Medicine’s solemn moments

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Not so long ago, at the start of a trial I took part in, the opposing barrister was ruffling through his papers while my witness was swearing the oath: “I swear by almighty God that I will tell the truth [ruffling of papers] . . . the whole truth [more ruffling] . . .” At this point the judge, with a frown, told my opponent to stop at once.

I was surprised by this judicial rebuke. Many barristers, for whom the court procedure has become second nature, pay little attention during the swearing of the oath. They arrange their papers, or re-read key documents, or fill a glass of water.

Yet the judge was right. Swearing an oath is a solemn moment, and the lawyers in the courtroom should behave accordingly. Now, during the oath, I keep as still as a statue and look the witness in the eye.

The recent death of the surgeon and writer Richard Selzer1 prompted me to re-read some of his work. I came across an interview he gave to the writer Peter Josyph: “I was commencement speaker at Boston University a couple of years ago. As we stood to recite the oath, I looked at the graduates, and I saw a couple of them laughing and snickering during the administration of the oath. I was offended down to my toes by that. I couldn’t believe that anyone would be embarking upon this work and not be focused on the words of it.”2

There are events, such as the reciting of an oath, whose significance we may not fully appreciate until it is pointed out to us. The significance is lost through familiarity or lack of reflection.

More subtle examples of solemn moments exist in medicine. One is the signing of the consent form, an act so common that many doctors scarcely give it a thought. Yet for the patient it may be as rare as signing the register in a marriage ceremony. It is an expression of trust like no other.

When asking the patient to sign the consent form, the person seeking the consent should act in a way that reflects the significance of the act. In the moments between the invitation to sign and the signing itself there should be no joking, no talking, no fiddling with phones or bleeps. The doctor’s demeanour will signify to the patient that this is an important occasion in the sacred relationship between doctor and patient.

Undoubtedly there are other solemn moments in the course of interactions with patients in rounds or clinics that, through habit, gradually lose their significance to become quite ordinary. It may be the giving of a diagnosis or prognosis or a physical examination.

One of Selzer’s great contributions to medicine is showing us that these moments are more prevalent than we are aware of.