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Dr. Jeff Kane: What’s going on

 

“Tell me about yourself.”

This was the way a medical classmate of mine, a psychiatrist, greeted every new patient. It’s a great opener, since that’s what psychiatry’s about, after all. But as a doctor and well-experienced patient myself, I wonder why docs don’t generally do that, since it would benefit all concerned.

For docs, perceiving patients in a scope wider than the diagnostic quest makes their work come alive … and, sadly, vice-versa. Patients have told me about medical groups that assiduously avoid that dimension, preferring to act as factories specializing in one or two procedures. That’s efficient, but it’s all these docs do. They remind me of Charlie Chaplin, who, on an assembly line in the film “Modern Times,” turns robotic.



In contrast, the docs I’ve known who returned to their practice after recovering from serious illness have made a point of getting more familiar with their patients. Evidently they learned something important at the other end of the stethoscope.

My best medical mentor, Dr. Elsie Giorgi, confided to me fifty years ago, “Listen to your patients carefully, and they’ll tell you exactly what’s going on.” She meant more than diagnosis. Comprehending all of what’s going on enlivens the practice and more deeply satisfies both parties.



A personal relationship also aids treatment. Depending on its gravity, our illness is more than physical derangement: we’re emotionally upset. This is no small matter. What disturbs you more, having a tumor or worrying about it? Anyone who’s been sick recognizes these two faces of illness, but we generally regard the emotional discomfort — called “suffering” — as an unfortunate side effect, and not the inevitable half of illness.

I’m continually surprised that in today’s medical training and practice we still limit intervention to the physical. Any humane skills — interest, curiosity, compassion — that practitioners bring to the exam room result from their personal development, often despite their training.

Several years ago I substitute-taught in an acclaimed “bedside manner” medical school course. Its syllabus offered sections on ethnic differences, forms of address, nontechnical explanations, and so on. All good stuff, but nothing on how to simply sit still and listen to people. There’s hardly any healthcare institution that doesn’t claim to address the “whole patient.” While that sounds ideal, we already know that words are vapor, and only action counts.

But is the “whole patient” the doctor’s responsibility? After all, the system already suffers from too many patients and too little time. Still, those who appreciate deeper contact will always find a way to do it. Besides, patients can go elsewhere, too — like to counselors or support groups — just like they now go elsewhere for X-rays and blood tests.

In any case, the impersonal medical style won’t warm up until practitioners liberate themselves from assembly lines and patients insist on more personal relationships.

Jeff Kane is a physician and writer in Nevada City


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