Doctors who don't know their patients make easily avoidable technical mistakes that can have tragic consequences. The best way "to do no harm" is to know and understand your patient.
The doctor/patient relationship has been the central instrument of healing throughout the history of medicine. Specific treatments come and specific treatments go. Some help patients; some hurt patients; many have no impact at all. But the constant of 4000 years of modern medicine has been the healing impact of the relationship with a doctor, however ineffective or harmful the type of treatment provided.
In recent years, high tech medicine has undercut the value previously placed on the doctor/patient relationship. Doctors spend more and more time tending their powerful medical toys, less and less time getting to know their patients. They treat lab values, not people.
This would be OK if the new medicine lived up to its promise of razzle/dazzle, technically-based cures. But usually it doesn't. Diseases are really complicated and we are much better at finding abnormalities than at making people better. And medical errors, often caused by doctors not knowing their patients, have become the third leading cause of death in the US.
We need to combine the science of medicine with its art and to get our doctors and our patients back in sync. Medical schools are finally beginning to recognize this and are revising their entrance test to place more emphasis on the social, not just the biological sciences. It is crucial that we make medicine more humane.
The "Empathize With Me, Doctor!" project is a promising initiative in this direction, developed by Vassilios Kiosses and Ioannis Dimoliatis of the Medical Education Unit at the University of Ioannina in Greece. They write:
"We provide an experiential training program aimed at improving health care professionals' empathy, based on the Person-Centered Approach (PCA) founded by Carl Rogers. Unconditional positive regard, empathy, and congruence are elements that can create a safe climate where students develop alternative ways to relate with each other and with their patients.
The training in empathy lasts 60 hours, distributed in three 3-day intense workshops, occurring at 4 week intervals. There are three modules: theory, personal development, and skills development.
Empathy is not taught as a technique but as a philosophy and a new way of being and relating. This is why an experiential training program is needed.
The theory part of the training includes an introduction to communication skills and specifically the importance of non-verbal communication. The student is taught how to gather a medical history in a person-centered way, combining open ended questions that allow patients to take the lead with more structured medical interviewing. The clarification of what empathy is, how it is used in medicine and how it can be applied during doctor/patient relationship, constitutes a large part of the training.
Last but not least, medical undergraduates are introduced to the theory of bereavement in the medical context, and also how to break bad news empathetically.
It is important in creating an empathic climate to be aware of one's own needs and boundaries during encounters with patients. That is why a personal development section is included, with experiential exercises in self-awareness, self-knowledge, and identification of others. To facilitate this process, we use artwork as triggers for introspection and increased awareness of their own and patient's inner needs. Creating in clay or collage allows students to be more freely expressive. Through this section students seek to answer "what scares me during my practice?", "what am I expecting from me?" or "how can I respect myself and my patient?"
Encounter groups provide an opportunity for verbal interaction and emotional expression. Students are encouraged to examine and explore their reactions and feelings about their relationship with their patients and others in the group.
The skills development section contains active listening exercises, role plays, non- verbal communication games and more practical implications of empathy. Medical undergraduates have the chance to try and develop such skills aiming at improving person-centered interviewing with a patient. Case studies are also used to help medical undergraduates to work on real, everyday problems in empathy.
This training aims at improving each student's interaction in the training group with the hope it will then lead to more empathic encounters with patients. Trainers try to create a condition full of acceptance, genuineness, and empathy to help trainees try new ways of interacting and relating. This not only trains professionals in a more effective communication techniques, but also sensitizes them to act in a more genuine and humanistic way.
The experiential nature of the training, has elements far different from what is usual in medical school. No lectures or study at home is needed. Student often describe it as "a life-changing experience" and "this empathy training taught me a whole new way to relate."
Hippocrates stated that patients often recover because they believe in their doctors. This training helps build that trust. Most doctors currently don't even ask their patients what scares them and if they are anxious about their treatment and health outcomes. We need to make them more alive to the emotional reality of the medical contact."
On the first day of medical school 50 years ago, the spare, spectral chairman of medicine wished all of us students a life threatening illness that we would recover from. Only in this way, he said, would we fully understand what it was like to be a patient. When he retired soon after, he did an astounding thing- he entered medical school as a student and did everything all students were required to do over the four years. He wanted to experience first hand from both sides what was wrong and what was right about medical training.
I don't have the dedication or endurance to repeat his heroic experiment. But I think there is no mystery in what is currently wrong with medical education. It has become far too technical and has lost its central focus on the relationship to the patient.
This is bad in emotional terms. But it is also bad in terms of medical outcomes. Doctors who don't know their patients make easily avoidable technical mistakes that can have tragic consequences.
The best way "to do no harm" is to know and understand your patient.