By James Drane
The first thing a visitor of the sick needs to do is to listen to the sick person. Don’t do all the talking. Helpful visitors of the sick and suffering listen and engage in dialogue. This is true if the visitor is just a friend, or if it is a doctor who is visiting.
The doctor-patient relationship today, like all human relationships, is more and more influenced by a powerful surrounding culture. Today’s market-driven, commercial, capitalistic culture invades and can corrupt the traditional doctor-patient relationship. The traditional doctor-patient relationship is defined by trust and care and a personal bonding. However, many patients today think of themselves as buying a certain doctor, and some doctors tend to commercialize their patients. Rather than being a person to be helped, the patient becomes an instrument for financial gain.
This change in the way a patient is viewed undermines the core of medical ethics. At the base of medical ethics is the doctor’s reaching out in a personal way to help a patient in need. All the ethical obligations listed in traditional medical codes originate from and are rooted in the primary obligation to reach out to help a person in need. If this foundation of medical ethics is undermined by our culture, and patients are turned into money-generating entities, then medical ethics itself is undermined.
When a patient is seriously ill, he or she is a person with serious needs. If the doctor does not recognize the needs, there will be no reaching out to help, and there will be no authentic doctor-patient relationship. As a result, the many forms and levels of patient suffering will be ignored. The complex needs of the patient will be covered over with a financial blanket.
Today’s powerful commercial culture invades the doctor-patient relationship first through what is charged for a visit, then by the powerful influence of insurance companies, drug plans and new technologies on a doctor’s decision and time. The more complex needs of a patient go unrecognized. Some patients whom doctors see will be full of fear and guilt. Others will be full of uncertainty. A loss of once enjoyed independence may be the core underlying concern. Even treatments to be received can become a worry because of medical side effects and disfigurements.
Different patients will have all kinds of questions and needs, all brought to the doctor for help. If the doctor makes no effort either to relate to the patient personally or to recognize his/her underlying needs, then patient needs will not be met and medical practice will be less and less ethical.
A good doctor is not one who just diagnoses a pathology and applies a therapy. The good doctor starts with a caring, personal patient contact and maintains that personal caring relationship. Even a scientific medication might need a patient’s hope in order to be most effective, and the doctor is the one to promote this hope by what he or she explains to the patient.
For another patient, there may not be a therapy and no scientific treatment. Then a good doctor will help the patient to manage this situation. A good doctor might help a patient to recognize the role of suffering in all life; the inevitable role of suffering as a human condition. Sometimes, the good doctor has to be part philosopher and theologian.
Some doctors will react very negatively to the idea that they should reach out in a personal way to patients and that a personal doctor-patient relationship is the historical foundation of medical ethics. For many doctors today, the noble profession of medicine has been deflated by the influence of our powerful commercial culture. Many doctors have become just practitioners of science, relying solely on scientific data and therapeutic technologies. Don’t ask these doctors to be more deeply involved or to engage in personal communication. Medicine for them is only a practice of science in order to cure. When curing is no longer possible, these doctors just leave the patient.
What a loss! Historically, the profession of medicine was about both curing and caring. The good doctor was scientifically competent but when science no longer provided a cure, the good doctor’s personal and caring presence became a symbol of the very presence of God. No wonder the medical profession historically was so respected.
Suffering and dying are experiences which, for most of us, raise religious questions. The presence of a caring doctor becomes a theological response to these questions. The caring doctor becomes a symbol and an image of the presence of God.
In a caring doctor, science and theology come together. In the absence of a caring doctor, suffering wins out and death becomes the final reality in a non-religious and uncaring way of life.
Drane, Ph.D., is the Russell Roth Professor of Bioethics at Edinboro University of Pennsylvania.