When a patient goes to the doctor, they usually have a specific health problem in mind. Sometimes, the treatment is straightforward; a urinary tract infection warrants antibiotics. A laceration can be sutured. Other issues, however, are more complex. For example, communicating a terminal diagnosis to a patient. Consoling his grieving widow two months later. In circumstances like these, even if there is no cure, there is still space for healing.
Central to healing is compassion. In medical school, I remember a particular assigned reading on the topic. The article included tips like putting a hand on your patient’s shoulder to comfort them in times of need. Nod your head to show you’re listening. I thought it was funny that we were learning such a step-wise approach to showing that you care. Whether it comes naturally or is an acquired skill, compassion is deeply embedded in the role of a healthcare provider.
In the summer after my first year of medical school, I travelled to Honduras for an elective. I studied with a physician there whom I will never forget: Dr. Juan Almendares. He is an Internal Medicine specialist and was formerly the Dean of Medicine at a large university in Tegucigalpa, the capital city of Honduras. He practiced a combination of traditional and western medicine and ran a free clinic for people living in poverty.
After fully exploring the patient’s initial concern, Dr. Almendares would ask, What else is worrying you? The patient would go on to talk about another issue, and then he would repeat the same question. What else is worrying you? He would continue asking this until the patient had nothing else to say, really getting to the root of the problem. His patients loved him and felt heard. After this experience, I knew two things to be true. First, this doctor was a healer, and second, I wanted to be more like him.
It’s not that easy, though. Taking extra time with a patient in a strained healthcare system might not seem feasible for many of us. Our aging population adds to the pressure. I have to admit, sometimes I hesitate before asking What else is worrying you? I know how time-consuming it could become. Not only might I fall behind in my schedule, but the time I take could also affect my colleagues and my other patients who are waiting to be seen.
Is it better to see many patients quickly, or fewer, and really take time with each? I’m not sure what the right answer is, but perhaps it lies somewhere in the middle. I recently had a conversation with another physician whom I really respect about developing the skill of determining which patients need more time versus those who can be seen more quickly. Counselling someone about an addiction, for example, requires a more thorough approach than administering a vaccination.
Funding arrangements also affect how much time is spent with patients. In the fee-for-service model, doctors are paid based on how many patients are seen per day. This method of compensation could be a challenge given that there are many costs associated with running a practice. There are other funding models (e.g., salary, hourly, and others) which allow doctors to spend more time with their patients. Many governments are moving away from the fee-for-service funding model for this very reason.
We all know the saying “time heals all wounds.” Spending more time listening and getting to the root of a patient’s concern allows doctors to not only practice medicine, but to become healers.