Next in a series.
What are some of the characteristics of healers? They listen and do so nonjudgmentally. They respond on the patient’s terms. They are humble. They are truthful. The healer communicates on the patient’s (and family’s) own terms. The healer always explains his or her reasoning. The healer tries to diminish the information gap.
Despite all of medicine’s sophisticated technology and providers’ skills, the patient still needs the doctor or nurse to be humanistic. For example, when he or she enters the room, sit down to talk with the patient eyeball to eyeball at the same level rather than the usual practice of standing as an imposing figure and looking down at the patient. The doctor (or nurse or other provider) needs to converse with the patient in clear English: not in medical speak. Medical speak is for the provider’s convenience but with a patient it is just a way of obfuscating but not communicating. The provider must expect to repeat what he or she said today again tomorrow and again the next day; expect that the patient needs to hear it repeatedly. And the doctor should not be annoyed that the patient forgot it all by tomorrow morning.
When doctors visit a patient it is important not to just talk but to listen. Listen hard and long. A faculty physician described a trainee getting behind him where he was seated by the bedside and looking across his shoulder at the patient. Somewhat annoyed by this intrusion into his space, he asked why the resident took that position. The resident responded that he wanted to see what the doctor saw. “I’m not looking, I’m listening” was the answer.
As a patient or family member, you need your doctor to nurse to be clear and truthful even when it is painful. The message needs to be in direct every day speech. A senior trauma surgeon told of going to tell a mother that her son had died. The surgical resident who had been working with him in the OR asked if he could be the one to deliver the bad news. “Sure, I’ll just sit to the side.” The resident used a lot of words about how injured her son had been; how they had tried to save him in the operating room and then stood up to leave.
“Wait,” said the surgeon. He went over, sat down, and holding the mother’s two hands said, “Do you realize that your son has died?” She had not. So it is critical for the doctor or nurse to be clear.
Here is an apocryphal story that is said to have occurred at a famous hospital. The world renowned cardiac surgeon and his retinue of young doctors in training flocked into the patient’s room. Standing at the foot of the bed with the others standing silently behind and around him, all in their white coats, he explained to the man lying in the bed in a hospital gown that he needed a heart valve replacement. He told of the risks of not proceeding promptly with the surgery and also the risks of the surgery and its aftermath. The surgeon announced that he would perform the surgery first thing tomorrow morning. The patient thanked him but said he needed to talk to his doctor before agreeing to the surgery. The expert was clearly annoyed that his expertise was seemingly being questioned.
“What is your doctor’s name?”
“Tell me his phone number and I will call him.”
“I don’t know.”
“Well how can I call him?” the surgeon sort of growled.
“Well, he’s here in the room — right over there.”
“He” was the third-year medical student, the only one on the team that had taken the time to really have a serious in-depth conversation with the patient — to listen to the patient as a person with all of his desires for life and his concerns for family and others. It was only with the student that the patient had a sense of rapport. The expert and his retinue left. The student remained behind. The surgery was soon scheduled for the next day.
The really good physician knows that medicine is a calling. This doctor understands that he or she wields great power through his or her knowledge but is nevertheless always humble. He probably knows, at least intuitively, what Ambroise Paré a French surgeon of the early 1500’s wrote: Je le pansai, Dieu le guérit. (“I bandaged him, God healed him.”) Such I suspect is the view of many physicians; that they can only do so much, the rest is up to the patient’s body and to a higher power.
The art of medicine, the art required to become a healer, is not necessarily innate. It takes learning and experience. Not so much book learning but observation of positive role models. When those role models abound the healing art is much easier to develop and put into practice. Medical schools and teaching hospitals need to be sure there are many such role models.
Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, senior advisor to Sage Growth Partners and is the author of The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You.