“Not every patient can be saved, but his illness may be eased by the way the doctor responds.”
Anatole Broyard, Intoxicated By My Illness
I received an e-mail from a colleague. The subject line read: “Wow look what they’ve discovered!” Attached was a link to the New York Times WELL column “Letting Patients Tell Their Stories.” My eyes drop down to the image of a doctor with his stethoscope in hand listening to a patient’s heart. I think about how a single image can convey a message much more effectively than words.
In his blog Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital, admits he’s a better doctor now at some things than when he began a decade ago. Yet from time to time he asks himself if he has lost what he had before: “understanding, empathy and imagination.” But on this particular night amid the chaos in the emergency department he introduces himself to a seriously ill older gentleman. He asks about his symptoms, i.e. bodily functions. “Son,” he says, “I’m dying. I’m alone. One day you’ll learn there’s more to a good death” than that.” In an instant, he finds himself reflecting on why he became a physician. Khullar, reminds himself “What’s needed, is a deeper of understanding of who the person behind the patient is…”
“Ah…” I hear myself say—“that is where I began 15 years ago…”
It had never occurred to the doctors or me that the skill sets I cultivated as a writer would prove useful in the context of healthcare. Illness calls for stories but telling doesn’t come easy—nor does listening. I observed the challenges doctors faced in giving the best possible care when the modern approach to medicine was being dictated by managed care. There was pressure to treat the disease, to reduce medical records to scientific data, to both limit and objectify impressions of patients and see parts instead of the whole.
To help doctors listen more discerningly to their patients’ stories, Dr. Bernard Bandman, a clinical psychologist, Dr. Carol Salazar, a primary care physician, and me, the cancer center’s resident medical humanist, received funding from Southwestern Vermont Medical Center to support “The Doctor’s Conversation Hour.” We facilitated a series of monthly programs that offered an opportunity for doctors to share their stories about the challenges of caring for patients living with incurable illness. In 2007, Vermont Public Radio recorded one of our programs “The Human Side of Doctoring.” I’m sure Dr. Khullar would appreciate his fellow doctors’ candid conversations, as they too asked themselves “Where did I go wrong in not appreciating what that patient wanted from me?”
Your work leads doctors and patients beyond the ‘going through the motion’ stage to living in the moment. To stop and listen and hear the patients point of reference and then to then clarify a response takes precious time. To learn about the patient takes precious time. Your work gives voice to just how equally precious the patient is.
Perhaps a better image would be the MD holding the stethoscope near the patient’s mouth, like a microphone.
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