ARTICLE IN BRIEF
Dr. Bhupendra Khatri discusses the stories and experiences that motivated his book, Healing the Soul.
In his book, Healing the Soul: Unexpected Stories of Courage, Hope, and the Power of the Mind, neurologist Bhupendra O. Khatri, MD, argues that certain technological advancements in medical care have led to the erosion of the doctor-patient relationship, which he believes is vital to promoting both recovery from and acceptance of a chronic neurologic condition.
The book, a collection of patient stories and insights gleaned over two decades of practice treating patients with multiple sclerosis (MS) and autoimmune diseases like myasthenia gravis, Guillan-Barré syndrome, and polymyositis, promotes Dr. Khatri's belief that a positive mindset and a resilient spirit can greatly aid in the healing process. The book is written for physicians and the layperson alike.
“As physicians, we know that some conditions are terminal and cannot be cured,” Dr. Khatri, founding medical director of The Regional MS Center and the Center for Neurological Disorders in Milwaukee, WI, told Neurology Today. “But by being positive, by touching the patient, by listening to them, we can heal them.”
Dr. Khatri recently spoke with Neurology Today about what motivated him to write the book, the impact electronic health records have had on modern medical practice, and the experiences that shaped his career and his approach to caring for people with MS and other neurologic disorders.
IN YOUR BOOK, YOU DISCUSS THE IMPORTANCE OF POSITIVE THINKING FOR PATIENTS' WELL-BEING. WHAT SHAPED THOSE VIEWS?
I took care of a vibrant young woman, Chris, who had developed a severe form of multiple sclerosis, requiring very aggressive therapeutic management. (I discuss her case in chapter one.)
We enrolled her in a double-blind, randomized, controlled trial of natalizumab for relapsing MS. She started to get the monthly infusions and, one year into the trial, she was so much better that she could trek down the Grand Canyon with a 45-pound backpack! She started to cycle and run; she was doing phenomenally well. Her MRI scan was getting better, as well.
And then the drug was pulled off the market because three cases of PML [progressive multifocal leukoencephalopathy] were reported in patients who had been given the drug. Chris was devastated. She begged the pharmaceutical company to give her the drug, and even went to the local newspaper, thinking there could be some pressure from those who read about her dilemma. The newspaper did a story on her. Her photograph was on the front page with the caption, “The drug which gave her life is now pulled away from her.”
We broke the study code, and I found out that Chris had been getting placebo the whole time. I called her and said, “Chris, I want you to know that you were getting placebo.” There was a silence for a while, and then she said, “You know, Dr. Khatri, that's the power of positive thinking.”
With positive thinking, Chris, who had a severe form of MS, could convert a placebo into a powerful therapeutic agent. And that made me wonder: If somebody has a severe disease and you invoke the power of positive thinking in them, can you make them heal? If they're terminally ill, can you make them better?
The same day I talked with Chris, I was called to the hospital to see a 76-year-old man with severe myasthenia gravis who also had a thymoma (a tumor in his thymus gland). The surgeon operated, but it was a stage 4 cancer; they took out what they could. The oncologists said that chemotherapy was indicated, but that it might kill him because he was so frail. They were reluctant to start chemo, but the family and the patient insisted on it.
So he did get chemo and, afterwards, he was the sickest person you'd ever see in an ICU. His white cell count dropped to zero, he became septic, he started to bleed in his intestines, and he was on a respirator. Most of the doctors who were caring for him thought he should go into hospice care. But my assistant and I would go to him twice a day and tell him, “Bob, hang in there, you're getting better. Your white cell count is looking good. Your chest X-ray is looking good. You're improving.” Although what we told him wasn't true, he did improve. It took two and a half months, but he walked out of the ICU.
These experiences shaped my belief that positive thinking plays a very big role in terms of healing. When somebody really strongly believes they're going to get better, they will.
SOME OF OUR READERS MAY BE SKEPTICAL OF THE IDEA THAT BELIEF IN GETTING BETTER IS ENOUGH. ARE YOU SAYING THAT POSITIVE THINKING CAN, FOR EXAMPLE, REVERSE THE MS DISEASE PROCESS? OR ARE YOU TALKING ABOUT HEALING IN A MORE SPIRITUAL SENSE?
Of course, conventional therapies play a critical role in treating a chronic disease, but the power of positive thinking definitely helps with the healing process. Patients who think positively feel better, their outlook on life is better, and they're less anxious. It makes a big difference in terms of their outcome and their quality of life.
Granted, positive thinking won't heal a person with cancer, for example. But it does help them deal with the disease better. Recent studies show that when the mind is less stressed, there are profound benefits for the immune system, for hormone levels, and for neurotransmitters, and all of these play a role in the disease process.
