When I accompany my wife to her cardiologist for her regular checkups, we would usually find ourselves in the company of other patients in the anteroom. We all wait silently for our turn to be called to get inside the doctor’s clinic.
However, my wife is a good trigger person. One casual question to the person beside her and a conversation starts. At first, it comes in trickles, and then it swells to an unstoppable torrent. Overhearing the thread, others would add to the exchange.
Human nature being what it is, people are normally predisposed to talk about themselves. What ails them, their age, their families, their problems and other ordinary details of their lives. I stay quiet but my ears are acutely tuned in to the chitchat because I’m on a constant lookout for materials for my think pieces.
One problem that crops up in every conversation is never having enough money to afford doctors’ fees and buy medicines.
The other issue is health illiteracy. Some say that they’ve stopped taking their medicines because they already were feeling well. Others say they sometimes resort to organic supplements because they’ve heard that prescriptive medicines are bad for the liver.
If the waiting at the anteroom takes long, the stories veer towards their families. Disputes with their children or with their spouses, in-laws or their neighbors. Dealing with a separated daughter with an autistic child. Problem spouses with toxic habits.
I can fill several notebooks of this stuff to help me conjure ideas for my various narrative writing projects.
But then at one point I thought, shouldn’t the doctor be the one listening to this? Shouldn’t a physician strive to know as much as he can about his patient’s lives to have a better handle on how to treat him? Someone should be recording their stories and come up with a body literature made available to students and practicing doctors.
Sure we are impressed with all the technology of diagnosing and treating diseases.
But the human aspect is mostly set aside. What happened to “the art” side of healing?
More and more young doctors are data-driven. Without even knowing the financial situation of the patient, the doctor writes an order for diagnostic test after another. X-rays, MRI, CT scan, blood chemistry tests. They cost. But the patient is left with no choice; the whole prognosis is based on those results. How about organic alternatives? Perish the thought. Most doctors trained in Western medicine would scoff at the idea.
But why not listen first before prescribing? This is a question I ask after so many years of going to doctors’ clinics. It’s not even rocket science, just simple common-sense logic.
In novels and films, there is such a thing as back-story. It is a set of events preceding and leading up to the present scene. It provides some missing details that help complete our understanding of the character in the film or novel and explain, for instance, why he behaves the way he does.
Many doctors don’t have the slightest interest to seek out the back-stories. They seem to forget that humans, unlike animals, can talk. Patients can tell doctors a lot about themselves (their peculiarities, their idiosyncracies, their limitations) that can help solve health problems in a way that is more enlightened and custom-tailored to each patient’s respective situation and habits.
This is why I believe we must add the study of the humanities in medical schools. Future doctors need to read literature and become adept in the use of narrative art as a tool in the healing process. In short, the doctor must learn to develop insights into human nature, learn to read human beings better. This needs intuition and empathy, which I think every human being is gifted with. One sage calls it “knowing from the heart.”
This is why I am all for the growing interest in narrative-based medicine (NBM), first used by Rita Charon in 2000 to describe “the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness.” In a nutshell, narrative medicine draws on the study of art and literature to enhance students’ listening and observation skills and to expand their view of patients to encompass more than just medical charts and diagnostic results.
Too bad the scientific evidence of the healing power of the narrative is sparse. NBM is not yet widely incorporated in clinical practice. More research is needed in this field of inquiry.
While the jury is still out on the subject, I believe there is much to explore in the possible links and synergies between medicine and the humanities. What roles can drama, poetry, fiction, biography and cinema play in reflecting and influencing good practice?
Take for instance a painting. A doctor who learns to appreciate a piece of artwork would be much more open to listen to people’s stories. If you gaze at visual works of art such as paintings of people by the French Impressionists, Caravaggio, Norman Rockwell or Fernando Amorsolo, they reveal stories that you don’t get just by a casual glance. It can teach a doctor that by being attentive to details, one gets to see the whole story, as if there is an ongoing dialogue between the painting and the viewer, facilitated by the artist.
The narrative-based approach shifts the doctor’s focus to the need to understand first before the need to problem solve. Thus, the patient-doctor relationship is strengthened and the patient’s needs and concerns are addressed more effectively and with better results.
A good way to start learning the narrative art is to read the literary works of Anton Chekhov, a Russian doctor who was also a writer. Many of his short stories are not only good read per se, but they also deal with themes of health and illness, doctor and patient, society and the human spirit, men and women, love and fate, aging, and death and grieving.
I also highly recommend the works of A.J. Cronin, a Scottish physician and novelist. His novella “Country Doctor” and his autobiography “Adventures in Two Worlds” are a must read for prospective doctors.
One physician who read Chekov was moved to write: “It was not only important but essential. Nowhere else in the medical curriculum did they confront and discuss the wide array of human concerns raised by Chekhov (and by our patients)—the deep and painful thoughts and feelings aroused by illness and death, the capriciousness of fate, the unexpected dignity in suffering, the power of simple acts of kindness, and the haunting desires and ambitions we discover in ourselves, sometimes at the worst of times.”
To any doctor who reads this, don’t just listen with your stethoscope to the beat of your patient’s heart or the condition of his lungs. Offer a listening heart. Everybody needs someone to listen to them. Scratch the surface of a physically suffering patient, and underneath there’s usually a spiritually wounded human being who is thirsting for the caring presence of other people. More than just the medicines, just being there totally with the patient can be the most essential thing every doctor can offer suffering humanity.
As a Buddhist sage once asked: who is available to you? To whom are you available? These to me should be the measure of a meaningful practice of the healing arts.