The Secret of Patient Care: Lessons From A Bathroom Wall

I learned the most important lesson of my career while sitting on a toilet seat.

I was fresh out of medical school, just beginning a year of internship, that infamous rite of passage that involves grueling work, sleep deprivation, and an endless stream of sick and dying patients. One night, in the middle of a twenty-four-hour stint in the emergency room, I trudged to the interns’ sleeping quarters. Exhausted, I hoped to collapse into unconsciousness for a few hours before returning to duty. But first, I made a detour to the toilet, sat down, and closed the door. When I looked up I saw a graffito staring me in the face, scrawled on the door by some anonymous intern: THE SECRET OF PATIENT CARE IS CARING FOR THE PATIENT. I was jolted. I knew in my heart that this pithy statement was absolutely true. It was seared into my consciousness at that moment and has stayed with me ever since.

I learned years later that this truism originated from Dr. Francis W. Peabody, a legendary superhero of internal medicine during the early decades of the twentieth century. Dr. Peabody was instrumental in setting up the Peter Bent Brigham Hospital, the Rockefeller Hospital, and the Boston City Hospital’s Thorndike Memorial Laboratory. He was a World War I Army field doctor and he helped establish the first modern medical school in China. He was an expert on typhoid fever and polio. Both his patients and his students adored him.

At age 45, at the peak of his powers, Dr. Peabody developed incurable metastatic cancer. He died seven months later. During his illness his thoughts turned to what it means to be a physician and a patient, and he delivered a series of lectures on these matters. These talks have become famous. They contain nuggets that should be tattooed in the psyche of every physician. Among them: “Medicine is not a trade to be learned, but a profession to be entered.” “The treatment of a disease may be entirely impersonal, the care of a patient must be completely personal.” And the comment that was abbreviated on the bathroom wall, “For the secret of the care of the patient is in caring for the patient.”

Many healthcare professionals consider Dr. Peabody’s comments to be old-fashioned musings from simpler times. Caring, empathy, and compassion are feel-good concepts that can’t compete with “real” therapies such as pharmaceuticals and surgical procedures. Even if they could, there’s simply no time in busy clinics and hospitals for these “soft” interventions.

This attitude is wrong-headed. When physicians express caring, empathy, and compassion, the duration and severity of illness are often reduced and the body’s immune system is stimulated.

In 2009, researchers in the Department of Family Medicine of the University of Wisconsin School of Medicine assessed the impact of physician empathy in 350 subjects suffering from the common cold. The patients rated the level of empathy conveyed by the physicians during their office visit and rated their physical symptoms twice a day. Nasal washings were obtained to determine the level of the immune substance interleukin-8 (IL-8). Patients who were cared for by the most empathic physicians experienced colds that were shorter in duration and less severe, and they had a larger increase in IL-8 levels, when compared with patients cared for by less empathic doctors. The researchers concluded that the effects of empathy are real, they can be measured, and they can make a significant difference.
Medical educators may be waking up to the value of compassion and empathy in healing. In 2006, medical schools in Israel altered their admission procedures to require the presence of compassion and empathy in every entering medical student. High grades and intellectual skills continued to be important, but were judged insufficient to qualify one for admission. “It bothered us,” said Professor Moshe Mittelman, head of the admissions committee at Tel Aviv University, “that here and there you meet a doctor about whom you say, ‘He may know medicine, but he is not a decent human being.’ We are a school that educates people to work in the medical profession, which is not only science but also humanism and dealing with people.”

Empathy and compassion have also been emphasized by the World Health Organization as crucial elements in what’s being called the “decent care” of persons with HIV/AIDS.

Caring, compassion, and empathy should be part of our current national debate about which therapies work and how we can reduce medical costs. But no one on either side of the political spectrum seems to notice their importance. We should not be surprised. Caring, empathy, and compassion cannot be legislated, and we do not need uncaring politicians to lecture us on the virtues of caring. Instead, we must honor the science validating the healing role of caring, empathy and compassion. We should also trust our personal experience of what helps us heal, and we should seek out physicians who embody healing. How? I have a simple piece of advice: If you feel worse instead of better after leaving your doctor’s office, find another one.

Erma Bombeck got it right when she said, “Never go to a doctor whose office plants have died.”
~ Larry Dossey, MD

References:

Oglesby P. The Caring Physician: The Life of Dr. Francis W. Peabody. Boston, MA: Harvard University Press; 1991.

Lavizzo-Mourey R. The secret of patient care. The Malcolm Peterson Honor Lecture. National Scientific Meeting, Society of Internal Medicine. Los Angeles, California, April 28, 2006. Available at: http://www.ramcampaign.org/pages/documents/riza_bylined_article.pdf. Accessed September 1, 2009.

Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Family Medicine. 2009; 41(7):494-501.

Mittelman M. Quoted in: Traubman T. Wanted: Medical student, compassionate and personable. Haaretz. http://www.haaretz.com/hasen/pages/RegisterSiteEng.jhtml?contrassI=null&requestid=233637. Accessed 15 April, 2006.

Dossey L. Universal access to compassion and empathy: A cornerstone of decent care. In: Restoring Hope: Decent Care in the Midst of HIV/AIDS. (Ted Karpf, J. Todd Ferguson, Robin Swift, and Jeffrey V. Lazarus, eds.) New York, NY: Palgrave Macmillan; 2008: 121-128.

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  • Heather

    I can only hope that more doctors will get the point. Even a touch on the hand, can mean so much to a patient and or family member. A patient is affected by a disease in every way.

    It's important to remember that the disease affects the whole family. It means the world to a patient and his/her family to have a doctor who is genuine in their empathy,compassion and who gives the required time to the patient. It feels horrid to have a doctor come and go in 3 minutes. One certainly doesn't feel cared about then, or even feel like a person. I hope this article will be sent out to all doctors. Patients and their families, above all, are people. Not just a body or a statistic.

  • Hollyhaupt

    beautiful article!!