COMPASSION AND DOCTORING

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When I think about my health care education several words come to mind. They include:

  • science

  • anatomy and physiology

  • analysis

  • pathology

  • disease

  • diagnosis

  • treatment

All of these words were part of an excellent education that taught me the science of health care. They provided basic skills to evaluate TANGIBLE conditions with treatment protocols that followed algorithms usually resulting in satisfactory patient outcomes. We were taught to rely on this education for the definitive ANSWERS designed to solve the problems our patients came to us with.

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As the years went by, clinical experience created insight that improved my skills to diagnose the patient often before an exam was even performed. I knew that 50 year old Mrs. “X” who was overweight, sedentary and ate an unhealthy diet complaining of numbness and pain in her feet was likely experiencing diabetic neuropathy (nerve pain.) I knew that 60 year old Mr. “Y” who smoked 2 packs of cigarettes a day for the last 40 years complaining of shortness of breath, a chronic cough and wheezing was likely suffering from Chronic Obstructive Pulmonary Disease. It almost became a game. Even though the diagnosis usually seemed pretty clear, I made sure to follow all the proper protocols to be thorough in my investigation of their problems. After all, this was the definition of being a “good doctor.”

Then one day it happened. The case involved a 15 year old girl who came to my clinic with her father suffering from recurring headaches. After performing a thorough exam I noticed her gait (the way she walked) was off. After taking an x-ray, I discovered an aggressive growth in the girl’s femur (thigh bone.) I referred this girl for an orthopedic consult which lead to surgery two days later. The surgeon told the family the child would have needed a hip replacement (at 15 years of age) if I had not discovered the tumor when I did.

Again, I was very proud of myself for being “that good” and exceeding the standards of typical care. As I was gloating to myself, my staff informed me the girl’s records were being requested for transfer to another doctor’s office. You see, the family called my office (not to thank me for looking beyond their daughter’s complaint of headaches) but rather to have their daughter’s files transferred to another doctor who participated in their insurance plan.

 

imagesHow dare they make me feel like I’m just another doctor that can be replaced by any other doctor. How dare they act so unemotionally and treat the matter in such a business minded fashion focused on the financial aspect of insurance reimbursement. I was angry and personally hurt by their response.

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That’s when I began to realize how patient’s felt when I simply “dismissed” them after treating their complaints. “Who’s next?” How relevant were they as people once their “condition” was addressed? These were human beings seen through tunnel vision as nothing more than diagnoses and treatments that generated my income. What about the rest of the person? Did it matter, or would it simply interfere with my ability to see another patient?

This was my  “Ah-ha” moment. It’s not that I was cold hearted, but rather focused on doing (what I believed) was my job. This was the moment I decided to open my eyes and actually SEE MY PATIENTS IN THEIR ENTIRETY AS A WHOLE PERSON. I began to learn how their ATTITUDES affected their BEHAVIOR that affected their HEALTH. I began to learn how to integrate the EMOTIONAL side of people into the health equation. I began to understand, experience and share two emotions with my patients my education excluded from its curriculum; EMPATHY and COMPASSION.

Not only was this not taught in school, it was rarely discussed. We learned the science, but not the humanity. We focused on saving lives without ever thinking to ask the patient, “is this what you want?” We addressed PAIN with various modalities and chemicals, but never thought to address pain by sitting down and talking to our patients about life and their families. This simple act of compassion is more capable of reducing pain and accelerate healing than most doctor’s realize. As I began to see my patients in a whole new light, I was able to help them achieve a better state of BALANCE resulting in a better state of HEALTH. My practice became FUN as I began seeing more and more patient’s smile and appreciate their lives and the quality of health they were achieving. The business side of health care that required so much energy no longer dominated my emotions. I began to learn and see the qualitative benefits even dying patients gained from the time we shared during office visits. You see, besides the clinical responsibilities performed, we discussed LIFE and LIVING.

