Alumnus Encourages Students To Focus on Joy in Medicine

By Dirk Hoffman

Joseph Failla, MD ’82, a distinguished orthopedic hand surgeon in Michigan and an author, presented a talk titled “The Hippocratic Oath: Fostering Empathy, Joy and Purpose in Medicine” during a Nov. 19 event sponsored by the Medical Alumni Association (MAA) and the student-run Orthopaedic Interest Group.

The event was held on the second floor of the Jacobs School building in the Medical Alumni Association classroom, which is specifically designed for use as a setting for interaction between alumni and medical students.

Michael Freitas, MD ’10, clinical professor of orthopaedics and family medicine, and student liaison and board member of the MAA, introduced Failla, and noted that Transitioning into Physicians (TIPS), MAA’s mentoring program, was sponsoring the event.

“This program allows our alumni to share their unique experiences and impactful careers with our students and others who are interested.”

He noted Failla received his undergraduate degree from Johns Hopkins University before obtaining his medical degree from UB. Failla also completed his residency training at UB and a hand surgery fellowship at the Mayo Clinic Foundation before “building a renowned career in hand surgery.”

Failla has retired from clinical practice. Throughout his career, since 1990 until recently, he was deeply involved in the medical community, as a volunteer faculty member at Wayne State University School of Medicine, where he taught upper extremity anatomy to first-year medical students and hand surgery to orthopaedic surgery residents.

Freitas noted Failla has authored two books, including a novel, “The Oath,” that was the theme of the evening’s lecture.

“It talks about the importance of finding fulfillment in your professional lives,” Freitas said. “So don’t forget about the patient who is attached to the body part you are taking care of and don’t forget the body part of you who is helping to take care of the patient.”

Failla said he had many fond memories of Buffalo and enjoyed the time he spent studying at UB. He even joked he brought home “a souvenir from Buffalo” — his wife, Amy, who he met as a medical student.

Failla said it was the golden age of orthopaedics in Buffalo when he was an orthopaedic surgery resident.

“There were only four of us. Our leader was Eugene Mindell, MD, a world-renowned tumor surgeon. He nurtured us and taught us everything,” he said. “People knew when you graduated Buffalo orthopaedics, that you could cut, and you could think. You basically could take your oral boards the day you graduated. That’s how amazing it was here.”

Failla said medical students would do well to adhere to the values of the Hippocratic Oath.

“The Hippocratic Oath is an ideal and the reality of life just slams into it and tries to change it and break it,” Failla said. “The reality is all the tough stuff you have to do with your patients and all the hard work you have to do staying late at night, and you tend to start getting a little jaded. But if you listen to the Oath, that will keep your thoughts pure and make you have that burning desire to stay happy in medicine.”

“I kept my optimism even though I saw the realest of the real in my practice — inner city medicine, gunshots, knife wounds, infections and tertiary problems. And I loved that because it was challenging, this is why I did my hand fellowship,” he added. “But it can get you down, so the way I stayed optimistic is by trying to live the Oath every day.”

Failla noted that oftentimes people decide to become doctors because of an experience with an illness or an injury.

“I broke my forearm when I was 12. I hit a triple with my forearm — with my radius — instead of the bat,” he recalled. “That is how I met my child orthopedist, who became the one who inspired me.”

“If you had some problem in your life or some pain you dealt with and then decided you wanted to become a doctor so you could help other people with that pain not have it — that’s called empathy and that is the best reason to become a doctor.”

Failla said the idea for his novel, “The Oath,” was inspired by an essay he wrote called “Beautiful Ellie” for the UB alumni magazine in 2005.

“It was based on a patient I took care of when I was chief resident at Buffalo General. She was beautiful even though her hair was a mess, and she was all disheveled. She would not talk, would not move, and would not even roll over in bed.”

Other residents had examined her, but no one knew what to do with her, Failla said.

He decided to conduct his own examination and the first thing he noticed was her shins were all red and inflamed with deep gouges.

Failla found that her toenails were horribly deformed and overgrown.

“Every time she moved in bed, she would scratch herself and she was in horrible pain,” he said.

After getting her some new clothes, a new hairstyle and clipping her toenails, the transformation in Ellie was remarkable, Failla says.

“How did I figure out what was wrong? I thought out of the box. It wasn’t her hip, it was the two points farthest away from her hip, her head and her toes,” he said. “Sometimes you do not even have to be a doctor, you just have to be a human being.”

Encountering similar instances in his medical training, Failla thought perhaps he could string them together and talk about the Hippocratic Oath as a guiding principle for physicians.

“Because when I realized that Ellie had lost her dignity and self-esteem, the first thing I will tell you about the Hippocratic Oath is it says: ‘I will practice my profession with conscience and dignity.’”

“Dignity is what we gave her back and that was the key element to her getting better — not medication and not physical therapy. It was dignity.”

For his novel, Failla created a fictional medical intern’s first day on the job in a hospital and detailed how he learned the Hippocratic Oath in 24 hours because he had never learned it in medical school.

Failla urged the medical students not to make that same mistake.

“Learn and live the Hippocratic Oath now; do not wait until your last day of medical school to learn it.”

In the novel, Hippocrates appears as a ghost to guide the intern through the day.

“He teaches the intern the only way to survive this coming ordeal of the next 24 hours when medical training is trying to crush his spirit is to be a good and empathetic doctor who is following his Oath,” Failla said.

“These days with electronic medical records, I know it is hard to look a patient in the eye and feel what they are feeling, but you must do it. You must look up from that computer screen.”

Failla said the first step toward empathy is being nice to others.

“Slow down, have situational awareness, be kind to others without being asked,” he advised.

Failla also told the medical students it is important to maintain a healthy work-life balance.

“It is good to have other interests outside of medicine. Those other interests make you who you are. They give you joy,” he said. “The only way to be a good doctor is to be joyful and happy, so pursue those other interests.”

Failla noted that Hippocrates asks students in the Oath to commit to the following: “I will not permit consideration of religion, nationality, race or politics or social standing to intervene between my duty and my patient.”

“That is just being nice. You are just going to treat everybody equally. They are a patient that needs you. Disease is the great equalizer,” Failla said.

Failla noted the three E’s of empathy, equanimity and ethics should be the bedrock of a physician’s life.

“Ethics is a system of morality, a guide on how to become a good doctor. Does that sound familiar? What is the best guide? The Hippocratic Oath is a recipe for being a good, empathetic and happy doctor,” he said.

Another line from the Oath: “I will respect the secrets that patients confide in me.”

“That is part of ethics. We are fortunate to live in a highly technological society, but empathy for patients will always improve our medical care and help us to do the right thing,” Failla said.

“Learn to be good and empathetic doctors at this great medical school. You are very privileged to be here,” he told the students. “Then go out in the world, help people, and spread the medical joy guided by the Hippocratic Oath.”

“Realize that medicine gives you much more than a living; it turns your purpose into your joy,” Failla said.

Failla concluded his talk by reciting the final lines of the Hippocratic Oath.

“I know that if I carry it out, I may gain forever a reputation among all people for my life and for my art, but if I transgress it and forswear myself, the opposite will befall me.”