Wednesday, February 10, 2016

Finding Encouragement In The Doctor’s Office

Book Review
Compassionate Medicine: There is healing power in words; if you have been on the receiving end of encouraging words, when needed, you will understand their meaning and power to both soothe and heal. Dr. Bomback writes in Los Angeles Review of Books: “In The Lost Art of Healing, Lown recalls the simple advice he received from a Siberian physician — ‘Every time a doctor sees a patient, the patient should feel better as a result’ — and spends most of his book trying to convince his readers that physician-patient dialogue is the only reliable way to ensure a positive medical outcome.”
Photo Credit & Source: LARB

Never underestimate the healing power of compassionate words, and all the more so when they are part of the traditional physician-patient dialogue taking place daily in the doctor’s office. How a doctor conveys medical news can affect a patient’s well-being and health. Such is the essential point of a book review article, by Andrew Bomback, in the Los Angeles Review of Books.

In “Don’t Let Me Be Lonely, Doctor: On Epigenetics, Placebos, and ‘The Lost Art of Healing’ ” (February 4, 2016), Bomback, a medical doctor practicing in New York, writes:
This year marks the 20th anniversary of Bernard Lown’s The Lost Art of Healing. Lown, now 94 years old, is a retired cardiologist best known for developing the direct current defibrillator used to resuscitate victims of cardiac arrests. He also accepted the Nobel Peace Prize in 1985 on behalf of International Physicians for the Prevention of Nuclear War, an organization he co-founded with a Russian cardiologist. Lown’s 1996 memoir, though, will also be one of his lasting legacies. The book is still distributed to first-year medical students around the world, part pleasure-reading gift and part instruction manual for the career they’ve chosen.
In The Lost Art of Healing, Lown recalls the simple advice he received from a Siberian physician — “Every time a doctor sees a patient, the patient should feel better as a result” — and spends most of his book trying to convince his readers that physician-patient dialogue is the only reliable way to ensure a positive medical outcome. “I know of few remedies more powerful than a carefully chosen word,” writes Lown. “Patients crave caring, which is dispensed largely with words.”
I took care of Lillian before reading The Lost Art of Healing. When I read Lown’s memoir a few years later, her case kept popping into my head. My colleagues and I published the largest case series of fibrillary glomerulonephritis patients treated with rituximab to date, and Lillian is the clear outlier, the only patient with advanced kidney failure who responded to the drug. We had no explanation for her success. Lown probably would argue that my optimistic words were a key player. “I attempt to discover a silver lining in the cloudiest situation,” he writes. “This has little to do with truth or falsehood. It flows from the deepest intent of doctoring, to help a patient cope when a condition is hopeless and to recover whenever it is remotely possible.”
True enough; and truer words have never been spoken on the beneficial effects of compassion. Can it be that a good part of the illnesses that are present in our society are due to lack of compassion? This human emotion, an action on behalf of the other, can help not only in the prevention of some illnesses, but also improve the outcomes of individuals who are suffering illnesses. Again, compassion is part of what I would call complementary medicine. As the placebo effect shows, it is a powerful anodyne. As are healing thoughts.  (Rationalists beware. Optimists fare better when faced with a life-threatening medical diagnosis.)

We do not understand why this is so from a scientific point of view, but we do feel emotional satisfaction and find it a benefit to our being when in the presence of someone who cares. As is the emotional connection made, when someone shows a personal interest, especially if that person is a medical doctor who has specialized knowledge. How this works is less important than why it works, or, more to the point, that it works. This is not a warm. fuzzy feeling; it is bettering emotional health, which has an important place in modern medicine.

Alienation and loneliness are often seen as social ills, as abnormal behaviours, when in fact they are normal responses to modern life today. Such “negative” feelings are accentuated in times of change and crisis. Many times people feel very alone in the doctor's office, afraid of the news. When doctor’s act as a patient’s advocate, working together, to get a positive outcome, I suspect that the results are significantly better. As are acts of kindness.

I was fortunate to have found an excellent and compassionate family physician (Dr. G.) before I began chemotherapy. (Our family had recently moved to Toronto.) Dr. G. was encouraging and also used soothing words. I still can remember this time in my life; and I believe that I will carry this memory forever, such is its importance.

Kindness does not have to be the enemy of science or of reality.

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