In retrospect, I never had the chance to thank the parents of that 15 year old girl for inadvertently teaching me one of the most important lessons I learned during my years in practice. I have, however, learned to replace the ANGER I felt toward them with the GRATITUDE I feel today. Not only did this lesson help me become a better doctor, it helped me become a better person.

Passion

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62 comments

  1. I used to have a doctor who could see patients “in their entirety as a whole person”. He retired. Was many years later I found another who left to work for the VA. He felt the deserved good doctors (they DO). I understood but it still hurt to lose him. I find after a while, as a patient, I get tired of looking for that “good doctor”. After a while, when I am doing all I know to do with diet, exercise, follow medication protocol – get my BP down, my cholesterol down, A1C down … and still live with pain and misery … one wears out in the search for a doctor who wants to work WITH me not just ON me.
    We need a lot more doctors who, like you, see patients as people, not just a sack of symptoms.
    Thank you for reminding me there are some out there – if we keep up the search we may just find one.

    Liked by 3 people

    1. I know it’s frustrating, but these doctors really do exist. The system often makes it difficult for the doctor to follow a creative course of action that differs from the standard protocol. It can lead to reprimand and ultimately dismissal. The doctor is often caught in this scenario “between a rock and hard place.”

      Liked by 2 people

      1. Horrible! And the medical care system does not look to be getting any better any time soon! 😦

        Liked by 1 person

        1. There is a faction branching off from various disciplines including medical, chiropractic and naturopathic healthcare called FUNCTIONAL MEDICINE. I believe this is an important added piece to our future approach to disease and dysfunction. It addresses the individual as a WHOLE PERSON and incorporates various options in a treatment plan that address the various deficiencies helping restore GOOD HEALTH to the patient.

          Liked by 1 person

          1. Is this something that is beginning in the Chiropractic circles and reaching out? How do I find someone who practices this way? Are these practitioners different from holistic healers, and if so, how are they different?

            Liked by 1 person

            1. Doctors of different disciplines have found an approach to disease and health that was lacking. Dr. Mark Hyman works at Cleveland Clinic and continues to implement this approach within his practice. I will give you a link you can check out to find a certified practitioner if one exists where you live. The link is https://www.functionalmedicine.org/practitioner_search.aspx?id=117
              Holistic healer means different things to different people. This approach seeks deficiencies in various areas and addresses ALL of them rather than simply the symptoms resulting from them.

              Liked by 1 person

              1. Thank you for the link. I will definitely follow-up on this information!

                Liked by 1 person

  2. Its been a while since I’ve stopped by to read your blog, Doc. Busy, busy. I’ve missed it! You. The sense you bring to the process of helping others through your particular gifting, it’s make me truly glad for those who were your patients. It’s a blessing to have a doctor who listens, empathizes, and helps, going that extra mile to understand the whole person. Yesterday I finally got to a new Chiro near my work. He had two wee patients come in while I was waiting. He started their session with a race, running behind them as their arms and legs flailed and their giggles filled the outer office, before willingly settling in for their adjustments. He won me over in those moments!

    I’m hooked, because he cared enough to be silly with little girls. So. Much. Fun!

    Liked by 3 people

    1. There are so many good doctors in so many disciplines. I’m glad you experienced such a good first impression. I hope your experience with him provides ideas and a realistic game plan to help you achieve the goals you desire..

      Liked by 2 people

  3. A compassionate read that tugged our hearts.

    What else could the fifteen year old’s family feel? Grateful you diagnosed their daughter, but you were just another doctor like their daughter was just another patient. It is a shame the humanity of the profession is often lost.

    Empathy, compassin, and humanity are not discussed during the education process? What about the prevention of illnesses and eating healthier, these topics aren’t part of
    an MD’s education?

