On Compassion in Medicine

After our exams this week, the last two days have been easy, with medical ethics-type lectures (which of course I totally geeked out to, especially since two of my favorite professors from grad school were guest lecturers), so compassion in medicine has been on my mind, and finally publishing this draft seemed appropriate. So here it is, tense left unchanged:

One of the blogs I read with some frequency (since I’m not in school yet and therefore still have what resembles a life and free time), is called “I’m 25 and My Boobs are Trying to Kill Me.” The author is a brave, witty life enthusiast who writes beautifully and sees the meaning in everyday life now that she is in remission from breast cancer. Having previously worked in breast cancer research, her story stuck with me because of how personal it was, in her own words as she was going through the experience of chemo. Her most recent post made me stop to think a bit about patient dignity.

You can read one of her latest posts here.

So, as a doctor, someday I’ll prescribe drugs or therapies in order to save someone, or at least bring his or her experience back to baseline. Most of the time when I do this, I will not have gone through it myself. I’ve never had cancer, so I don’t know what the experience of chemotherapy is like. Sure, I can read that I’d lose my hair and be nauseated with frequency, but I do not know what that experience is like firsthand. Reading this blog has guided my thinking about what patient care, and good patient care, really is. It’s not just good enough to nail down the diagnosis and prescribe the drug. In my mind, anyway, there needs to be something more.

She had her dignity. Her confidence. Those around her either destroyed it or built it up. How many of us take for granted those little things that make us feel like ourselves? She talks about how seeing the Gollum in the mirror when she expects a head full of long, brunette curls affects the way she views herself, and even more than that: she didn’t want other people to have memories of her as a bald woman. It speaks to how much she has lost her sense of self due to her illness. Realizing how the illness affects the person’s normal, day-to-day life outside of the clinic/hospital. It involves seeing them as a whole person. I am completely convinced that medical personal narratives can do wonders for patient peace of mind as well as give insight to physicians about how a patient can be better treated. Competently demonstrating compassion in a clinical setting is a complicated thing to do. What if one of her physicians would have asked her about how she felt now, in remission, even without her hair? Would she have felt better about her self (and herself) if the focus was put on how she was handling life outside the clinic, instead of her status as a cancer patient?

The term “holistic” gets thrown around a lot in the healthcare sphere these days. Whenever I read comments on how doctors think they treat patients holistically, I have to chuckle just a bit. Treating a patient as a whole person goes above and beyond calling a patient Mr./Ms. so-and-so instead of “the case of X in room 215.” I remember in grad school talking about caring for a person’s narrative in Narrative Ethics and Caring in The Ethics of Care. “Of course I see my patient as a whole person and not just a disease!” they say. Oh, really? We had cases on a regular basis… they would just roll in, endlessly. Many cases were brought to a bioethics committee’s attention, but more often than not, they never made it that far. There are plenty of opportunities for finding ways to change medicine that do not necessarily revolve around cost-containnment, new drugs, illness management, or the like. Establishing a relationship for the patient and physician is of the utmost importance, but many that I have encountered who plan on going into medicine seem to brush it off, which I feel is just incrediblely sad and a disservice to our future patients.

I think I just wrote a manifesto. It was not my intention, but that is where my mind wandered.

I hope I do not forget this as med school progresses.

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