William Osler, the father of modern medicine, once said, “The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.” Writing a prescription is one thing, but really sitting down with a patient and talking with them, or putting a hand on their shoulder when you hand the prescription to them, can have a profound effect.
IN THE BOOK, YOU SAY ELECRONIC HEALTH RECORDS ARE HARMING THE DOCTOR-PATIENT RELATIONSHIP. HOW SO?
Nowadays, physicians are so hurried. We're pulled in different directions, and we're forgetting the powerful strength and healing property of touching somebody and showing them compassion. Electronic health records are good for retrieving data quickly, but on the other hand, we are really not interacting with the patient when we use them. We bring the computer into the room, we enter the patient's complaints, we do a quick exam, and then we put the prescription into the computer and it gets sent to the pharmacy. It's so mechanical.
YOU USE THE STORY OF AN 80-YEAR-OLD MAN TO WARN ABOUT THE LIMITS OF ELECTRONIC HEALTH RECORDS. TELL US MORE ABOUT IT.
Yes, I saw an 80-year-old man with severe headaches. His primary care doctors did an MRI, angiograms, even a temporal artery biopsy to make sure he didn't have arteritis. They didn't find anything, so they put him on narcotics to control his pain. One night he fell and broke his hip.
I went to see him in the hospital as a consultant. I sat down with him and asked, “How long have you had these headaches?” He said it had been about six months. I asked, “What happened six months ago? Did you bump your head? Did anything happen?” He said no. So I asked him, “Who else is at home? Where's your wife?” And he said, “My wife died about six months ago.” He had no children.
It didn't take a genius to figure out why he had the headaches. His wife passed away six months ago; this man was depressed. So we sent him to a psychologist, who worked with him and got rid of his headaches.
But when I went into his electronic health records, there were voluminous notes about his headache, his level of pain, about this test and that test — but nobody had bothered to ask him about his wife. And that's what I mean when I say these visits have become too hurried. There is no laboratory test to pick up a psychosomatic disorder. You have to listen. You have to observe. Otherwise, you'll just order test after test and nothing is going to help.
WHAT CAN NEUROLOGISTS DO TO ENHANCE THEIR RELATIONSHIP WITH PATIENTS?
The way we practice medicine today has changed completely and rapidly, and we need to adapt to new technologies and regulations. But at the same time, I think it's important that we do not lose the power of communication and the power of touch. We need to recognize that behind each “case” is a person — a son, a daughter, a wife, or a mother.
When hospitals and health care networks buy out practices, they pay doctors based on how many patients they see each day. It becomes like a factory, almost like an assembly line. I think we need to resist that as physicians. Each patient should be treated with dignity and respect.
The other thing I've come to appreciate is the importance of addressing the patient from every angle, not just focusing on the disease. We need to talk about what's going on in the family and talk about stress, which is a cause of many diseases. We need to spend time with the patient and try to understand what caused them to be where they are now, so that we can help make them better, rather than doing a patchwork or a quick symptomatic relief, because then they'll just keep coming back with the same problem. We tend to neglect that in this day and age because there's no code to bill for that.
WHAT HAVE YOU LEARNED FROM YOUR PATIENTS?
One couple who I feature in the book really changed my life. Christiana and Charles, both in their 80s, had come to Wisconsin to celebrate their grandchild's graduation. They'd been married for 67 years. The husband, Charles, had a heart attack while he was in Wisconsin. He had a successful bypass surgery, but a few days later he had a massive stroke that left him comatose and on a respirator. We knew he was not going to pull through. His wife, Christiana, would not leave his bedside.
One evening, when I went to his room to talk with Christiana about her husband, I found her by his bedside with a hand over his head. I walked her to the sofa; those were probably the most difficult steps she ever took. I could see how much she loved him. I explained that, in my opinion, her husband would not recover. She told me, “It doesn't matter if he's on a respirator. If his heart is ticking, I want him alive. Our marriage went by too fast; I want to say so much and I want to talk to him so much.” I understood what she meant. I told her we'd get an air ambulance to take him home when he was stable.
As I was leaving the room, she called out, “Dr. Khatri, remember: Tomorrow never comes.” It stopped me in my tracks; I had goosebumps. That evening, as I drove home, I thought, “I shouldn't wait. If I want to hug somebody, if I want to travel, if I want to do anything, I should not wait until everything is aligned. Don't wait; just do it.” That was such a profound lesson, and I wanted to convey it to readers. I think stories like those relate to everybody, not just to people who have illnesses.