    Liked by 2 people

    1. You bring up many good questions. The education often focuses on cause and effect. If you haven’t seen the movie, Patch Adams (starring Robin Williams) you should rent it. You won’t be disappointed! Many people would be surprised by what they would ASSUME to be inclusive in a doctor’s education. Health care has reached a point where more and more doctors are seeking new answers to health problems frustrated with the lack of success their patient’s experience. I believe our future doctors (in all disciplines) will begin addressing their patients as WHOLE PERSONS and begin identifying the different CAUSES (components) that will result in the restoration of GOOD HEALTH rather than the maintenance of chronic disease.

      Liked by 2 people

      1. Yes, I have seen the movie several times.

        Hopefully, I won’t be too old and gray when that day finally comes along.

        Liked by 1 person

        1. Hopefully you won’t need these docs for many many many many years until you’re old and gray (or in my case, bald! 😀 )

          Liked by 1 person

  4. In my illness battle with numerous doctors I would say I rarely found compassion. More like a rushed doctor who makes you wait hours and than rushes in not listening and prescribed you something. Out of 20 doctors I have found 1, yes only 1 who looks at me when we have a conversation and actually listens to me. Both doctor and patient need to communicate and work together. I get busy, i get stressed but that is not an excuse for not showing compassion, care and listening to your patient. The residents are usually the ones who listen and discuss and take their time. I wonder if doctors lose the patient care part along the way? Hopefully there are more doctors out there like you, am still looking.

    Liked by 1 person

    1. Thank you for your kind words. There are plenty of good qualified compassionate doctors in all disciplines. I recommend that people do some homework BEFORE health concerns arise and interview various doctors in order to establish a TEAM of professionals to utilize when needed. I also encourage people to seek various types of primary doctors (naturopaths, chiropractors, internists, asian medicine practitioners, ayurvedic physicians, etc…to provide various perspectives and options as well. You will find the time spent creating this TEAM is absolutely worth it!

      Liked by 1 person

  5. You blessed me this, your heart is so big that occupies the soul and the inner being of your patients. I wish that there are more Doctor like you. Please take good care of yourself Doc. for there are people who needs a kind of Doctor like you.

    Liked by 2 people

    1. You are a very kind man for saying these nice things. I hope you are finding a healthy path to follow that brings you much joy and happiness in this world.

      Liked by 1 person

      1. Wow, thank you for all your good wish. God bless Doc.

        Liked by 1 person

  6. There is a lesson in this for all of us, Jonathan! Thank you for sharing.

    Liked by 1 person

    1. I hope people walk away from this article realizing the strength and commitment found in the doctor/patient relationship is far more complicated and important than simply a diagnosis and treatment.

      Liked by 1 person

  7. This is a great post. Your openness on how you were feeling at the time when the girls parents wanted to swtich doctors allowed us to see the reasoning behnd your lightbulb “ah ha!” moment which makes the lesson so much easier to grasp.

    I enjoyed too what you say about learning about the science but not the humanity. That is a powerful statement and one I wish more intellectuals would take to heart.

    I think most people naturally fear showing vulnerability as a defensive measure. It’s the best way to relate to others though and is why I so appreciate when bloggers open their hearts up like you do. It definitely helps us non medical professionals get a peek behind the curtain as to what you doctors go through. I am sure it is not easy!

    Liked by 1 person

    1. Thank you so much for all your kind words and understanding. I’m sure all professions have their difficulties and challenges. Physicians have to learn their place in ASSISTING their patients with their health care needs rather than assuming it is their responsibility to take “control” of the decision making process and dictate the treatment plan. This doesn’t reduce the importance or the role of the doctor. It simply removes the pedestal and places the doctor and patient on the same ground in a better position to communicate intentions. Treatments options should be SUGGESTED (not decided) by the physician. This provides choice that would lead to a mutually agreed upon treatment plan that would likely be followed with greater compliance. This is a more humanistic and respectful approach to patient care that offers better outcomes.

      Liked by 1 person

  8. The simple fact of the matter is that if I could hug you right through this screen I would!! What a wonderful post this was to read! Your ah ha moment made my heart swell and I love it when that happens! Im very glad to be following your blog 🙂

    Liked by 1 person

    1. Thank you very much for being so kind.

      Everyone sees life from their own perspective. I thought by sharing my experiences, the world just might develop a better understanding of the emotional challenges that BOTH the doctor and patient experience.

