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View from the Other Side of the Stethoscope: Love and Compassion

Harpham, Wendy S. MD

doi: 10.1097/01.COT.0000368459.51410.b0

“Only a coward is afraid to love his patients.”



The statement grabbed my attention. I didn't know either the nurse who emailed me or her son's oncologist—the source of her quote. But after finishing her heartfelt message, I took the declaration as gospel.

“She should know,” I figured. She was an experienced oncology nurse—that species of health care professional with its nose pressed up against the physician-patient bond. Moreover, she'd just credited her son's oncologist with playing a key role in helping her find peace during her teenager's illness and then after his death.

I didn't talk to anyone about the quote until I was onstage two years later at a survivorship event. Surprising even myself, I went off-script and ended my comments about physician-patient relationships by repeating, “Only a coward is afraid to love his patients.”

The amplified “love” reverberated throughout the auditorium. I felt queasy with embarrassment, having offered as truth something I didn't understand, so couldn't possibly know if I believed.

Another year has passed. Now pastel-colored Necco conversation hearts are making their annual appeals from candy jars atop counters and desks. “Love you.” “Love me?”

Sweet-talked into it, I feel compelled to find out about the quote. First I'll email the nurse. While waiting for her response I'll explore what it might mean to love a patient.

Since I don't know the oncologist who said it, the only thing I can be sure of is that this “love” he mentions is an emotion experienced by physicians in their relationships with patients. Given the derogatory nature of the word “coward,” I assume the oncologist perceives this “love” as a force for good in clinical settings.

I also trust it's a love with no place for Eros or Cupid. In clinical medicine, all thoughts or expressions of sexual desire must remain shackled offstage with the keys thrown away.

And, obviously, this love for patients is not the love one might proclaim for an iPhone or periwinkle blue. It's different, too, from the love of clinical medicine, a passion I once knew well.

So what sort of love for patients is good? What are proper emotions for physicians to feel toward their patients?

I wonder if the oncologist means a love like the feelings one has for a dear friend, parent or child, or spouse or partner. But when I ask myself if it's good for an oncologist to experience that profoundly tender affection, my answer is “No.”

The heightened emotions of such relationships are notorious for interfering with the objectivity needed to do a good job. For exactly this reason I sent my close friend to a colleague instead of taking her on as a patient when I opened my practice. This is why I've never treated my own children. And since becoming a patient, I have consciously chosen not to socialize with my oncologist or internist, knowing I need them to be able to make difficult medical decisions.

Maybe a clue to understanding a healthy love for patients lies in a fundamental dictum of many religions, with a slight twist: Love thy patient as thyself. What could be wrong with the empathy believed to be universal, innate, and imbued with the power to bring people together in peace?

This is what's wrong: In social settings, healthy self-love is a good thing for everyone. In medical settings, diagnosing or treating oneself is colossally foolish.

I'm seeing a pattern: Common and useful insights about love keep falling short when talking about physicians’ love for patients. Why? Because the doctor-patient relationship is special.

Modern physicians serve as patients’ only link to the science and technology that can help them. Consequently, nothing must hinder oncologists from using their expertise optimally when diagnosing and treating cancer. And as mentioned earlier, physicians’ emotions can create problems.

But physicians shouldn't be automatons, either. Surely when Dr. Peabody taught Harvard medical students in the early 20th century that “The secret of the care of the patient is in caring for the patient,” he was referring as much to physicians’ own feelings as to their outward expressions of kindness.

In my search for proper feelings physicians may have for their patients, I've come ’round to the emotion most often associated with model doctors: compassion. And, indeed, such empathic caring is a force for good.

When physicians care about the person with the disease, they might note critical details that otherwise might have been missed. Caring can motivate physicians beyond the call of duty, conferring the equanimity and fortitude needed in trying times.

Importantly, compassion is the only way to communicate to patients, “You matter to me.” Especially when the science lags behind the art, patients’ awareness that they matter to their physicians can reassure them that they are getting the best care possible.

For families, physicians’ compassion to the final heartbeat can bring comfort like nothing else. Knowing the life of their loved one impacted the physician can help quiet any doubts and questions, helping them through their grief.

Discussions of physicians’ emotions invariably become complicated, because illness and death are dramatic life events. Positive emotions can easily get confused with love. Borrowing from Corinthians, compassion—like love—is patient, kind, not envious, not proud, not rude, not self-seeking, not easily angered, and so forth.

There is nothing wrong and everything right with physicians sharing in the emotional highs of patients’ joys and emotional lows of patients’ sorrows. But if—and only if—it won't jeopardize their ability to make the next medical decision, which might be just around the corner. And only if physicians keep their own emotions in check while making decisions or prescribing treatments.

Maybe one day I'll meet the oncologist with the big heart who said, “Only a coward is afraid to love his patients.” He's on to something at a time when innumerable forces threaten to sabotage physician-patient bonds.

I'd like to meet him, because I can always learn something from a physician who treats his patients with compassion.

© 2010 Lippincott Williams & Wilkins, Inc.
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