One Door Closes, Another Opens

I recently discovered an article I wrote titled “A Medical Humanist Says Good-bye” that was published in the Journal of the American Medical Association (July 9, 2008). It recounted the role of medical humanist I created at the cancer center in Bennington, Vermont and the position coming to an end. Included in the article was a farewell email I sent to the hospital’s medical staff. I wrote,

To my colleagues on the medical staff,

Today health care institutions are faced with having to make difficult budgetary decisions. As a result, the medical humanist’s position at the cancer center will soon be coming to an end.

Thank you for your willingness to integrate this role in the care of your patients. Many of you have let me know it enhanced communication from both sides: it helped patients to achieve a better understanding of their illnesses, themselves and their physicians; and allowed you to understand the physician experience differently and more deeply. It is now time to say good-bye.

Upon reflection, we’ve demonstrated the humanist’s role had a catalyzing effect and changed the manner in which medical services were delivered. To demonstrate is not proof. The degree of evidence required for proof in science is lacking but our individual experiences and anecdotes confirm the role benefitted patients, families, clinicians and the institution. It has been a privilege to work with each of you.

                                                                                                                 Celia

It was no more than an hour later I received a reply from a physician who said,

Sadness, quiet denial, a lump in the throat.

These are what I feel as I read your message.

And, a smile at the end for the civility, the kindness, the clarity of focus and the promise of the future.

Thank you for all that you’ve done for me and the patients we shared. It meant a lot to me.

Godspeed.

This email was not the only response I received but it captured that moment in time when I was departing a job that gave me great satisfaction. I understood how the experience of working on an inter-disciplinary cancer care team provided me a window into the complexities of doctor-patient communication. However, I didn’t know what my future work would look like.

But what became of my departure is a good story because what I learned was the basis for developing SpeakSooner: A Patient’s Guide to Difficult Conversations, a tool that could simulate my role. Now, through the use of the guide, patients can identify their questions, concerns and misunderstandings, which they could express to clinicians without an intermediary like myself.

In today’s healthcare environment, financially strapped institutions are unlikely to hire a staff member like me whose time is not reimbursable through medical insurance. With this budgetary reality in mind, the Center for Communication in Medicine is collaborating with oncology practices to train doctors, nurses and social workers to implement our SpeakSooner model, which prepares patients to open conversations on topics in the guide. So, rather than just one person (me), there’s a team of cancer care providers supporting patients in identifying and communicating questions and concerns about issues regarding their health status and planning of care.

It was my hope that the closing of one door would open another. Now, with the guide in hand and the help of healthcare providers, patients are positioned to advocate for themselves and become their own medical humanists.