      Liked by 1 person

      1. Yes sharing that experience with all of us out here was very thoughtful of you. You most definitely have given me a better understanding of what doctors go through. Sometimes its nice to have a reminder that no matter the degree on their wall they are human first. Carrying the weight of their own worries and needs as well as their patients. All it took was for me to read your post and I truly have found compassion for my doctors! So thank you for that! Your patients must just love you!

        Liked by 1 person

        1. I believe they term it, “a love/hate relationship.” They know I love them and I know they hate me gently, but persistently making certain they comply with the treatment plans they agreed to follow. Sometimes I think I care more about their well being than they do! Regardless, they are truly special people that will always have a special place in my heart. 🙂

          Liked by 1 person

          1. You might be right! Judging how some of my family members ‘care’ for their own well being. They might not like that you expect them to follow through with their plans but I cant imagine anyone hating you! 🙂

            Liked by 1 person

            1. They don’t really hate me personally; they hate knowing I will follow up with them and politely “inquire” about their ongoing progress. Prior to retiring I used to joke about building confessionals for my treatment rooms. I would walk in and say “good morning” and patients might respond with, “I haven’t been drinking as much water as I should and I didn’t exercise this week.” I would laugh, tell them to relax and say, “let’s try this again, good morning.” 🙂

              Liked by 2 people

              1. yes maybe you were the angel on their shoulder and they spent the week listening to the devil on the other. They felt guilty or nervous and just spilled their guts right away haha! Im sure just from our comments back and forth out here in the land of blog that you were a great support to them all 🙂 and even being retired I have no doubt that they carry your advise with them still! So do you ever think about that? You are still helping them you know.

                Liked by 1 person

                1. If my patients remain on course and continue to follow their new chosen paths in life, I would like to believe my “legacy” will live on. I am humbled and thankful that so many people have given me the opportunity to earn their trust and accepted my recommended guidance for so many years. I have as much admiration for them and all their hard work as they may have for me. It was a wonderful career I would choose to re-live if I had to start it all over again.

                  Liked by 1 person

                2. That is lovely! No two ways about it! Just lovely! 🙂

                  Liked by 1 person

  9. Its really diificult as a patient when you are not seen as a whole person. So many things effect our health. Thanks for addressing this.

    Liked by 2 people

    1. So true. This is why patients need to communicate their needs with their physicians. If the two are not on the same page it becomes difficult to “make a square peg fit into a round hole.”

      Liked by 1 person

  10. Wonderful post Dr. J. – I certainly appreciate doctors who are genuinely interested in a patients wellbeing. I especially understand the importance of this aspect at this point in my life. Hope you have a happy day, thank you for this post.

    Liked by 1 person

    1. Thank you so much, Gary. I know you have been through quite a run and hope your journey will soon reach a point where new opportunities and blessings await. You have many followers that truly care about you; so much so the love they share with you resonates in their comments. I wish for you good health, happiness and many joyous memories with each passing day.

      Liked by 1 person

  11. Thank you, for becoming the kind of doctor every patient needs in their time of need.

    Liked by 1 person

  12. Thank you for all your kind words.
    In reality, all I did was exactly what I asked from my patients; I did the best job I was capable of. I was raised by parents with very strong ethics. I was told, “if you are going to accept the responsibility to undertake a job or assignment, do it to the best of your ability, or don’t bother doing it at all!” I took their words and values to heart.

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  13. I am really blessed with a doctor that asks me how everything else is, is my life, and a surgeon that takes time to listen. That being said, both are in my insurance network.

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    1. That is called a double blessing. I (basically) avoided participating with insurance companies during my career. I chose to spend my time with patients rather than sharing their time with the massive paper work required by insurance participation. In a group practice, staff is paid by the corporation to do much of this work. In a private practice, the doctor assumes much of this responsibility.

