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Thursday, April 12, 2012

Treating patients like persons - why we don't always do it and how we can change

Last evening I put aside the urgent matter of getting my taxes done to attend a truly inspiring committee meeting. I know, I know...that sounds like an oxymoron.  But our Health System's new Narrative Medicine committee is truly exceptional. Populated with a diverse group of professionals - social workers, nurse practitioners, art curators, medical school faculty, a "quality" expert, chaplains and physicians from specialties as diverse as opthalmology and pediatrics - this working group shares a passion for putting the "care" in "healthcare."

As I drove home last night, I wondered: "why are we necessary?"  By this I mean, why is it not automatic for health professionals to bring all that they are to the bedside of every patient?  I believe there is no single answer.  What we know is that empathic capacity among physicians and nurses has been measured and tracked, and that it declines during training.  The more time we spend with patients, it seems, the more insulated we become from their experiences of isolation, fear, anxiety and loss of control.  The evidence is clear: without heroic countermeasures, the more expert we become, the more we disconnect from the human experience of illness.

And so we find ourselves in a conference room snacking on nectarines, potato chips and Pelligrino water (true story!) swapping ideas about interventions and research projects that might bring the perspective of "narrative medicine" to bear for the benefit of wounded patients and wounded providers of care.

"Tell me everything you feel I need to know about you" to understand you, to address your fears, to respect your short, to provide you the care you need.  This is one message of Narrative Medicine.  Another, equally important stream is directed at the wounded caregiver: what are you feeling?  What fears, what resentment, what kinds of inadequacy have you locked away in order for you to do your get through your day?  And how can we use words and written expression to unlock those hidden recesses of our psyche, and to purge the toxins from the culture of healthcare?    

I am very hopeful.  The antidote to burnout is not less work.  It is the chance to participate in meaningful work, and to know in our bones that our labors are worthwhile.   Half a century of progress has provided technologies for extending life and health that would have been unimaginable to our forefathers.  We stand at the frontier of a new that values these advances, while also bearing witness to the human act of caring, and honoring in a way that is very new and very old the act of one vulnerable person caring for another.


  1. Unfortunetly I don't see the patient represented on this committee.

    1. I think the reader makes a good point. So routinely do we convene forums to discuss what is right and necessary for patients without giving thought to having their voice clearly present at the table. I am not sure if it is just a lack of awareness or fear of inviting those we care for into the inner sanctums of our professional worlds. Meetings are messy and often convey that perhaps we don't always know what we are doing or why we do it and that we don't always do it perfectly. By having patients and families present we make ourselves vulnerable-an unsettling feeling for most of us. I think it is time we face up to this vulnerability-embrace it and move forward in a renewed partnership with those we care for. At the very least, our meetings should engage the voice of the patient through the inclusion of narrative works. Recently,I took the step of inviting a patient and their family into a meeting I chair- it was a very powerful way of helping those of us around the table understand why we need to change our practice of doing business as usual.