The soul of our vocation is to heal our patients

As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could only heal them to a limited degree. My team would encourage me to use diagnostic data to uncover why the patients were ill, and they taught me to use the appropriate treatments based only on this information. The patients’ histories were adapted to the SOAP note for the chart. The patients’ stories in their own words was rarely heard.

Much to the dismay of my team, I started asking my patients what they thought brought on their illnesses. The answers I received somewhat surprised me – they were nothing like I expected. While they at times seemed touchy feely to some of my attendings, the responses invariably deepened my understanding of individuals’ experience of illness. Often, what they told me felt more real than what my diagnoses purported.

For example, one woman, whom I’ll call Cindy, was a type 2 diabetic with poorly controlled blood sugars. As we spoke, she shared with me that she felt she did not know how to manage her stress. She said she felt ashamed of this, and would deal with the emotions by self-medicating with comfort foods. Diabetes and obesity were, in other words, a side effect of an entirely changeable behavior pattern. Having learned this, I encouraged her to engage in therapy to heal her relationship with herself and she was able to lose weight and reverse her diabetes.

“Mary,” for her part, came to me for both peri-menopausal symptoms and depression. When I targeted her depression and asked her what she felt was the cause of it, she poured out a story of an unfulfilling marriage in which she felt slightly neglected. Mary said she didn’t have anyone to talk to such that she could figure out what her next step would be. Weeks later, she had taken action in her life and was symptom-free – not just for depression, but also peri-menopause symptoms.

In these cases, the answers that the patients believed were underneath their illnesses carried an opportunity for healing that went far deeper than symptom-management. If I hadn’t asked each of these women what she thought the cause of her illness was, I would have missed the opportunity to connect with and understand her precise experience of it. I would have merely diagnosed and treated, denying my patients the opportunity to partake in their own care, address any lifestyle causes or contributors, and ultimately put themselves on a surer path to wellness.

As physicians, we all probably remember the moment when we decided to enter this vocation. We wanted to heal others and decrease suffering. We had the intelligence to solve highly complex problems. Through our studies, we gained a molecular understanding of pathology and disease. Yet what we were not taught, was how to ask other questions: What do patients think their symptoms mean? Why do they think they are sick? What do they need to feel well? What do they need to feel whole?

These questions do not take much time to ask. But their answers may be the most empowering tool we can give our patients. Further, remembering that in the face of so many challenging problems, we can always make at least a small difference can help us, too, in this sometimes difficult and draining profession. We must remember that the soul of our vocation is to heal our patients. This may be the exact medicine that can also heal us.

Rose Kumar is an internal medicine physician is founder, Ommani Center for Integrative Medicine and blogs at The Doctor Blog

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  • Andrew Levin

    This approach is certainly germane to disorders precipitated by psychosocial struggles (diabetes from overeating as compensation for stress, per your example) but is less relevant to the treatment of most diseases. I don’t think diving deep into a patient’s psyche will cure multiple sclerosis, for example.

    It also might not be helpful to ask most patients why they feel sick–it begs the question by assuming they are at least partially responsible for their illness, which is often not the case. Smoker with lung cancer? OK, probably. Teenager with a brain tumor? Not so much.

    Empathy and communication are crucial skills for a physician, but rigorous scientific skepticism is paramount

    • Filo Bedo

      It’s just food for thought Andrew. Take it or leave it.

    • Patricia

      I think you are taking the wrong approach to the thoughtfulness of this article. Of course a teenager with a brain tumor needs a different approach. However, that approach should certainly include empathy and discussion around issues besides the tumor. These types of connections can foster trust in the doctor and in the (hopefully) healing process.

      I don’t think this author was trying to say you shouldn’t use “rigorous scientific skepticism”. And learning to discern what is going on for a patient is extremely helpful *and* can help the person get better *or* stay off expensive medications.

  • teri green

    Great article, the answers are the key.
    Thanks
    Teri Green

  • Suzi Q 38

    I like the idea of your article.
    People are human and the psychological may be affecting the physical.

    For example, I have low-level OCD and at times I expect perfection. I expect it not only from myself, but other family members, co workers and my doctors as well.
    This causes me stress, which affects my BP and eating habits.
    The eating habits cause me to crave sugars and carbs, which increase my blood sugars. At times my stomach hurts, so I suspect ulcers.

    Luckily, I have revealed this comically to my family, and they understand. My co-workers only know that I like things done a certain way, and they can count on me to do it. My doctors know that I am particular about my care and most of the time, they oblige. If I need an Xray, I get one.

    Your patients my have a myriad of personal problems and psychological conditions.

    It isn’t always the prescription pad that does the healing.

    Asking them why they feel sick is a very good idea.
    If it is cancer, they can feel better telling you about their first symptoms.

    If it is a virus that has entered the spinal cord, the first symptoms may hold some answers for all.

  • Patricia

    This is a really thoughtful piece. You describe a really important aspect to patient care that is unfortunately missing in today’s medical practice (or let’s say not very prevalent because I am sure many doctors and nurses practice in the way you describe). I think it takes a lot of insight to be able to have this perspective which for some reason many docs don’t possess.