      Finding good quality physicians is the responsibility of the patient if they want quality care. Often, this responsibility is thrust upon a primary doctor that people often randomly pick from a list within their insurance network. Recommendations are often based on fellow employees within the corporate grouping rather than clinical experience and expertise. The consumer may want to consider using the corporate model for hiring as their model for “hiring” their physicians. This includes interviewing them and finding the best choices based on experience, expertise AND CAPABILITY TO LISTEN, HEAR AND UNDERSTAND THE PATIENT’S WISHES.

      This approach offers the consumer a better chance to find a quality doctor (of any discipline) they will have greater confidence in and likely comply with treatment recommendations achieving better outcomes.

      Liked by 1 person

      1. I never thought about interviewing a dr. I just muddled along until I was ticked enough, then found someone (in this case) closer to home on my list. I am lol, though, remembering some of my physicians.

        Liked by 1 person

        1. We prepare Wills, we purchase insurance policies. Why shouldn’t we prepare a team of physicians BEFORE an emergency occurs? I call this, “thinking outside the box” and encourage people to consider this option to save them time and aggravation should an emergency arise.

          Liked by 1 person

  14. This is why I don’t go to the doctor. My medical plan has commercials that claim they care and want people to thrive and be healthy, but their doctors, the ones I have experienced do not adequately mirror that marketing line. Or perhaps their idea of thriving and being “healthy” is just to treat the symptoms and not the actual issue. To dismiss things because, “Well, you are getting older.” Oh well.

    Liked by 1 person

    1. I understand your response. Many people feel like you do. The system has truly failed the consumer/patient. This, however, doesn’t mean that good quality doctors don’t exist. Just like anyone else you’re considering “hiring,” doctors should be interviewed to find one that matches the skill level and personality sought. It is worth the time and effort.

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      1. Yes, doctors should be interviewed, but I am not sure that my health provider allows for that. When I signed up I was told I had to pick one. I went to her twice and after the second visit when she laughed at me and sent me to a specialist who laughed at me, I have not been back. I wish my health provider allowed for more “holistic” approaches as opposed to just the pharmaceutical. But perhaps one day.

        Liked by 1 person

        1. In my opinion, any doctor or doctor’s corporate office unwilling to schedule a brief (5 minute) FREE consultation to determine whether the two of you have a compatible approach to health, is a doctor’s office that can be removed from a list of choices. If they don’t have 5 minutes for you when you’re healthy, how do you know they will provide adequate time when you’re sick or hurt.

          When we pay for a service or product, we get to participate in the terms of the agreement. If more people began thinking in these terms, doctors would be more responsive to our concerns and our health needs.

          Liked by 1 person

          1. Yeah, there is a lot that could be changed in the way we think about “healthcare”. 🙂

            Liked by 1 person

    2. Unfortunately, I don’t see how a doctor is incentivized to put in the extra effort.

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  15. They are *both* good reasons to be proud: diagnosing the teen’s unusual condition and making lemonade from lemons when the family switched to an in-network doctor.

    Liked by 1 person

    1. Thank you. Life is too short to live it focused on anger and frustration. If we are willing to step back from our emotions just long enough to think whether they are increasing or decreasing our quality of life, we just might discover a method to achieve a better outlook on life.

      Liked by 1 person

  16. I hated to have to change my MD because of Insurance coverage….I couldn’t afford to continue with my GP, really had no choice but to change because of finance, however, I have in the past made appointments to go in and say thank you for taking care of me and speak personally with my MD and let him know that due to the conflict of insurances coverages I had no choice…I also followed up with a thank you card for caring about me…..however I am not sure all MD’s care if the patients ever come back…seems they are overloaded….glad you were able to learn from this patient and the family…I am sure they did not want to see a different MD but financially they were unable to continue with you….a lot of people don’t thing to call and say thank you….not sure why, but most people I have spoken to never give their MD a second thought…..sad!! Kat

