Bestselling author Thomas Moore couldn’t agree more with William Osler, widely regarded as "The Father of Modern Medicine." During his tenure at Johns Hopkins School of Medicine, Osler advised his students, “Just listen to your patient; he is telling you the diagnosis.”
Unfortunately, today, there is little time for listening. A recent study in the Journal of General Internal Medicine finds that physicians give a patient an average of 11 seconds to describe their issue before interrupting. Often the provider is rushing against the clock with a waiting room full of patients, or they may be dealing with their own burnout. Moore believes that listening with patience and encouraging conversation does not need to take time away from fact-gathering. The single most important aspect of a physician’s job is to create an environment where good communication can take place. The doctor must carefully listen not only to what is being said but for what is not being said.
Moore explains, “There is a skill to listening, and it starts with being open enough to set aside some time in your agenda to listen. You need to be open to the patient’s own way of speaking – his jargon, his culture, family, job, and his way of life. It is the job of the professional to create an opening so that communication and conversation can happen. The patient cannot be expected to do it – they are absorbed in their feelings and anxieties.”
Moore suggests that the best way to listen to someone, especially someone who is upset, is to repeat back what the person has said – changing a few words, speaking with kindness and without judgment – to let them know that they are heard. “It is a deep thing to echo someone with great empathy. Most professionals have not had education in counseling, so they probably do not realize how valuable it can be. If they don’t have it in their repertoire, they miss out.”
There is soul in medicine and sickness and in the profound emotions and fantasies found during serious illness. Thomas Moore encourages providers to think about how much is going on with a person as they face the challenge of illness and treatment. After being diagnosed with prostate cancer, essayist and New York Times editor Anatole Broyard wrote, “To the typical physician, my illness is a routine incident in his rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.”
The provider should never treat the patient as a body alone or speak of a sick person as a case or body part. The enlightened provider can grasp the deep poetry in the body and illness: a heart problem is not just that of an organ or a pump but also the heart as the seat of emotions and relationships. Moore stresses, “Here we see the soul in medicine: a deep feeling for humanity showing itself in many compassionate and creative modes of service.” This kind of physician “can practice medical skills with wisdom and humanity. He doesn't reduce human experience, including illness, to the physical body, but understands that issues of soul and spirit play themselves out in our illness and therefore have an important role in healing. He is not a stranger to the religious and spiritual issues of humanity. He is not ignorant of the role of emotion and fantasy in sickness and healing.”
Moore elaborates on soul: “When you treat people as objects, as cases and syndromes and machines in need of repair, you will not be a healer, not even a doctor or nurse (or pharmacist). You will be a technician, a human repair person, a functionary in a world of objects. Soul will not enter into your work, not into your skillful use of techniques, and not into your relationship with your patients. Your work will not satisfy you, not because it isn’t worthy work, but because there is no soul to give it a deep human pulse. (However), when soul is present, when you are capable of being present as a human being and making a connection to a patient, even simple applications of your skills will make your work fulfilling and bring you close in touch with the people who come to you for help. A hospital with soul is a place of healing. A hospital without soul is a body repair shop. The depth of human feeling and care will show itself in the people, in the building, and in the atmosphere. In a sense, it is the atmosphere that heals!”
The writings of Anatole Broyard resonate with Moore, who referenced him several times in his book, “Care of the Soul in Medicine”. Broyard was diagnosed with prostate cancer in 1989 and lived with cancer for fourteen months before he died in October 1990. Many of his writings center on the type of doctor he would have liked:
“I have a wistful desire for our relationship to be beautiful in some way that I can’t quite identify. A famous Surrealist dictum says that “Beauty is the chance meeting, on an operating table, of a sewing machine and an umbrella.” Perhaps we could be beautiful like that. Just as he orders blood tests and bone scans of my body, I’d like my doctor to scan me, to grope for my spirit as well as my prostate. Without some such recognition, I am nothing but my illness.”
Broyard, like Moore, sought to shine light on the humanity of the physician. “Not every patient can be saved, but his illness may be eased by the way the doctor responds to him - and in responding to him, the doctor may save himself … In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and much to gain by letting the sick man into his heart. If he does, they can share, as few others can, the wonder, terror, and exaltation of being on the edge of being, between the natural and the supernatural.”
References / Works Cited
Broyard, Anatole. Intoxicated by My Illness: And Other Writings on Life and Death. New York: C. Potter, 1992. Print.
Moore, Thomas. Care of the Soul in Medicine: Healing Guidance for Patients, Families, and the People Who Care for Them. Carlsbad, CA: Hay House, 2010. Print.
Moore, Thomas, Ph.D. "Telephone Interview with Thomas Moore." Telephone interview. 15 Jan. 2015.
Moore, Thomas, Ph.D. "Thomas Moore Email Interview." Telephone interview. 7 Dec. 2014.
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