My credo: K.nowledge I.ntegrity R.espect E.mpathy

June 15, 2007

A medical mishap early in her career taught this internist that the Hippocratic oath isn't always enough.

We all take the oath, "First, do no harm" at medical school graduation. Over my career, I've also molded my own credo-KIRE (Knowledge, Integrity, Respect, and Empathy).

I developed the KIRE credo 12 years ago, after a patient event that's forever etched in my mind. I had moved to a new city to join a well-established group of internists. Relatively fresh from residency, I was eager to show my new partners my wealth of knowledge.

Six months into my new job, a middle-aged woman came to see me for a large knee effusion. After examining her and determining she would benefit from a therapeutic tap, I explained the procedure to her and obtained a signed consent. I prepped the site sterilely, and quite easily withdrew 40 cc of clear effusion. I was extremely pleased with my "slick" technique, and I even bragged to one of my partners.

My mind was racing. Did I permanently damage her joint? What should I tell her? Will I get sued? Will my new partners question their decision to hire me? I took a deep breath and looked into the patient's eyes and knew what I had to do.

I sat the patient up and called her daughter into the room. I told them I believed I had contaminated her knee on the tap two days earlier. She would probably need to have surgery. I braced for the accusations. Instead, her daughter merely looked at me and waited for me to continue. I told them I sent the tube down for a stat cell count, and I was going to call one of the premier knee orthopedists in the city.

I paged the orthopedist. I told him about the prior tap and today's appearance of the effusion. Then I ended the conversation with, "I told the patient that I most likely caused her infection due to contamination of the sterile field." The other end of the phone went silent. I don't know if the orthopedist thought me a fool or respected me for my candor. But he promised to get her into the OR within the next few hours to irrigate her knee.

I told the patient and her daughter the plan, and to my great surprise, they thanked me as they left. Still, I slept poorly that night, worrying mostly about the patient but also about the impending call from a malpractice attorney.

The orthopedist called me the next day. Fortunately, after irrigation and antibiotics, the patient's knee was recovering beautifully. The woman is my patient to this day.

This began my formula for the KIRE principle. I believe we should maintain a high level of integrity and respect in the exam room. I learned it's not the "slickness" of technique, but the overall quality of care (knowledge) and compassion (empathy) that define a good physician. This is the true backbone of the doctor-patient relationship, and the KIRE credo has become an integral part of my daily routine.