of their illness. It’s a story of what happened to them. We need to take the time to listen to our patients, and we need to take the time to explain to them, in a language they understand, what’s going on. What is important to remember about being in the medical profession in general? Do you have a favorite piece of advice for those in the field? It is important to remember that all physicians will one day be patients. Someday, they will be on that other end. I truly believe that what goes around, comes around. Did you ever see the movie “The Doctor” with William Hurt? That movie illustrates my point exactly. U.S. News & World Report recently published their annual “best hospitals” issue, and one of the new advancements mentioned was robotic medicine. The technology is basically a robot with a TV screen and a doctor’s face on it, and that is how they are saying the future of medicine will be — you won’t even see a real doctor in person! You may not be aware of this fact, but physicians in America also have the highest suicide rate — 400 doctors kill themselves every year. Also in America, physicians have the highest divorce rate, highest rate of alcoholism, and the highest substance abuse rate. I cannot help but believe it is the lack of human contact that does this. If we overmechanize medicine, if we become increasingly emotionally detached from the people we treat, it can have a profoundly negative effect not only upon patients but upon ourselves. Tell us about your involvement with the Chicken Soup for the Soul books. Which stories did you contribute? The editors at Chicken Soup for the Soul approached me about reprinting a previously published story of mine for one of their new Chicken Soup books. They also asked me if I would write an original piece for them. I agreed. “It Should Once Again See Light” and “Awakening” were published in the Chicken Soup for the Jewish Soul; I also published a piece called “The Accident” for the Chicken Soup for the Soul: Living Catholic Faith. Five of my stories, including “The Just,” “Tikkun Olam,” “Washing the Body,” “The Accident,” and “Driving Elijah,” were published in the book Jewish Stories from Heaven and Earth, which was essentially a sequel to Chicken Soup for the Jewish Soul.