a doctor's touch

 

 

 

This week, I planned to provide a few prompts for physicians and healthcare providers who are blocked for whatever reason from telling their stories, perhaps because of constraints on time and energy, self-doubt, or lack of inspiration and support. I had planned to offer words of encouragement by Julia Cameron (http://www.theartistsway.com ).

 

"Writing is medicine.

It is an appropriate antidote to injury.

It is an appropriate companion

for any difficult change."

~Julia Cameron~

 

…and by mindfulness meditation leader Jon Kabat Zinn:

 

"Cultivate wisdom and equanimity

~not passive resignation~

in the face of the full catastrophe

of the human condition."

~Jon Kabat Zinn~

  

Then a friend of mine (she knows me too well...) sent me a link to a YouTube video by Abraham Verghese, titled "A Doctor's Touch.”

 

https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch/transcript

 

"The most important innovation
in medicine to come along in the next ten years:
the power of the human hand."
~Abraham Verghese~
 

Suddenly a whole new set of questions arose. This video emphasizes the therapeutic effect of the laying on of hands by the physician...the healing roles of ritual and expectation...the importance of time spent with patients. It undermines the glorification of the ten-minute office visit…the game of "Beat the Clock" that doctors are required to play in order to meet productivity quotients. Don't get me started...

 

"The life sciences contain spiritual values
which can never be explained
by the materialistic attitude
of present day science."
~Sherwin B. Nuland~
 

These trends in the practice of "modern" medicine, among others, are what led me to bow out of practice because of fear of the inevitable: that the day would arrive when I would miss something important because there simply wasn't time to do the job well.

 

These are the questions I still can’t answer:

 

--Should I have taken a stand against the system and what I perceived to be the erosion of my wisdom and authority as a physician in the care of my patients

 

--How could I have done it...without risking my job?

 

--Would it have made any difference?

 

--Is it too late now?

 

Thankfully, there are physicians like Abraham Verghese who are able to speak eloquently on our behalf while the rest of us scramble to collect our thoughts and yet fail to act on what we know to be true.
 

 "What moves men of genius,

or rather, what inspires their work

is not new ideas,

but their obsession with the idea

that what has already been said is still not enough."

~Eugene Delacroix~ 

 

 

Is there an issue you need to confront? What is holding you back? What kind of a difference can you make? When will you begin?

jan

 

 

 



wash your spirit clean

The mountains were calling...



I was lucky enough to have spent the past two weeks hiking in Sequoia and Yosemite National Parks under cloudless blue skies with people I love. It would be impossible to put such magnificent beauty and grandeur into words, so I took hundreds of pictures. When I got home, though, I realized that none of the pictures really captured what I saw or communicated what I felt out there. You have to stand on a mountain top, or hike to the base of a waterfall, or look up at a Sequoia to appreciate what that feels like and how it can affect you.

 

"I only went out for a walk, and finally concluded

to stay out till sundown, for going out,

I found, was really going in."

~John Muir~

 

 



I imagine this is what it must feel like for patients when we ask them to describe their illness. How hard it must be for them to express what they feel. To help us understand what they are experiencing and how it affects them physically, psychologically, and emotionally. All of which we need to know in order to help them heal.

 

"Between every two pine trees

there is a door leading

to a new way of life."

~John Muir~

 

 

How does the patient describe the fear he feels when his doctor pronounces the word "cancer"? What does it feel like to survive a major stroke or heart attack? What sadness blankets a parent whose child is suffering?

 

The tests we order, and the x-rays and scans we review help us make the diagnosis but they don't reveal a thing about the patient's experience. Like my pictures, they don't capture the patient's feelings or reactions to his illness. To his treatment. To his sense of helplessness, or, God forbid, his sense of hopelessness.

 

"The clearest way

into the Universe is through

a forest wilderness."

~John Muir~

 

 

 

You have to climb the mountain to see the view. You need to hike in the woods to appreciate the trees. You have to wade in the river to enjoy the water.

 

What do you think it takes to understand a patient's illness? What does it take to heal? 

 

"Keep close to Nature's heart...

and break clear away once in a while,

and climb a mountain or

spend a week in the woods.

Wash your spirit clean."

~John Muir~

 

 jan

 

tell us what you think we should know

 

 

If you are a health care provider or therapist in any discipline, you may find yourself frustrated from time to time when a patient does not respond to treatment. You find yourself questioning the diagnosis. You ask the patient about his symptoms over and over again, re-examine him, and order additional tests without getting anywhere. Something doesn’t add up. There must be a missing piece. Too often, the patient is labelled as uncooperative, difficult, or mentally ill...when you may not have heard the patient’s whole story.

"The simple yet complex act of listening is,

in and of itself,

a clinical intervention.

Listening constitutes the very heart and soul 

of the clinical encounter."

~Mary T Shannon~

Some days there just isn’t time to explore the details of his illness with every patient. Perhaps you’re running behind schedule, or an emergency interrupts you. Some patients can’t bear to disclose the sorrow or fear or shame that underlies their symptoms. Some remain in denial for reasons we don’t understand.

Rita Charon, MD pioneered the practice of “narrative medicine” almost twenty years ago as a path to help clinicians uncover the missing piece in their patients’ histories. It trains the healer to recognize the fact that the problem exists, and then to elicit the patient’s untold story—to listen, receive, interpret and apply what the patient reveals.

This is how she begins with a new patient. She simply invites the patient to "tell me what you think I should know about your situation." Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated...paying attention to the patient's posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story. This approach may take more time in the beginning, but in the long haul,  it saves us from revisiting the history again and again, from ordering unnecessary tests, and from wasting time and resources on ineffective interventions because of what we have missed. 

“I am, by calling,

a dealer in words;

and words are, of course,

the most powerful drugs used by mankind.”

~Rudyard Kipling~

When we reach into our patients’ cholesterol-laden hearts to understand why they are poisoning themselves with food, we need to know more than what they putting into their mouths. When we let the patient talk, we may discover that the real reason for this one’s fatigue or that one’s intractable headache is end-stage disappointment or anger or shame that has festered for years.

 

Only then can we help them heal.

"Histories must be received, not taken."

~Sir Richard Bayliss~

jan