Dialogue Volume 12 Issue 3 2016 - Page 34

practice partner doesn’t mean you’re listening to them ing.” Did doctors understand Jerry’s fully,” he says. That requires probing, unique history and personality? Did and sometimes getting at the patient’s Jerry know how desperate surgery was, “If you’re not real agenda (or getting beyond your that there was no chance of a cure? own initial views). Was he aware of the possible complicainterested in a “If you’re not interested in a patient’s tions? Everything was being done to patient’s story, story, you’re not interested in medicine keep Jerry alive, says Dr. Hébert, “but you’re not frankly,” he says. “Medicine requires sometimes communications is the really caring about a patient. It’s a core clinical skill needed most.” interested in ethical skill.” He tells another story about a medicine frankly” woman he calls Mary. She felt unwell, Show that you care with slightly enlarged neck glands and red spots on her torso. The spots He learned that not only as a doctor spread to her limbs and itched. Her but also as a patient. Dr. Hébert was GP wondered if Mary had bedbugs. One dermatolodiagnosed with Parkinson’s disease in his 40s, and from gist told Mary she had neurotic eczema (and later 2005-2009 underwent six major surgeries for serious suggested that she meditate). A second dermatologist back problems. His illness and disability caused him to said Mary must have hidden psychological issues. A retire from practice (but not from medicine). fourth doctor (“This is the last!” said her referring GP) The experience was instructive. Dr. Hébert didn’t said Mary had an uncommon rash called dermatitis always feel empathy from the health-care professionals herpetiformis. treating him. For instance, they didn’t grasp the extent Even when the rash improved, Mary was listless. She of his suffering and how it was affecting his life, his lost weight, felt swelling in her neck and had severe ability to do things and his relationships. back pain. Now her GP prescribed anti-inflammatory “They sometimes have a superficial approach to pain, pills and pain medication. Finally, Mary got a referral and don’t understand the multidimensional aspects,” to a hematologist, who ordered a battery of tests. Two he says. “I learned how deep despair can be, and how years after Mary first saw her GP about the rash, she terrible it is when people don’t listen to you. I’m now was diagnosed with non-Hodgkin’s lymphoma. A large more attentive to the stories of people’s suffering, not lymphoma-related mass was pressing on her spinal cord. just the physical pain but the psychological. It’s so Today, Mary is fine. Dr. Hébert suggests that Mary’s important to have a health-care professional acknowlinitial practitioners “failed the empathy exam”. They edge that. It shows that someone cares about you, and didn’t imagine themselves in her shoes or ask how her is concerned about your condition as a whole.” symptoms were affecting her life. They neglected to There’s much talk about personalized medicine, fully consider symptoms that didn’t fit their diagnoaround diseases and more tailored treatments. That’s sis. And they didn’t tease out Mary’s views about her the technical notion of personalization. “Personalcondition. ized medicine also means understanding the patient’s Without Mary’s strong voice, only the voices of the unique needs, wishes, beliefs and values. That’s somedoctors were heard, says Dr. Hébert. What would it time harder to do.” have taken to figure out she was seriously ill? Not necYet it’s essential. On the last page of his book, Dr. essarily more time or resources, he writes, but following Hébert circles back to the thought he introduced at the this mantra: “Know thy patient well.” outset. “No matter how simple or complex our illnesses Dr. Hébert submits that at least 80% of diagnoses may be,” he writes, “the empathic connection between can be made simply by talking with a patient, not by patients and physicians is the moral core of medical tests or procedures. “You can hear somebody, but it care. It is the art of good medicine.” MD 34 Dialogue Issue 3, 2016