Communication and the art of medicine

The practice of medicine is often referred to as the “art of medicine.” Making the correct diagnosis, planning the proper treatments that offer maximum benefit while minimizing side-effects, and timing of procedures are all part of the “art.” I believe the greatest element that best defines medicine as an artistic entity is communication between the patient, family and friends, and healthcare providers.

I was talking with my brother, also a physician, asking him if he ever had patients who died soon after being told of a diagnosis for no apparent reason other than the person just willed himself to death. He told me of a situation in which a man overheard a couple of physicians discussing the prognosis of another patient. What he heard was the probability of an impending death after one year. The doctors were not holding the conversation in front of the man. They even clarified later that their communication was about another individual. However, this man was certain they were talking about him and refused to believe otherwise. Tragically he died exactly one year to the day with no apparent underlying illness evident.

Here is another example of the effects of communication on health. Several years ago I diagnosed a middle-aged man with a mild lung disease. He was actively playing golf three times a week. Almost immediately he became incapacitated and passed away after only 6 months. His prognosis was excellent for a life expectancy of years not months. I was never able to determine what he understood his illness to mean in his life despite multiple explanations of what should be the natural history of his illness. I believe he willed himself to death.

It is common in not wanting to tell ill family members their diagnoses. This is especially true of a cancer diagnosis. It is believed that being told a diagnosis of cancer will cause these persons to give up and die. I have never believed this, although, I did have a man die within three weeks of being told he had early-stage cancer. Again, there was no apparent explanation other than he, too, just gave up.

I have always held the opinion that the patient should know the diagnosis and the prognosis. How strange it seems for someone to go for chemotherapy or radiation therapy and not be told they are being treated for cancer. Unless the patient has some metabolic disturbance causing confusion or a dementia, they will know the treatments are for reasons not merely to make one feel better.

Understandably, patients should undergo physical, mental, and spiritual preparations when diagnoses and prognoses are extended, especially if it portends bad news. I suppose this is where the art of communication enters. The healthcare provider must be honest. Honesty is imperative; not half-truths to soften the blow. A genuine show of compassion eases the impact of learning about illnesses especially terminal illnesses. The same should be the rule among family members – honest communication with compassion.

Let’s put the shoe on the other foot. What about the patient? It is imperative that patients have the autonomy to decide for themselves what treatments, if any, to take. They should not be forced into doing something they really don’t want. The patient should be honest in expressing his or her desires. They should not do something to satisfy the wishes, real or perceived, of their families. In many respects, families need proper preparations too.

I believe one key component to that preparation is a spiritual accounting of those involved. One may not exhibit any spiritual dimensions until a serious illness appears. So it may seem strange to begin church attendance or start a more formal prayer routine. Being able to assist patients in the manner of addressing an aspect of their lives that may suddenly take on major prominence belongs to healthcare providers and loved ones equally.

All that we are given in life ultimately comes from God. It has been stated that the only things we truly own are our sins. There is a purpose to what has been given us. It behooves us to explore this purpose through prayer and perhaps through the Sacraments. Fears and concerns of what illnesses may bring to us or mean to our families should not limit communications. Any communication must be honest but not so brutally honest as to remove all hope. Compassion for individuals is best served by encouraging communications with those providing care and with families and friends.

The presence of an illness may bring to question our faith – where is God’s mercy and love?  It is at these times when communication with our Lord is paramount. In a meaningful relationship with God, the desires to just “giving up” may become inconsequential as true joys and freedoms are discovered.