Dr. Jeff Kane: Advice from Cole Porter
Our popular image of the doctor as a white-coated, objective medical scientist has been apt during the past century, when our greatest medical advances were scientific. In fact, we justifiably think so highly of science that in our secular culture it’s arguably a major religion featuring the physician as priest. My parents’ generation took the word of doctors as gospel. If, when I was a child, my doctor had recommended sewing my elbows together, my mother would have enthusiastically acceded.
But only half of medicine is science. Our professional forbears perennially advised that it’s both a science and an art. That maxim sounds grand, but the sad fact is that docs aren’t taught the art, only the science. It’s like knowing only a coin’s heads and nothing of its tails.
Unless the art informs our practice, an entire profile of sick people will remain invisible to us. To the extent we comprehend patients as disordered physiologies begging repair, we act as technicians rather than healers.
Here’s how Cole Porter put it in his song, “The Physician”:
He said my bronchial tubes were entrancing,
My epiglottis filled him with glee,
He simply loved my larynx
And went wild about my pharynx,
But he never said he loved me.
He doesn’t have to love me, only empathize: appreciate my individual personhood, witness my suffering.
However the deficiency disturbs patients, it outright damages physicians. Not long ago I witnessed an encounter between a young woman with severe rheumatoid arthritis and Dr. N, whom I know as a loving human being. Describing her pain, the patient cried. I watched the doctor. If I could see the thought balloon over his head, it was something like this:
“My goodness, this poor young woman is suffering something awful; I want to get up and just hold her; on the other hand, that’s not very professional.”
He wrung his hands, his left and right sides wrestling. In the end, he stayed put, resumed a passive face, and wrote her a prescription for a more potent painkiller.
Afterward, I couldn’t help but ask the doctor how he felt. He said, “Ripped in half.”
“Ripped in half? Can you say more about that?”
“No,” he answered. “I don’t want to talk about it now. I have more patients to see.”
Suffering that’s buried is buried alive. Over years and decades, suffering accumulates in us docs like a festering abscess that becomes systemically toxic. Look up physicians’ rates of divorce, drug dependence and alcoholism. American doctors’ current suicide rate, about four hundred annually, amounts to losing an entire medical school every year. My profession’s statistics are grim enough for a few docs here and there to realize they’re tired of holding that clinical-distance pose. But they need help, since it’s less a doctor problem than a cultural conspiracy.
We’ve too long considered healthcare an exclusively scientific realm. Without skimping on science at all, we can rebalance by recognizing what’s ever more obvious: since our medical conditions are exquisitely personal, impersonal healthcare styles might hit the target, but never the bullseye.
Not long ago, while I was undergoing complex clinical testing, my doctor rushed into the room, ran past me, and glued himself to the computer screen. I cleared my throat. “Ah, Richard, I’m here, too. Remember me?”
“Oh,” he sheepishly replied. “Oh yeah. How are you doing?”
“Pretty well, as a matter of fact. How are you doing? No. Really.”
Constant, friendly reminders of the humanity at both ends of the stethoscope might be all it takes.
Jeff Kane is a physician and writer in Nevada City.
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