Physician, Be Still
By Richard Payne, MD
Last month my sister spent 10 days in the ICU receiving treatment for a stroke and pneumonia. The ICU, while efficient, is not a calm place. I admire the efficiency of medical professionals, but as I sat with my family, trying to be with my sister, trying not to be in the way, trying not to give in to the angst and bustle of the environment and situation, efficiency became anxiety.
The scene was nothing like the iconic Sir Samuel Luke Fildes painting of an attending physician where the great feeling is stillness. Though this classic painting hangs in medical offices throughout the world, it emphasizes what healthcare environments fail to be.
Today, all too often patients and families are rushed into harried physician’s offices to be seen in seven to 10 minutes as demanded by productivity guidelines and the economic needs of the medical practice. Such a rush is typical even when patients have several medical conditions and are taking multiple medications.
Physicians may spend even less time on hospital rounds with acutely ill patients, preferring to scour laboratory test results or review diagnostic images, which have unprecedented capacity to “see” anatomy and pathology. But advanced imaging techniques do not see the patient’s fear and alienation; no diagnostic gives physicians a readout of the loneliness a patient feels in the dull hospital afternoon.
Often, specialists caring for the acutely ill have no established relationship with patients, don’t have time to develop such a relationship, and lack incentive and inclination to be interested in anything more than a professional, superficial, and utilitarian relationship.
These problematic contemporary medical practices are likely to become even more prevalent as our society wrestles with healthcare reform by cutting costs and demanding even more efficiency and productivity.
We are actually proud of the “harried” physician. With the popularity of medical dramas such as “ER,” “Scrubs,” and “Grey’s Anatomy,” television is crowded with images of frantic physicians. The most common theme of such shows is the breakneck pace. Physicians run from surgery to rounds to the cafeteria to rounds to the bar downtown and so on. Almost every conversation takes place in a hallway. Such shows reflect the present reality: we identify physicians with hectic and frenzied lives. Patients expect white flying coattails.
We’ve become technologically efficient enough to diagnose our patients without taking the time to be still and sit with them. Medical knowledge will always be incomplete if it lacks a relationship with the patient. It is only through relationship that values, personality, and soul emerge. These things make a body human as much as arms, legs, and organs. There can be no substitute for relationship in medical treatment.
Physicians truly do care for our patients. Unfortunately, the limitations of efficiency and business have caused many of us to lose sight of the person for all the care we provide. Physicians must slow down and be still in order to find relationships with their patients. Loud voices are needed to call us back to caring in the way of friends.
For these reasons we should applaud the wise decision of the Cunniff-Dixon Foundation and the Hastings Bioethics Center to begin a new award to recognize caring physicians. The purpose of the award is to hold up role models of clinical and doctoring practice in palliative and end-of-life care that focus on relationships as an integral part of medical care.
Because I am a doctor, my family often looks to me in times of medical crisis, but sitting in the ICU, surrounded by doctors and nurses and specialists and other medical professionals, what my family and sister needed was not more medical advice, not more procedures, but a brother. I’m a doctor, but sometimes the most important thing I can do is sit still.