A three thousand year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating; caring is supplanted by managing, and the art of listening is taken over by technological procedures. — (The Lost Art of Healing: Practicing Compassion in Medicine, by Bernard Lown, MD, 1996).
I recently changed from one family physician to another. When we first returned to Toronto after many years in California, I’d endured weeks of frustration of trying to find a family doctor. After several referrals that only resulted in “I’m sorry, Dr. So & So is not taking any new patients,” I finally found a doctor, recently graduated from medical school, who was taking new patients. Given my medical history, I had concerns about becoming a patient to a doctor without significant experience, but it seemed I had little choice but to sign up.
Our was discussion at the first meeting was relatively brief, but I reasoned that with more than a few medical experiences and my age, I was not at all shy about asking for referrals or expressing concerns. I pushed my reluctances aside and became her patient for an entire year, but all the while, experiencing a vague concern about a lack of connection or trust. While I never had difficulty being seen my appointments rarely lasted beyond 10 – 15 minutes. As I’d begin describing the issues or symptoms that prompted my appointment, she typed, her hands flying across her keyboard while I spoke. Her questions were few, and even as I left her office with a referral or prescription in hand, a sense of unease lingered.
Paracelsus, the great German physician of his era, included among the basic qualification s of a physician “intuition which is necessary to understand the patient, his body, his disease. He must have the feel and touch which makes it possible for him to be in sympathetic communication with the patient’s spirit…the aim is to understand the medical problem as well as the person behind the symptoms. (Lown, p. 3, 29)
To be clear, I feel very lucky to have had the experience of being a patient of two extraordinary physicians; one, a neurosurgeon, early in life, and the other, my current cardiologist. Dr. C., my neurosurgeon, literally saved my life when I was a teenager, and I quickly discovered that he saved–and touched–many more lives than my own. Patients’ faces lit up when he walked into the room, radiating compassion, warmth, and optimism. He listened intently to my fears and questions, laughed at my attempts to introduce humor into my condition, and held my hand when tears overtook me. Once I was was well enough to be mobile, he encouraged me to visit with other patients in the hospital–which I did, witnessing the sorrow of a young mother whose two-year-old son was dying or another teenager with head trauma from a car accident, neither as fortunate as I was. Intended or not, he was teaching me about compassion and healing. Dr. C. operated on me twice in less than a year, and long after I’d resumed a normal life, I continued to stay in touch with him throughout high school, college, marriage, and my career journeys He always replied, writing in an elegant cursive, once telling me how much it meant to him to hear from me–saying that a doctor didn’t often hear from former patients. When he died a few years ago, the expressions of gratitude were numerous from those whose lives he’d touched. Dr. C. was an extraordinary neurosurgeon, but he was also a healer–and that required far more than his technical expertise and scalpel in treating his patients and saving lives. Now, in the autumn of my life, I’ve been fortunate to experience, once again, not only considerable knowledge and expertise, but compassion from the cardiologist who deals with the matters of my heart. It makes a significant difference to me as a patient.
“Choosing a doctor is difficult because it is our first explicit confrontation of our illness…to be sick brings out all our prejudices and primitive feelings…You don’t really know that you’re ill until the doctor tells you so…The knowledge that you’re ill is one of the momentous experiences in life….When the doctor told me I was ill it was like an immense electric shock… I began to look around me with new eyes, and the first thing I looked at was my doctor… Now that I have cancer of the prostate, they lymph nodes, and part of my skeleton, what do I want in a doctor? pp. 36-38).
Heart failure, cancer–these are “momentous experiences” in our lives. In my expressive writing workshops with cancer patients, I encourage participants to write about their medical experiences with various doctors, asking, “What do you want in a doctor?” I was inspired to do so after reading Anatole Broyard’s book, Intoxicated By My Illness (1992), a collection of autobiographical essays written during his prostate cancer treatment and published two years after his death. In Part Three, “The Patient Examines the Doctor,” Broyard attempts to answer this question in an attempt to understand his feelings about his doctor. He describes several characteristics he would like to have in his doctor:
. a doctor with magic as well as medical ability
. a close reader of illness and a good critic of medicine
. someone who enjoyed me
. gropes for my spirit as well as my prostate
. surveys my soul as well as my flesh
. understands that beneath my surface cheerfulness, I feel…panic
Invariably, the responses to the question of what Broyard wants in a doctor are powerful, some revealing that his experience might reveal what some call the loss of the human touch in medicine. “Not every patient can be saved,” he writes, “but his illness may be eased by the way the doctor responds to him” (p. 57).
Several years ago, I posed the question “What do you want in a doctor?” to a group of cancer patients. One woman wrote as if she was addressing her oncologist in a letter, describing her feelings about her most recent appointment with him. She had been his patient for over a decade, but that day, he’d given her the news no one wants to hear. Her cancer had metastasized and spread throughout her body. Yet he had delivered this news without the warmth and compassion she had come to expect.
“I’ve been his patient for ten years,” she said, tears welling in her eyes. “We’ve developed a close relationship in all that time, but he wouldn’t even look at me when he told me this news.” The group members listened quietly, passing her tissues as she began weeping, and at the end of the session, many offering her hugs. What no one expected, however, was see her return the following week, her face wreathed in smiles. She told the group she’d made an follow-up appointment with her doctor and mustered the courage to share the letter she’d written in the group describing the pain she felt in the manner he’d delivered what was, clearly, her death sentence. What happened next, she said, was an apology and his honest admission that he was trying to control his own feelings, the immense sorrow he felt as he began conveying the results to her. The hurt and distress she’d felt was eased. She was calm and smiling as she shared their conversation with the group, reassured that despite having only a few months of life left, her doctor would be there with her until the end.
Even when cure is impossible, healing is not necessarily impossible. While medical science has limits, hope does not. I believe the maxim proposed by Dr. Edward Trudeau about a century ago: “To cure sometimes, to relieve often, to comfort always.” The miracles reside in the capacity for comforting and healing (Lown, p. 319).
About Dr. G.
He goes out of his way every time to ask how
I’m doing. He is the tree whispering through
the cracked hospital window, the shiver of white
narcissus, the breeze lifting the skirt of the nurse
opening my door. He is the song in my head that
doesn’t stop at night, the way curious medicine
wanders my blood–I no longer go out of my way to
picture the mound of earth dug just my size.
Sometimes someone touches your hand in an
unexpected room and you close your eyes
like the lid of a music box that’s been wanting
quiet for years. When I start to die, this is
how it will be: no terrible music, no one taking
my place, his footsteps in silence carrying on.
By Ann E., (1955-2013)
poet & cancer patient
I have a different family physician now. Quite unexpectedly, my daughter’s doctor’s practice opened up for a limited number of family members of her existing patients. I made an appointment for a consultation, and during our conversation, experienced a sense of connection and trust I’d found so elusive with my former family doctor. While I appreciated the warmth of this doctor, more importantly was the time she took to ask and answer my questions, listening attentively to what I had to say. “Trust in a doctor,” Bernard Lown writes, “is also fostered by the thoroughness of history-taking, by questions about work and other social issues…by expressions of genuine solicitude for serious problems” (p. 330). I left her office feeling a sense of relief and calm. I’d found my new family doctor.
- Try answering the question: “What do I want in a doctor?” Why are the things you want important to you?
- If you have, as I have had, a doctor who inspires your trust and confidence in your care, what are the qualities or behaviors that contribute to your feelings about your doctor?
- Write a narrative or poem about a doctor who has made a difference in your life.