If money is no object, how do you define “best patient care”? Thirty years ago, my answer was captured in my mission statement: “Helping patients through the synergy of science and caring.” But since then the science has progressed dramatically, forcing me to rethink what this “caring” looks like today and how busy clinicians can make “best” an everyday routine.
Caring rests on compassion. As I noted in my last column (“In Defense of Compassion,” 3/25/13 issue), physicians' compassion does more than just help patients cope and hope. It also helps them benefit from the science and technology that promote physical healing. And it always will. Because if nothing else, your ability to determine the best course of action for a particular patient will always be a judgment call that depends on knowledge of this patient as a unique person—knowledge obtained through both scientific inquiry and compassion.
It's important to note that showing compassion and feeling compassion are two different things. You need only a moment to show compassion. And while your encouraging words or hand-squeeze may mean the world to a patient, these generic gestures of compassion depend on nothing more than your assumption that your patient has feelings.
In contrast, it takes time and effort to develop compassion for a particular patient. You may need hours over the course of many visits to learn about a patient's lifestyle and support system, fears and hopes, strengths and weaknesses, values, priorities, and risk-taking preferences. Only then can you know best how to address your patient's physical and emotional needs in difficult cancer situations.
Of the various tasks that go into providing high-quality care, it seems to me that developing compassion is the ultimate rate-limiting step. If so, this puts you in a quandary. Your primary job is controlling or curing your patient's cancer while the demands of the science and technology continue to monopolize more and more of your time.
So where are you supposed to find time for meaningful discussions that enable you to really know your patient? I'd like to share a few ideas that might help speed the conversations that cultivate the seeds of compassion.
For starters, you can encourage your patients to help you get to know them. Consider asking them to bring two or three fun photos to their visits every now and then. In just a few seconds, the stories told by the pictures can bring to life the activities and relationships that define the patient.
When discussing your patient's symptom(s), along with calibrating severity using the traditional “On a scale of 1-10…,” assess impact by asking what hobbies or relationships have been hindered or precluded by the symptom(s). Keep your threshold low for referring to allied health workers, such as physical or occupational therapists, social workers, or counselors who can help your patient overcome obstacles to enjoying hobbies and important relationships (or finding new ways to enjoy them).
Along these lines, you can discuss medical markers, such as clear scans, not as an end but as a means to the patient's feeling good enough to enjoy a favorite activity or coveted milestone. Striving for cures or disease control is worthy, but goals having to do with living well connect us as human beings.
One last idea: Help patients manage their hopes. After preparing them for the likely outcome, let them know you have not given up hope for the best possible outcome. Invite them to share with you their short-term and longer-term hopes, as well as their overarching hopes. In less than one minute, this mutual sharing of hopes may unlock the secrets of the heart and strengthen the clinician-patient bond in healing ways.
Just 100 years ago science played a relatively small role in patient care, leaving plenty of time for doctors to develop and express compassion. House calls made it easy for doctors to see with their own eyes how disease had changed the rhythm of a patient's daily life. Talking with family members over a cup of tea presented opportunities to gain insight into the patient's concerns, challenges, resilience, and will to live.
Today you have to go the extra mile to learn about your patient's life before and after cancer. Yet you still do it because it's worth it. You take a history and discuss treatment more efficiently. You confidently recommend the best course of action where no “right” choice exists. If the outcome is not what everyone hoped for, you are empowered to comfort your patient's family—and you—with reassurances that you all did the best you could do. Moreover, it has been shown that families rarely sue doctors who show genuine compassion.
In oncology, personalized medicine usually refers to therapies designed for diseases with specific genetic fingerprints. But in any discussion of best practices, a broader definition serves us better: A model of medicine based on customized care, with all discussions, decisions, and treatments tailored to the individual patient.
Developing compassion for your patients feeds your soul and immunizes you against burnout in a field where the work is extraordinarily demanding and death is a constant companion.
You may feel sadder if patients die. But your life will be better overall for having known them.
As for patients who don't specifically acknowledge your efforts, I trust I speak for them when I say, “Thank you for caring about us while caring for us the way you do.”