CHAPEL HILL — Today's medical culture continues to shift from doctor as "god" to doctor as practitioner of patient-centered medicine. The problem with this approach is that being "polite" or "nice" to patients fails to address one of the most important components of the patient's clinical picture - suffering.
While it is important to have our bodies fixed and repaired, correctly and in a timely way, we are not just our bodies. We each have an identity and sense of self. We have unique psychological, social and spiritual dimensions, all of which may be profoundly affected by illness, trauma, disability or a terminal diagnosis.
Of course it is unrealistic to expect physicians to have time to know their patients on a profoundly personal level, especially the way health care is delivered today. It is not, however, unreasonable to hope physicians can see patients as real people, not just as consumers of services or tasks to be done.
How is this possible? True compassion replaces "niceness" when physicians understand that suffering is about more than the flesh; that it also encompasses a person's mind and spirit, hopes and dreams, sense of control and fears about what is to come.
Unfortunately, physicians often do not receive sufficient training to be able to understand the mind/body connection. Beyond the immediacy of physical pain and limitation, physicians may fail to recognize the invisible yet powerful dimensions of patient suffering: loneliness, hopelessness, powerlessness and loss of dignity.
From our caregivers, we need kindness and compassion, not wrapped in pleasantries but from a place of shared humanity, as we struggle to create meaning around what is happening to us. Suffering is not just the domain of patients; it also affects the physicians and nurses who care for them. Seeing suffering causes suffering. Health care providers sometimes fail to see the suffering before them because, if it does not exist, there is no responsibility to attend to it.
Eric Cassell, who wrote the definitive work on the subject, "The Nature of Suffering," explains that, through opening our hearts, we learn to see our patients not as objectified customers but as individuals with needs beyond medical science. Working with patients through heart-centered care requires no extra energy or time. Seeing the suffering around us is not a function of what we do but of who we are. Seeing the suffering around us is the only way we can begin to ameliorate it.
Being nice is adequate in a checkout line at the grocery store. We do not need to feel a sense of humanity with the cashier as our vegetables are being priced. However, when our health or life is at stake, when we lay in the foreign land of a hospital as our former life dissolves with no new future yet in focus, our personal identity may be temporarily destroyed, as we struggle to understand the enormity of what we are losing, have lost. In these moments, a superficial pleasantry may seem worthless, even insulting.
"It is only with one's heart that one can see clearly. What is essential is invisible to the eye."- Antoine de Saint-Exupery's "The Little Prince."
Donna Helen Crisp is clinical assistant professor at the UNC School of Nursing in Chapel Hill.
