On one of my first days of medical school, I shuffled into a lecture hall surrounded by professional looking individuals as we had done the days before. This similar routine persisted for a few days as we became oriented to our new school. Leadership had indoctrinated us with professionalism, administrative staff had terrified us to the point of avoiding any patient information for fear of being sent wherever they send HIPAA violators, and the resident financial guru helped us slide into the reality that we are all financially doomed by debt. This flow of lectures seemed to follow every day of orientation, until one of the days, a dean of the school stood up and told us all we were shamen. He aimed to convince us that we were all now healers. He artfully wove together a narrative musing that for thousands of years, and still in many places today, traditional healers are who people turn to when they were in need. Healers throughout time have held the role of meeting people where they are, understanding their illness and applying the knowledge and wisdom gained through years of study.
The healers of old did not offer evidence-based medicine, immediate imaging, risk stratification or even don the prestigious white coat. Instead, healers connected to a person’s belief in the healer’s ability and offered to them the best treatment they could muster. There was much left up to uncertainty. These traditional healers birthed many of the medicines in our modern repertoire, yet I think in our newfound world of sterility, we have forgotten how to wade into the uncertainty with our patients. I do not mean wade into the uncertainty of medical decision making, which procedure is correct, or “Doc, what do you think?” I mean the murky uncertainty of human beliefs.
Until modernity crept into existence, a healer would live out their calling within in the same cultural and religious milieu of the people for whom they were caring. This unified their relationship and simplified their understanding. Cultural and religious competency was more or less a non-issue as there were only one culture and one religion represented. Both people would be familiar with their culture and be living in the same realm of religious beliefs. Trespasses or marginalization would be rare or at least in line with the expectations of the society.
Starkly contrasting old paradigms is the current plurality of cultures, religions, and beliefs in which medicine is practiced. Every person in society, not just medical providers, now can purposefully or inadvertently act in such a way as to marginalize or infuriate another with ease. It seems modernity has led us into the melting pot of cultures ill-equipped to support each other’s beliefs. To put this another way an absence of tact in sensitive moments is understandable when for much of medicine’s history this diversity of world-views was not encountered. This does not mean that we do not know how to empathize or show compassion for our patients, because that would be untrue, but an erosion of decorum seems pointedly apparent when a patient says something like “Doc, can I pray for you?”
This is the moment where tact has been lost or rather possibly never developed. Here a sterilized professional, empathetic white coat comes face to face with the request of a hurting person. Our convenient convention of leaving religion at home is untenable when your place of work is where many people will walk through their darkest days. It is in this moment where blank stares can be the most damaging.
As a fourth-year student working in the MICU, I watched as we updated a new family about their critically ill and intubated mother. The conversation was handled beautifully. The third-year resident did everything we are taught in having difficult conversations. He set the space up, so everyone had a chair, he silenced his phone, he asked for permission to start talking about the situation, gauged their understanding and left silent, space to allow the family to process and ask questions. I hope I can one day walk families through conversations as he did that day. As we wrapped up and were walking out of the room the eldest daughter, and now the acting matriarch of the family, coolly said, “Doc, I am praying for you and the team.” Her heartfelt statement was answered with only blank stares.
In those simple words, mountains of motives can be misconstrued. Somehow in all the difficult conversations, we have this simple question can level an agonizing blow to our composure. It seems because every other discussion we are trained for and this one we are taught to avoid. The only advice uttered about it during my training has been “talking about religion is something you can figure out when you are farther along in your training.” People in these moments are not asking for our philosophical viewpoint or religious manifesto. They are asking for comfort and connection with another human being who is in that moment with them.
Do you think heaven is real?
Do you think god exists?
Will you pray with me?
Can I pray for you?
All of these sentences are common to the hospital wards and exam rooms. People ask them as they are grappling new realities which are often frightening and overwhelming. Responding with blank stares to an invitation for connection is not what most people would want. Pew polls and published studies have shown that the religious beliefs of physicians are significantly different from that of the general public. This is further seen as the general public will rely on strength from their religious beliefs during difficult times much more often than physicians, and patients who are critically ill frequently welcome physicians’ questions about their beliefs. So, what if instead of felling frozen by the differences between patients and physicians in the realm of faith we respond with humility and grace. “That isn’t something I usually talk about, but what do you think?” or “Thank you for your prayers.” What if it is that simple? Not deflecting, not downplaying, but allowing patients and families to stand upon the support they use in their most challenging days. Sometimes patients need us to be people instead of physicians. I hope to be like the healers of old, sitting across from another person leaning into our similarities as people, so at that moment I can offer more than just blank stares.
Christopher Zalesky is a medical student.
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