Wednesday, September 14, 2016


I get a fair number of emails from people asking me for advice on careers in medicine. I don't answer them often, because realistically I can't make those decisions for someone else. A career in this insane field, not to mention all its different branches, is a pretty personal choice.

A medical student, though, recently wrote and asked what one piece of advice I'd give anyone already in med school (besides "cut your losses and get the hell out"), so I thought about it.

Here it is:

Learn to tie shoes.

Yes, you read that correctly. That's my sage advice, for whatever it's worth, to all of you in training.

Now, I figure you already know how to tie your own shoes (although in the age of Velcro straps I could be wrong). What I'm talking about is tying someone elses shoes. This is a 180° reversed perspective of tying your own, and takes a little bit of getting used to, and not making them too tight.

During my 4th year of medical school I had a rotation where I was assigned to a family practice doc, just for his morning rounds at the hospital. I don't remember his name. He was in his mid-50's, and was always neatly dressed with a tan blazer. I'd meet him outside the doctor's lounge every morning and we'd see his hospital patients.

What always impressed me is how he knew his patients. Not just their medical stuff, but he'd often make comments like "she bakes the best sweet potato pie" or "he paints great landscapes." And his patients clearly adored him, too.

Anyway, the time we rounded was usually when breakfast was being brought around. Most docs I'd met would just ignore it, and have the food set aside until they were done talking to them.

But not this guy. He'd take the trays and help sit the patient up to have them. He'd ask what they liked in their coffee (though usually he already knew!). He'd open those little cardboard milk cartons (they can be tricky) and pour it in cups or on cereal. He peeled and cut up bananas for them.

And, if we happened to go in while they were getting ready to go home, he'd help them tie their shoes.

Although some may find this silly, I found it was a pretty important lesson. Letting your patients know you care about them goes beyond looking in ears and reviewing labs. It wasn't an act, this guy obviously just wanted to help them.

I typically don't round during meals, but I do tie shoes. Checking feet for atrophy, sensation, and reflexes are a big part of being a neurologist, so you end up with barefoot patients sitting on your exam table.

Younger people generally don't want help, but older people or those with physical limitations appreciate it. Helping them put on socks and tie their shoes may not seem like a lot... But it is. It's letting someone know you care about them, no matter how grody their toenails are.

Pro tip: always keep a shoe-horn handy.

No matter how far you go in medicine and life, never think that you're above helping another person put their shoes and socks on. You aren’t. And someday you may be in their position.


Orli said...

I thought my med-surg rotation discharges would be hard because I had to help people deal with their ostomy appliances and urinary catheters and learn how to help them put clothes on over and around them--that was the easy part! Getting some of my elderly clients' painful, frail feet into the correct positions for their shoes was much harder. I do wish we had a shoe horn.

Anonymous said...

Thank you Dr Grumpy. Helping a patient with their laces allows the patient to notice the balding spot on your own pate, and gives the patient a different perspective to your ministrations. As well.

Sometimes, it's the body language in those few seconds that speak louder than words. It elicits a complicity in a patient-physician relationship not described by words in a dictionary.

My spouse is not medically trained--an engineering and logical background which sometimes distorts the idea that people do not behave physiologically like pieces of machinery at a certain point. I try to explain medical issue and physiology to him with certain expectation that human beings are not robotic, but I think sometimes he thinks I'm making it all up, so it was very refreshing for me to hear the nurse taking care of our ill son the other day. She said, "it's difficult for you to understand this, but you are not medically trained, so let me give you an example..."

Anonymous said...

One of the most touching memories I have is when my sister and I accompanied our father to his last scheduled visit with the podiatrist. He'd had some calluses or plantar warts or something on the bottom of one of feet for a while she'd monitored periodically over the previous couple years and had made the six-month or one year check-up at the time of the previous appointment. In that time he'd been involved in a car accident with broken ribs and subsequently it was discovered that a rampaging pulmonary fibrosis side-effect of methotrexate emerged, requiring hospital visits, corticosteroids, and finally continuous oxygen which he'd adapted quickly for trips to the city pool using the disability transport, then finally stay at home oxygen therapy with bottles and tubing all over the house.

It was still early enough to hope for a miracle, or at least a few good months, but there was some question about getting out of the house in winter snowy conditions (that part doesn't stop Alaskans!) but, with the oxygen bottle, walker, etc need to use the restroom, and Pa was by this time walking around with lower than usual oxygen levels so was half of the time trying to remove the oxygen nasal prongs. Still, the podiatrist was a dear heart and examined his feet and helped him on with his socks, and the shearling slippers. Pa expressed his enthusiasm for another trip south for warmer weather (he had permission at this time to fly with oxygen), but it was a chance to express appreciation both for patient and doctor, and their farewells.

Anonymous said...

Thank you for this beautiful lesson. It echos one of my favorite quotes: "How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and strong. Because someday in your life you will have been all of these".

George Washington Carver

Stacey Gordon said...

Touching someone's feet goes a long way towards demonstrating that you are truly serving them. I know there are religious overtones to it as well, but kneeling before someone to assist them, brings you to their level. That goes a long way towards showing how much you really do care.
In Swahili, the word "Shikamoo" is used as a respectful way to greet an elder. It's literal translation is, "I hold your feet".
The response from the elder, is "Marhaba"-which is permission, as in, you are welcome to do so.

bobbie said...

