My internal medicine attending asked me a flattering question today: she wanted to know how I got my patients to like me so quickly. I told her that I must have learned it by epigenetic osmosis from my mother, who has been a charismatic woman for decades straight, and still going strong. She probed further, “Some people do not come by this skill naturally. If you were to teach what it is specifically that you do to build quick rapport with your patients, how would you design your lesson?
A fascinating prompt. So, this is my secret, and not just for the doctor-patient relationship, but for life:
I would suggest a lengthy syllabus of novels. Lifelong regular reading of long novels. Perhaps Thomas Mann’s The Magic Mountain to start. Then Dostoyevski. Then anything by Chekov. In addition to that, I make two simple decisions, daily.
1. Before we meet, I have already decided, irrevocably, that I’m going to like you. And this isn’t a Minnesota Nice thing or the Southern Gentility smarmy I’m-going-to-pretend-to-like-you-but-really-I-can’t-stand-you. In sincerity, my eyes are bright with the thought of you before we’ve met because all humans deserve proper welcome. I have learned from reading novels that ALL characters have some fascinating aspect that can, with careful observation and moral imagination, endear them to their reader. So, upon greeting, my first few seconds will be spent gathering likeable facts and features about you, in the same way that I, as a writer, might search for distilling details to portray you as protagonist. I am looking for that very specific feature that will solidify you in my mind as a fellow human being who has the same core emotions as I do; who, like me, wants to feel loved, wants to be heard, and wants to belong to something greater than themselves, but who has their own take on the world, their own strange and alluring personal flair—and when I discern that delicious idiosyncrasy that, at least in my mind, makes you a lovable protagonist, this discovery will serve to reinforce the second important thing I have already decided about you:
2. We are now family. It is my personal sensibility to treat you like I would my own family member. I will internalize your concerns as I would take to heart those of my mother, my brother, my aunts and cousins. This decision of kinship changes everything. Patient given verisimilitude to family transforms work into quality time. No longer do I “go to work” or show up to “do a job” or “give a performance” –what I do is spend time with loved ones and make sure they are well cared for. What a privilege to do this for a living!
These attitudes, which are simple decisions fundamentally (and therein the lesson), can turn any office into a hearth—can make any hospital hospit-able. I think patients can tell instinctively that I like them, and, curiously, that I’ve always liked them. If you had a good mother or father, I imagine an encounter with the ease of automatic approval is much like the consoling hunch you must have had as a child, the hunch that this parent has always loved me, and that their always-love comes from a deeper well of care and affection that goes beyond mere habitation within them, an always-love that transcends the fickleness of feeling, and that the locus for this goodness remains mysteriously elsewhere. Perhaps life is a long lesson in learning to turn to face this goodness so as to feel its endless warmth, and radiate some of it ourselves in passing. Some sort of cosmic goodness here. Affection as reflex being something like the cornerstone of human decency—this is my secret.
Perhaps you are wondering what all of this has to do with tomatoes and bread. Well, it’s hard not to like tomatoes. And breaking bread together is an automatic family-making sort of activity.
Pane al Pomodoro (Tomato Bread)
Adapted from The Italian Baker
1 clove garlic, minced
2 tablespoons finely chopped shallot
2 tablespoon oil from oil-packed sun-dried tomatoes
1 cup sourdough starter
1 cup water, at room temperature
1/3 cup to 1/2 cup coarsely chopped sun-dried tomatoes packed in oil
3 3/4 cups unbleached all-purpose flour
2 teaspoons salt
1 large egg white, beaten, for glazing
Lightly saute the garlic and shallot in the oil; let cool to room temperature.
To mix by hand: Stir sourdough starter into the 1 cup of water and the garlic and onion with the oil; then stir in the tomatoes. Mix the flour and salt and stir 1 cup at a time into the yeast mixture. Knead on a lightly floured surface, sprinkling with 2 to 3 tablespoons of additional flour as needed, until the dough is soft, velvety, and slightly moist, 8 to 10 minutes.
First Rise: Place dough in a lightly oiled bowl, cover with plastic wrap, and let rise until doubled, about 1 hour.
Shaping and Second Rise: Punch the dough down on a lightly floured surface and knead briefly. Shape the dough into a ball. Place on a lightly oiled baking sheet or a peel sprinkled with flour, cover with a towel, and let rise until doubled, about 45 to 55 minutes.
Baking: Preheat oven to 425 degrees. If you are using a baking stone, turn the oven on 30 minutes before baking and sprinkle the stone with cornmeal just before sliding the loaf onto it. Make three parallel slashes on top of the loaf with a razor. Brush top with egg white. Bake 10 minutes, spraying the oven three times with water. Reduce heat to 375 degrees and bake 25 to 30 minutes longer. Cool completely on a rack.
One other secret, as an aside: I try to talk to my patients about food routinely. Not diet scolding, but about tantalizing things one might do with an eggplant or cauliflower for example. For some reason, talking about food seems to make everyone a little happier–food thoughts snuggle up to a dense emotional center in the brain– and perhaps the next time they see me there will be something like a full-body Pavlovian response, but with happiness, not drool.