Medicine is Love?

“For a long time, I had carried the belief that as a physician my love didn’t matter and the only thing of value I had to offer was my knowledge and skill.  My training had argued me out of my truth.  Medicine is as close to love as it is to science and its relationships matter even at the edge of life itself.”

–  Rachel Naomi Remen, MD – Kitchen Table Wisdom

I observed a patient talking to my trainee recently.  The patient was musing about some of the things that had happened in his life – he wanted to just talk to us.  My trainee needed to re-direct him several times to get through the assessment.  Afterward, I thought about the medical assessment questions – and yes, answers to those questions gave us the symptoms.  But we lost the opportunity through the patient’s musings to talk about what he loved, what he had lost, and what made him tick. This is a common challenge for trainees – they sometimes focus on remembering and getting through all of the questions, without also focusing on the patient as person. Being comprehensive in the questions is essential to making the right assessment – but so is really listening to the patient as they share.   And sometimes, that is non-productive, but often it takes us so much closer to the real needs and the real motivation for (or barriers to) healthy change.   

When I listen to patients, I find the humanity is in between the questions.  Hearing peoples’ stories makes it hard not to love them, and appreciate all they have gone through as they walked through their lives to reach that very moment where we met.  When patients reveal themselves to me, I can see and appreciate the beauty in them.  What risk that patient has taken, being willing to subject themselves to my questions.  What intimacy they have opened themselves to – sometimes telling me what they have told no one else, sharing their secrets, their joys and their terrible sorrow.

I believe that when we offer – and the patient feels – our love of their humanity (and of them as an individual), every other intervention works better.  Their trust in us leads them to engage more, to get more out of the intervention, to sustain hope even in dark places.  Call it the placebo effect if you will – in studies, even populations in the control group usually improve, simply because of the regular contact and caring attention.  Because the treatment is a relationship, we relegate it to the Placebo category.  If it were a device, a pill or a procedure, we would say that this remarkable treatment effect shows efficacy with few side effects. 

Loving is Risky. And Difficult.

And Worth It.                                  

Now, loving your patients is risky business.  They might still get sick or die.  They might leave you.  They might get angry with you.  You might feel it when they suffer.  

What’s more, it’s practically and logistically challenging: when I’m pressured and working fast, do I remember to listen between the questions? Can I stop between the symptoms assessment and ask, “Who is this beautiful child of the universe in front of me?” Do I take a moment to savor this interaction with my patient and revel in the joy of the connection?  Do I remember to love them, and show it? 

For me, there is no choice.  I have to risk my heart every day.  I have to learn to care, walk at their side and then say goodbye.  I have to commit to giving myself the extra love, care, nurturing and resilience I need so I can pour the same on them. To be present, fully, with each person, in that moment, is powerful, healing, and deeply satisfying work. What a wonderful way to spend my life!