In the fast changing world of modern medicine where new diagnostic techniques, improved therapies, and healthcare insurance debates usually attract the most attention, the doctor-patient relationship still remains the rock solid foundation.
Time restrictions, a focus on scientific facts and measurements, and the emphasis on curing instead of healing have all detracted from the vast theapeutic potential a good doctor-patient relationship can offer.
But if the circumstances are right and the doctor and patient are a good match, and the doctor is indeed a healer who considers the whole patient, wonderful things can happen to help the patient cope with a disease, even if that disease is very serious or life-threatening. And this goes beyond the correct diagnosis and the appropriate medical therapy. The relationship can indeed take on a sacred and spiritual aspect that benefits not only the patient, but the doctor as well.
Here are some of the characteristics of a good doctor-pstient relationship that can be therapeutic and by their very nature, sacred.
Empathy – Empathy is the ability of the physician to understand and be aware of and accept the patient’s feelings, thoughts, and reactions in a non-judgemental way that conveys to the patient that the patient is being heard and acknowledged. It is the doctor’s way of saying, “I understand your situation and what you are going through.” This response alone can take a tremendous burden off the patient by validating the patient’s symptoms and concerns. It can even free up the patient to give more diagnostic information because the patient feels more accepted. It can also bolster the patient’s confidence and lead to more participation in his/her care and recovery. A doctor’s empathy shows a sense of humanity and, as a result, offers great support to the patient. Showing empathy, in itself, is a sacred act.
Being Present – To show empathy to the patient, the doctor has to be present for the patient. This, of course, involves no distractions during the patient interview, but it also requires good listening skills – what the symptoms are, what do they imply diagnostically, what does it all mean to the patient, how does the patient react emotionally while telling his/her story. Just being willing to listen to the patient’s story is a sacred gift in itself. This is another way of validating the patient and says “You are important.” The art of being present to another person is so powerful. In our age of constant distraction, usually by technological devices, it is fast becoming a lost and neglected practice.
Connection – We all long for connection to others. Someone with a disease can feel so isolated by either loss of function, loss of physical connection to others, lack of understanding of one’s disease by either close relatives or friends, and loss of connection to the world in general.
Dr. Rachel Naomi Remen has said, “Oftentimes the will to live is weakened more by isolation than by disease.” (Hematology/Oncology Clinics of North America, 2008, p.771) A good doctor-patient relationship can counter that sense of disconnectedness that is so destructive. The patient has someone to share concerns with, someone who understands what the patient is experiencing, someone who can offer encouragement, support and information. One human being connecting to another in a helpful way is a sacred event.
Collaboration – A good doctor-patient relationship involves a collaboration between the two parties. It is well know that a patient who actively participates in his/her care frequently does better. This is the ideal situation. It gives the patient some autonomy and promotes a positive self-image for the patient. It also encourages both the patient to be well informed about the disease and the doctor to impart the necessary information. Patient participation in major medical decisions allows the physician to tailor the therapy to the patient’s needs. In addition, collaboration allows the patient some sense of control over the disease, a therapeutic situation in itself. Collaboration adds to the bonding between the doctor and patient. Two people coming together so that the potential abilities of each can be realized has a sacred quality to it as well.
Touch – The power of this aspect of the doctor-patient relationship is frequently overlooked. The physician must touch the patient during a physical exam in order to gather information that will help make an accurate diagnosis. Obviously, this should always be done is a very respectful manner. But too often today with time restrictions and sophisticated diagnostic equipment like MRI available, patients are being touched less. This is a shame, because everyone has a need to be touched, even if it is in a diagnostic way. It is part of the connection between doctor and patient and is reassuring to the patient that the doctor is probing for answers. There is the other aspect of touch as well – the hand on the patient’s shoulder or the physician taking the patient’s hand when the patient is upset or needs comforting or reassurance. This is the powerful and sacred aspect of touch – it’s an expression of feeling and understanding and supports the connection that all of us seek.
Sharing Humanity – In a good doctor-patient relationship, there is a sharing of human experience. If the physician is open as well as supportive and accepting of the patient, the patient will be totally free to be himself/herself. This is a sacred gift in itself – the freedom to be who you really are. To encourage this situation, the physician must bring his/her own humanity and life experiences into the relationship. In fact, the more the physician is aware of his/her own humanity and vulnerabilities and previous difficult life situations, the more compassion and understanding that physician will have for the patient. This awareness can enable the physician to encourage the patient to develop strengths and coping skills the patient may inherently have.
Dr. Remen points this out so movingly when she says, “Healing is not a relationship between an expert and a problem. It is the outcome of meeting as two whole people who recognize the potential in their relationship to exceed the limitations of both science and disease.” (Hematology/Oncology Clinics of North America, 2008, p.771). Two people sharing their humanity – a very sacred relationship indeed. In this process, the patient can also teach the physician and add to the physician’s own sense of humanity. Physicians definitely can learn from their patients’ life experiences and grow as a result. This is one of the rewards of being a physician.
Healing – This is the outcome of a good doctor-patient relationship. Even when a cure is not possible, healing can still occur. This is so often forgotten in the Western mode of medicine where relief of symptoms and survival of the patient are the only measure of a successful outcome. But even a dying patient can know healing and wholeness, if this is promoted by the physician. Patients can be encouraged to find their strengths and attributes, to grow, to live more fully, even if they are dying. Patients can also be helped to learn what their illnesses can teach them and change their lives as a result. This is healing in the true sense, and while it cannot be measured or quantified, it is still a possible powerful outcome of a good doctor-patient relationship. And helping patients to be whole and realize their potential also has a sacred quality to it.
A good doctor-patient relationship still remains the solid foundation by which medicine gets practiced. While the primary purpose of that relationship is to help the patient improve by providing information, diagnosis, therapy, and support, the relationship can also relieve the patient’s isolation, anxiety, despair, sense of powerlessness, and confusion by the very nature of a good interaction. In the process, the doctor can grow as well by learning from the patient about the nature of human experience and how we all share a common humanity.