Being there for the other

adult helping senior in hospitalPREVIOUS: Timing and waiting

Why should a clinician take the trouble to listen to a patient’s story? A delicate ‘business’ at best, frequently challenging, and calling upon a clinician to the limits of his or her emotional and relational competency.

Let’s get one issue out of the way before we address our question of ‘why should I..?’ From a pragmatic perspective, if there is, for example, an acceptable drug (e.g. an antibiotic) or a surgical procedure (e.g. removal of a cancerous tumour) a focus on story is inappropriate, certainly in respect of relieving suffering or enabling potential ‘cure’ of the current condition. But there are chronic conditions for which there is a potential benefit of combining normative biomedical approaches and a serious consideration of ‘story’ i.e. the whole person approach. And it is in this context that clinicians split off in a number of ways.

Firstly, we have the clinicians who internally rebel against the drift of modern healthcare into modes that are highly instrumentalised and depersonalised. These clinicians may have struggled with their own chronic conditions, or may have chosen healthcare out of a desire to help ‘people’, only to discover themselves dominated by algorithms and lack of time or support for person-centred care. Some may see ‘stories’ obviously influencing their patients’ health but feel relatively powerless to address them. Others, disenchanted, may be seeking or may have discovered that the person-to-person approach seems to be effective and delivers the greatest professional satisfaction. Many are clinicians who are people-oriented and get frustrated when this element gets side-lined or minimised. They get great satisfaction from being with people. There are many variations of this (link to third book). Hopefully this website will, one way or another, help many such clinicians.

…we are in healthcare to serve the interests of the other (patient or client), and if by not responding to them as a whole we fail to best serve their healthcare then we are being professionally neglectful.

Then we have clinicians who love their discipline as it is. It is enough to be competent in their well-attested and legitimised field. They entered it for what it is already. They did not sign up for this troublesome and potentially exhausting variation. It is not part of their ‘scope’ of practice. Most others are not doing it so why should they? They are happy to set limits on what they do and prefer to stay within their comfort zone.

There are other clinicians who are unable to grasp the idea that mind and body are not separate, or fail to grasp that when they ignore either the body or the mind (depending on the discipline) they are excluding a crucial aspect of the whole. Some such clinicians appear not to think conceptually or philosophically, and perhaps, more often, are not accustomed to reflecting on emotions and feelings. What they do is diagnostic, logical and practical, and for many conditions this can work very well, but there are always conditions that are not well attended to at the margins of such practice.

Of course, everybody is different. Some have greater capacity for different forms of functioning. Nevertheless, nearly all patients want to be treated as whole persons. Secondly, we are in healthcare to serve the interests of the other (patient or client), and if by not responding to them as a whole we fail to best serve their healthcare then we are being professionally neglectful. This does not mean that every clinician should have the same breadth or depth of skills. It does mean that each of us positions ourselves towards the whole person other and searches for ways to provide our patients and clients with whole person options.

Brian Broom

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