Down at the Docks
Adam Possner's desire to better know his patients leads physicians to Baltimore's shipyards.
Date: October 1, 2010
Cardiologist Sheldon Gottlieb has treated patients who load and unload ships, drive heavy equipment at the docks, and monitor the flow of cargo through one of the nation’s busiest ports. Over the years, he has often wondered about the world framed by the tall, elegant cranes he can see from his hilltop Bayview office.
But it wasn’t until he visited Seagirt and Dundalk marine terminals last spring that the physician actually observed the work conditions of longshoremen and also gained a sense of their challenging schedule. “I didn’t realize how intense the atmosphere was … how relentless the pace of the work is.”
Gottlieb was one of roughly 30 Hopkins physicians on a rare guided tour of the two Port of Baltimore terminals only three miles from their offices. Organized by Adam Possner, one of the chief residents of Johns Hopkins Bayview Medical Center’s internal medicine residency program, the two-hour journey brought the providers into a striking industrial landscape. For academics increasingly used to iPhone-size tasks, the outing was a powerful reminder of the satisfactions and stresses of physical labor. You might also consider it a preliminary step in the medical history-taking of an entire community.
“Mostly patients come to us and everything revolves around us and our exam rooms,” says Possner. “This way you can see where someone works, which helps you empathize and connect more deeply with them.”
Eager to learn more about the lives of his patients, Adam Possner began investigating industrial areas of Dundalk as a first-year resident. With the support of David Hellmann, vice dean and chair of medicine at Bayview, Possner organized the first Hopkins group tour at the steel mill at Sparrows Point two years ago. Hellmann says such outings embody medical pioneer William Osler’s belief that “it is much more important to know what sort of patient has a disease than what sort of a disease a patient has.
“Certainly one of the best ways to get to know the patient as a person is to visit where he or she works,” he points out.
Shel Gottlieb used his new knowledge recently when treating a 350-pound worker admitted to Bayview for “sky-high” blood pressure and heart failure. The 27-year-old man told the cardiologist that he worked part time driving cars on and off ships.
“Oh, you mean the Ro-Ro ships?” Gottlieb asked, using port slang for the vessels that carry wheeled cargo.
“He gave me this big smile, like a kid who’d been recognized for doing something special,” the doctor recalls. Before long, they were discussing various aspects of his work and reasons behind the large amount of weight the patient had gained in only one year. The young man said that because of his low seniority in the union, he never knew when he’d be called in to work and that the lack of control over his schedule was stressful. He also told the doctor about other difficulties, such as snoring and fitful sleeping.
“We were able to have a very real, fluid conversation about things he wouldn’t ordinarily have mentioned to me,” Gottlieb says. “In this case, he knew that I understood what he was all about.”