No wonder you are such a good doctor! Beautiful post ~

Lizard said...


so true and so beautiful.

Clairesmum said...

The image of the Pope washing the feet of of poor people (homeless, prisoners, etc) on Holy Thursday speaks powerfully of dignity and service to others...and when you help someone to wash their feet or put on socks and shoes, you are demonstrating respect to the person.
On a less lofty note....nurses and nurses aides are the ones who most often help with bathing feet, socks and thank you, Dr Grumpy, for pitching in. I imagine nurses enjoy working with are kind to the patients....nurses know how much that matters.

Anonymous said...

Doc you sound like a really great person. Mrs. Grumpy and the kids are fortunate to be your family.

Anonymous said...

For some, practicing medicine is a career; your services will always be in demand and the pay steady. For others, medicine is a calling.

J said...

I wish I had gotten this advice years ago. I'm retired now (former xray tech) and I now see that I failed too many of my patients.

Brent said...

Great advice. Also good to keep a pair of toe nail shears on hand. For some patients this might be the only time they are able to get their nails trimmed. I've seem some doozies- and no joke-I wear safety glasses.

Kathy said...

Great post! Thanks!

BobF said...

At 71 I've had 5 spine surgeries, part of which have fused my lumbar plus 1 down and 2 up. Aero flexion now. Putting socks on and tying laces require lots of time and rather different positions. Stretching muscles isn't the answer -- its flat out stop points with the bone structure. You have no idea how much I would appreciate assistance with those two tasks -- I'm long over the embarrassment. Be the reason medical or just plain human caring, I'm glad to see you are doing it. To some it is not a trivial thing.

However, to make it easier on both of us I wear sandals to all medical appointments. I can do that year round here in central Florida. :-) Otherwise, I live in sneakers with Locl Laces

Anonymous said...

Excellent post, so true. The one Dr Ill remember was the one who told my dad, "I cant cure you, but I can make sure you see your daughter walk down the aisle and dance on her wedding day." He Knew what was important to my dad and even after he turnd his care over to a new dr still called to see how he was doing.

milford delaware said...

As a long time reader, one of your best posts. Thank you.

Ms. Donna said...

Thank you.

Me said...

It's usually the little things that mean the most (sounds like a familiar line in a TV commercial, doesn't it? 😄). Doctors can be intimidating and when one does something like you suggest, it brings humanity into the transaction.

Dr. Grumpy, your patients are so fortunate to have you. I hope you receive the appreciation you deserve.

bunkywise said...

You were so fortunate to have had that doctor teach you that lesson and your patients are even more fortunate that you learned from it and live it every day. There is something that has always spoken to me about helping and protecting the very young and the very old...they are equally vulnerable.

Bonnie said...

When my doctor works on my feet she sits on the floor. Says she's likes that & it's more comfortable for her patients. I really like her!

I wish the various health care people would have been as helpful when I was having problems with my back. At home, husband helped me with my socks & shoes, but at appointments getting them back on was a long & painful ordeal.

SwanSpirit said...

Many years ago , in Children's Orthopedic Hospital,and Center for Reconstructive Surgery, in Baltimore, there was an amazing surgeon named Kirby Von Kessler. He was a big shot, at Johns Hopkins, and at Children's. But sometimes late at night, he could be found tending to some of our most debilitated patients needs,like cutting their toenails, or helping them with their shoes.
He used to flirt with me, I was much younger then. I should have flirted back.

Old FoolRN said...

When I helped patients put their socks on I always rolled them up from the top to the toe (the socks- not the patient.) Patients were always impressed how easily they went on without all that tugging and pulling. I even taught them the rolling technique if they wer interested. It's always the little things that count the most.

Anonymous said...

I love this story, Dr G. (But, those are some UGLY looking shoes... .)

I was thinking about this the other day when I used one of several shoehorns near the back door at home. I'd told my co-workers that wearing lace-up shoes was my form of morning exercise, but truth be told, I often resort to use of a long-handled shoehorn.

Since I married my Japanese husband, we've always had shoehorns in the house, ranging from a green advertisement tchotchke to a sturdy steel one-piece. I remarked about the one I use most of the time. It's long-handled with a sheetmetal-stamp 'Made in Japan', and its textured black plastic handle has a plastic hanging loop above the stiff metal spring handle. I thought it looked tacky, but unlike any other similar product made here,

Hubby said there's a shoehorn industry in Japan, unlike here in the States and I considered the innovation that went into its design. There was a time, in American and Japanese postwar-recovery history when goods arrived here from Japan with an indifferent quality, however with a difference in necessity for use of shoehorns, there is probably more of a market and variety there.

Indeed. I noticed an ad for a standing horn with its own holder of a design crafted in the hardwood of one's choice. I imagine with the aging of the population there will be a robotic version none too far away in the offing. With the personability of Japanese culture, it would probably glow in the dark or wish you a 'good day'.

Veronica Reilly said...

How touching. The only doctor I ever had put my shoes on and tie them was my podiatrist and since I'm not yet 50, I felt it was very thoughtful.

matt johnson said...

Thank you for posting this. I am currently in a clinical rotation and have been called: young, naive, and other such things for just performing what I consider to be deeds that acknowledge that the patient I am dealing with is a real human being. I am glad to know that an experienced Doctor (or yak herder) still believes in treating all patients with respect.

Wire said...

I teared up. Thank you.

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