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A new essay argues for a whole-person approach to medicine
People visit their doctors to be healed, but that’s often more complicated than fixing an ailing body part. Addressing a person’s whole range of suffering—the physical, the emotional and the spiritual—is rare in modern medicine.
But taking this whole-person approach to health care is simpler and quicker than it seems, according to a new essay written by two physicians and published in JAMA. A more compassionate, patient-focused kind of medicine starts when the doctor asks one simple question: What’s the worst part of this for you?
“Even in very mundane everyday things that doctors do, we have so many opportunities to recognize suffering and use very simple language to quickly address it,” says Dr. Ronald Epstein, professor at the University of Rochester and co-author of the essay. “We just have to be attuned to it.”
He and his friend, oncologist Dr. Anthony Back of the University of Washington, reviewed the scientific literature of how doctors handle the suffering of their patients. Finding little, they devised three strategies for doctors to use in order to offer their patients better healing.
First: the question. “If you ask someone, ‘What’s the worst part of this for you?’ you’ll often be surprised what patients say,” Epstein says. Responses are often personal and may not even be related to physical pain; sometimes, the worst part is the psychological or financial toll of the medical problem. “Then you can respond with empathy or compassion—a normal human response—but at least you’ll know what a patient is experiencing,” Epstein says.
Once a doctor understands their patient’s suffering, he should “turn toward” it—not away from it, as doctors often do—by being present, authentic and engaged, the authors write. Offering compassion, instead of rushing someone out the door or referring them to a different specialist, can help ease suffering, too.
The last step, Epstein says, is this: “If patients are trying to make sense of their suffering, help them do it.” Refocusing and reconnecting a person with what’s meaningful in their life can make them feel better.
The authors caution that the last step must be done carefully. “Physicians may unwittingly impose expectations—for example, being a fighter, accepting the illness, or growing spiritually—implying that patients had failed if they hadn’t found meaning or experienced gratitude,” they write.
Yet applied correctly, these tactics can be powerful and positive. “When doctors feel helpless, it’s a signal to know the patient better, to be more curious, to be more present, and in that way you can discover aspects of the patient’s suffering you may be able to do something about,” Epstein says.
The essay comes at a time when many doctors are wrestling with their own unhappiness—and where the field is grappling with how best to improve the profession. An analysis published this month in JAMAconcluded that 29% of young training physicians are depressed, and another 2015 survey found that about half of physicians have symptoms of burnout. Modern medicine is intense, fast-paced and at times compassionate to neither doctor nor patient; new calls for reform in its training and practice hope to rally improvements in the field for both MDs and those they heal.