    Liked by 1 person

    1. I certainly understand the financial strain people are under. Sometimes I think, however, that people don’t actually think in terms of cost, but rather are programmed to find “in network” doctors by insurance companies. Many are unaware that flexibility in pricing exists for non participating providers. Regardless, this young adolescent would have undergone a surgical procedure, rehab and future surgical procedures (based on her age.) I assure you the cost (both financial and physical) would have exceeded my office visit. Regardless, if people are unhappy with the system, it will never change if people follow it anyway. Their complaints lead to ongoing frustration resulting in greater dissatisfaction. It is my opinion people are better off accepting what is, or stepping up, and ACTIVELY participating in CHANGE.

      I’m sure your doctor appreciated all the effort you put in. Most people simply walk away. People must also remember the cost of healthcare correlates with the patient’s willingness to take responsibility for their lifestyle. For the average person choosing to live an unhealthy style and then complain about “network” or “out of network providers” (and their costs,) one must question whether these individuals realize THEIR LIFESTYLE is the ROOT CAUSE of this problem?

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      1. How true…the in-network doctors, PT, OT and the rest of the medical world that has become second nature to insurance…I did ask if they could lower their visit rate so I could keep my Md and they (the complete office of MDs) were not willing to do it, it was a large office with 10+ doctors and the census was if we do it for one, then we have to do it for all….so that was that….kinda disappointing to me but it was what it was…I learned to well the cost of health care when I needed a D & C and needed to pay out of pocket as I didn’t have insurance…the price was over the top…I wasn’t having open heart surgery!! It was almost 40K….for less than 10 minutes of time…..I know, all the up to and after has to be condidered, but when I challenged the hospital they said that they had to raise the price to help pay for the uninsured….I reminded them that was me..LOL..I was one of the lucky ones I guess, I kept fighting it and challenging them and I walked away paying only 11 thousand….still way to much for less than 3 hours in the hospital start to finish…I did my home work and brought them prices from other acute hospitals….and kept reminding them I didn’t feel it was my place to pay for the homeless in town, that was where they should pick up the price…but I understand what your saying about taking control of you own health to keep from having health care cost skyrocket….but most people don’t even give it a second thought….

        Liked by 1 person

        1. Health care expenses are rising at a rate the average person simply can’t afford. I know some offices that have thrown insurance out the window and replaced it with a “pay what you can” with a recommended cost provided.

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          1. that’s always nice to see….the insurance companies are out of control…pretty insane

            Liked by 1 person

  17. Reblogged this on disue.

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  18. The Modern GP · · Reply

    Amazing post

    Liked by 1 person

    1. Thank you for taking your time to read my article. It is greatly appreciated.

      Like

  19. You are a very good doctor just by the fact you take the time to analyze a situation and react accordingly.

    Liked by 1 person

    1. Thank you for the compliment. I am critical about our health care system because I want those inside and outside its framework to open their eyes to weaknesses permitting ongoing growth and improvement to our system. We must learn to be more responsive to the patient’s needs. We must be more open minded to quality efficacious treatments that DIFFER from our own traditional treatments. It is our responsibility to extend our limited knowledge (based on our educational system) by reading, discussing and taking course work to expand our “arsenal” of tools to help our patients achieve a better quality of health and life. Those only willing to work within the confines of traditional care may very well jeopardize their patient’s health. This is unacceptable because an individual’s EGO does not outweigh the ethical and moral responsibility that accompanies the title “physician.”

      I wish you much success on your current journey toward achieving BALANCE in your life (both mentally and physically.) A positive ATTITUDE is an important starting point. You already seem to possess this. Finding good doctors willing to evaluate and treat you as a WHOLE PERSON is equally important. I suggest creating a “TEAM” of quality doctors adding their individual expertise to restoring the imbalances that currently exist. This approach strengthens existing HEALTHY cells while creating an “unfriendly environment” for UNHEALTHY cells. Only you, however, can determine the path that best suites your personal needs.

      Stay positive while becoming healthy again!

      Liked by 1 person

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