Hope As A Vital Sign

Doctors caring for patients facing incurable illness often feel pressure to come up with a “miracle” treatment. But what if what those patients really hope for is far more achievable than this?

In a previous post I responded to the human side of doctoring: the difficult task doctors face in reconciling patients to illness and dying. As a consequence, they sometimes find themselves offering “one more thing,” even knowing it is not a good thing. Their rationale for doing so, as noted in that post, is based in their fear of “taking away hope.”

Since that posting I have been thinking about how doctors explore hope with patients whose disease they can’t cure. Dr. Lidia Schapira, of Massachusetts General Hospital/Harvard Medical School and a CCM Board Member, has described hope as an emotional “vital sign,” saying, “I can’t do my work as a doctor without knowing my patient’s temperature, blood pressure and pulse rate. If I am to do my job well, it is just as important for me to take a ‘reading’ of their level of hopefulness or hopelessness.”

How does a doctor take this reading? One of the most important questions I heard a doctor ask a patient was “Tell me what you hope for.” Simple as that: she asked.

That patient’s answer was equally memorable. She admitted that for her, hope was “different moment to moment, hour to hour, day to day…” In one sentence she captured the volatility of hope. By inviting her to express this volatility, that doctor gave her patient permission to be honest—and showed herself to be open to hearing that honesty.

In his essay, “The Patient Examines The Doctor,” Anatole Broyard—speaking as a patient—says that the doctor’s presence and his or her willingness to reach the patient are the assurance every patient needs. Cathy, one of the patients featured in our Difficult Conversations Workbook, echoes this same idea, explaining that patients need to hear that their doctors care and will do their best—even if they can’t offer a cure.

I cannot help but wonder if the pressure to find “one more thing” arises from what doctors imagine their patients need from them—when what is often needed is not a miracle but a sense of partnership.

Readers, I invite you to weigh in. Does the doctor’s fear of “taking away hope” just come with the territory? Or can it be alleviated—and how?