The Silent Dimension
Expressing Humanism in Each Medical Encounter
UMANISTIC BEHAVior is considered an essential component of professional medical care. However, the evidence shows that it is often neglected. Many barriers to the expression of sensitivity to the patient’s concerns and empathy and compassion in the clinical encounter can be identified. Time constraints, poor continuity of care, appearance of alienating factors between patients and physicians, and the “hidden curriculum” are just a few in a long list. To overcome them, personal adoption of the CAPTURES* mnemonic technique is suggested. It includes Curiosity about the patient’s personal aspects, finding something to Admire, trying to see things from the patient’s Perspective, Touching and Using body language to convey caring, Reacting to the patient, and Stressing any positive or encouraging aspects to provide Support, reassurance, and hope. Four brief case examples are presented herein to demonstrate that a warm, interested, and supportive attitude toward patients can be regularly adopted with ease in every setting. Personal inclusion of the humanistic aspect in each patient-physician encounter accompanied by several of the institutional educational changes indicated may significantly alter the current scene despite obvious limitations. Marked benefits for both physicians and patients can be expected, including improvements in patients’ satisfaction, trust, and compliance, leading to significantly better “hard” health outcomes. Thus, sincere humanistic behavior can become an integral part of the encounter, correcting current deficiencies and catching
up with the astounding advances of modern biomedicine. INTRODUCTION “The care of a patient must be completely personal”1(p877) and “the secret of patient care is in caring for the patient”1(p882)—these words by Peabody remain as apt today as when they were first conceived almost a century ago. They recall Osler’s earlier dictum “it is much more important to know what sort of patient has the disease than to know what sort of disease the patient has.”2 Medical care encompassing both professional skills (disease oriented) and humanistic values (patient oriented) as two sides of the same coin defines professional competence.3,4 “Humanistic medicine” has a number of meanings, but I believe it centers around the physician’s comprehension of the patient’s narrative and emotions, compassion, and commitment to act and try to alleviate the patient’s suffering. Reality, however, lags far behind this consensual ideal. Physicians tend to interrupt their patients within seconds of commencing their story,5 leaving many agendas, mostly personal, unvoiced.6 Most of the clues and direct expressions of affect pass unacknowledged. 7,8 Of 384 empathic opportunities presented by patients with cancer, 90% were not taken by their physicians, who preferred shifting to biomedical issues.9 Patients are often frustrated and cite impaired concern and unsatisfactory communication with their physicians as a prominent reason for turning to complementary and alternative medicine providers.10 Many writings of patients (or physicians’ experiences as patients) reveal deep disappointment with the caring and
empathic dimension of today’s medicine.11-13 A novel concept of patient centeredness could improve “humanistic” performance,14 but its use remains limited.15-17 When looking at the current medical scene, which is rife with barriers and interferences to a humane physician-patient relationship (Figure 1), this failure is hardly surprising. Nevertheless, it must be overcome. The sincere adoption of a few simple attitudes and techniques as summarized by the “CAPTURES*” mnemonic (Figure 2) may prompt physicians to focus on the humanistic aspects of patient care as a routine component of the encounter. CASE EXAMPLES Case 1 An 87-year-old woman presented with sudden shortness of breath and was diagnosed as having large...