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.