Monday, July 31, 2017

empty-handed and broken-hearted


I learned something new today. This is reason to celebrate because some people like to joke about my incipient dementia. At least, I think they’re joking.

I was contemplating the theme for this post—“primum non nocere”—and its English translation—“First do no harm.”—when I learned that this saying has nothing to do with the Hippocratic Oath. This was news to me. It actually comes from Hippocrates’ writings in “Epidemics”: “The physician must…do no harm.” These words are the bedrock of medical ethics and practice even today.

In fact, many of the traditions that influence the way we practice modern medicine were passed down to us by men like Hippocrates. Not because women were excluded from the practice of the healing arts in ancient Greece. On the contrary, way back then, women were highly respected as physicians and healers. Even Plato held them in esteem. Though they were few in number, patients sought them out. They were regarded as the “wise women” of the community. Their “soft hands” were considered to be “healing hands”.

“Have a heart that never hardens,
a temper that never tires,
a touch that never hurts
~Charles Dickens~
But as the science of medicine advanced, the feminine ethic lost credibility. Its wisdom and power to heal were disdained in favor of dispassionate technical expertise—testing, procedures, and proofs. Today speed and efficiency reign, and reimbursement issues drive the system. Over time, tradition has suffered, and as a result, patient care has suffered.
Unfortunately, one of the time-honored traditions that did survive is the one that expressly prohibits the physician from entering into a personal relationship of any description with a patient. This, of course, is an impossibility. It disavows the emotional intimacy that is the inevitable fruit of shared suffering. It contradicts the compassionate physician’s experience and denies him a powerful tool.

Today, the physician is taught that it is unprofessional to share his personal experience, insight, beliefs, or values with the patient. This rule of non-engagement was hammered into our heads during training when we were still easily moved to empathy, at a time when connectedness with other human beings was still something to be desired and defended.

“The good physician treats the disease.
The great physician treats the patient
who has the disease.”
~William Osler~
Sadly, this means that patients may know more about their hairdresser or mechanic than they know about their doctor—the person they trust with their health, with their children’s health, with their lives. This can be troubling for patients. They may have little choice when it comes to selecting a physician, and except for the credentials displayed on the walls in his office, they may know nothing at all about him. They worry about it and they should. Is he competent? Is he caring? What motivated him to undertake years of grueling study and training? What sustains him? What is it like for his family? How does he manage it all?
This precedent distances us from our patients at times in their lives when what they may need from us more than anything else—more than another prescription or another test or another procedure—is our presence with them, our strength, our compassion and support especially at times of serious illness and suffering. At times when fear and grief cut deep. At times when they may need to understand that nothing more can be done for them…or for someone they love—a friend, a spouse, or a child.

When our patients need us the most—that is, when there is no hope for recovery—we are trained to turn their care over to the nurses, their family, their pastor, or to hospice. We leave the patient’s bedside the way we approached it—as a stranger. We lose sight of the greatest gifts we can offer as healers—our time and attention. Our presence. Our touch.

“Some patients,
though conscious that their condition is perilous,
recover their health simply through their contentment
with the goodness of the physician.”
~Hippocrates (460-400 BC)~
We leave the bedside empty-handed, and sometimes broken-hearted.
“Tell me your story,
show me your wounds,
and I’ll show you what Love sees
when Love looks at you.
Hand me the pieces,
broken and bruised,
and I’ll show you what Love sees
when Love sees you.”
~from “When Love Sees You”~
~lyrics by Mac Powell~



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