Hoping for the Art of Medicine
Since my Doctorate of Medicine degree in 2004, I have experienced many challenges during my career that continue to enlighten me in the pursuit to becoming a better physician, caregiver, counselor and communicator. Certainly this journey is ever evolving and probably always will be.
Is the one thing you should be able to give every patient. Imagine your body has failed you, you don't know why. You do your best, but still don't have an explanation or solution. What can you do? You search for hope. Most will hope the wrong, will right itself. After all, we get over the cold, walk off the aches and "sleep on that" to de-stress. Time brings hope, Time appears to fix all or at least most, problems.
But the problems persist.
So you seek advise and input from the accessible, trusted and the understandable. This may be a friend, your spouse, neighbor or someone who's lived it. A trip to the library has been supplanted by Google searching for hope.
Ultimately, some seek a doctor for help. Some are seeking a cause that can be a conduit to resolution, some want a diagnosis, but is a diagnosis satisfactory? A diagnosis can be interpreted as something you have, but do not want. Sometimes a diagnosis will suffice in lieu of cure or cause.
Although unsaid, I believe many are really seeking hope, in the least, hope is as crucial as the answer to, does she loves me, or not?
Does hope trump all others? Why should the physician spend his/her time delivering hope? I do know facilitating a diagnosis does not always result in patient satisfaction. Similarly, providing a reason, cause or explanation tends to be followed by a course of intervention, testing, trial and error and these generally do not lift a patients spirit.
In the course of a medical visit or consultation, questions are required, evaluations and reviews need to be done to document and enact an assessment, plan, prescriptions or investigations. There is barely any time left for Q & A. Thus, despite the good work, novel treatment and authoritative answers given, patients often leave without hope and instead with info-overload, multiple prescriptions (on top of existing unwanted multiple prescriptions) and an ominous concern about their well being.
The lack of optimism turns negative by well-intentioned interlopers, television ads, glum, pharmacy visits, medical bills and the firm belief that "medications can't be good for me" and "my labs don't look as good as the doctor says they do" (whats with those red out of ranges?).
So the prescription goes unfilled or the medicine only tried once or half taken. Although patients accept your prescription and orders, it is like you accepting your grandmother's pitch to taste her soursop pie even before you accept, your face goes sour and you think "thanks but no thanks".
Imagine if we offered hope to every patient, maybe even at every visit. Sometimes hope needs to be delivered through established goals. Hope, goals and a principle of behavior are a positive, smart, prescription that irrefutably engages the patient and makes them partly responsible for their own healthcare outcomes.
Giving hope may involve:
Discussing the range of possibilities
Expressing alternative or creative options that are better aligned with the patients realities or sensibilities
Discussing a time table for results, response and medical outcomes
Sure there are times when hope is not appropriate; but open conversation, guidance and goals can be as comforting as hope.
What is the worst thing a physician can say to a patient? "There is nothing that can be done for you"
Conversely, hope may be the best thing you can give to your patients.
Hope is the "Art of Medicine". The quest for excellence in medicine is sometimes at the expense of hope. Patients are more likely to listen to hope than science.
Shouldn't they be given both?
My answer is YES.
I present this blog as I see patients that join our practice for care and likely hope. Most of them remain, some of them chose to leave. In the end, I hope my message is imprinted in our patients regardless of where they choose to be cared for. Always reach for that answer.
Everything will be alright in the end; and if it is not alright, then its not yet the end.
-Suni Kapoor ( from the Best Exotic Marigold Hotel)