“In the sick room, 10 cents’ worth of human understanding equals 10 dollars’ worth of medical science.” — Martin H. Fisher, MD (1879-1962)
Chester “Trip” Buckenmaier III, MD
COL, MC, USA
It is a particular pleasure in federal medicine to have an opportunity to talk with our patients concerning their lives. Through the eyes of my patients, I have visited the D-Day beaches of Normandy, served as a B-17 tail gunner over Berlin, experienced the chaos following the USS Cole bombing and felt the helplessness during the Taliban raid on the airfield at Camp Bastion, Afghanistan. I feel it is a unique gift my patients give me, these experiences they have lived, costing only my time and slight diversion from the medical business at hand.
Perhaps more importantly, I have learned that this modest investment of my time tends to vastly improve my effectiveness as a diagnostician and physician. Patients appreciate being listened to, and they work harder in providing their medical histories and describing their symptoms when they are speaking with another human (as opposed to only another busy physician) who is interested in them
Over the decades of my military medical career, one aspect of medical practice has remained constant: the steady increase in the pace of medical change. I am continually amazed at the magnitude of difference between the medicine I practice now and my practice only 10 years ago. Much of this change is associated with the bewildering increase in electronic paraphernalia that has gradually insinuated itself between the patient and us: machines that go “beep,” keyboards, screens and devices of every size and shape. Then, there is the endless paperwork that seems to have doubled since we went “paperless” with electronic medical records. While I appreciate the advantages much of this electronic stuff provides in managing patients, I feel like it all is conspiring to prevent meaningful communication between patients and their caregivers. The sad fact is, the patient stories I enjoy so much are becoming a rare luxury.
Despite the technological barriers to communication that are a growing fact of modern medicine, the need to communicate effectively with patients is perhaps more important than ever. As the technology and sophistication of practice increases, so does the need for focused time educating patients on the complex care they are about to receive. Informed consent demands a fully apprised patient, but we seem to be so hurried that just obtaining the signature on the consent form seems overly burdensome. Additionally, it should be noted that most complaints against physicians are not related to physician clinical competency but tend to arise from issues stemming from poor communication.1
Increasingly, I find friends and family seeking my advice and interpretation of what they had been told during a visit to the doctor. They often convey frustration at the rushed atmosphere of modern medicine and the sensation that the provider is harried and needs to move on. Confusion, misinformation and fear are not uncommon feelings that are expressed from these less-than-optimal clinical encounters. I recognize, and I am certainly exposed to, the same pressures in the clinical practice environment that presently values “doing things to patients” rather than talking with patients.
To be clear, I certainly am not lamenting the incredible advances and promise of modern medicine. As a medical researcher, I embrace the fantastic future that medical science has in the offing for humanity. I only hope that, as we careen into medicine’s future, we do not leave behind what is perhaps medicine’s most noble quality — one human listening and caring about the pain and suffering of another.
Dr. Martin Fisher reminds us that no amount of medical technology or scientific understanding will ever replace the profound therapeutic value of the physician-patient relationship, unless, of course, we allow ourselves to be removed from that relationship. While I appreciate my medical gadgets and machines that go “beep” as much as the next doctor, they are a poor substitute for the subtle joy of communicating with a patient about their experiences and concerns. The values of our medical system are currently evinced by what we are paying for in medicine. I sincerely hope that, as our technology evolves, our understanding of the value contained in simply talking and spending time with patients will be rediscovered.
Ha JF, Longnecker N. Doctor-patient communication: A review. Ochsner J. 2010 Spring; 10(1): 38–43.
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