The Cry of the Patient - Are We Listening?
by Keith Frey, MD and Elizabeth Boatwright, MD
Today's Christian Doctor - Spring 2007
A recent study published by our institution looks at patient perceptions of ideal physician behavior.1 This study highlights the fact that a patient’s relationship with his/her physician, and thus the patient’s experience of illness, is influenced by that physician’s behavior and interpersonal skills, not simply his/her technical knowledge. After interviewing nearly 200 patients seen at the Mayo Clinic across fourteen medical and surgical specialties, the authors generated and validated seven ideal physician behaviors that emerged as primary for patients. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough (see table 1).
As Christian physicians, we hear this description of the ideal physician as a cry for God - for an all-powerful, yet all-loving Healer who will touch the sick person at his or her greatest point of need. Confronting the frailty of one’s physical body, even in the context of a minor illness, brings up the God-ordained longing we have for the eternal (see 2 Corinthians 4:16-18). Though we have been trained as physicians to focus on healing the physical body, we conduct our work in a uniquely spiritual context.
It is therefore highly relevant for us to turn to Scripture and study the divine attributes of the true Healer, Jesus. As our ultimate physician role model, and the source of our life and strength, Jesus perfectly blends authority over all things with compassion for the lost and suffering. As God and Man, He has a unique understanding of the human condition that propels Him with the intense purpose of saving souls and pointing people to God. He consistently connects word and deed, healing in the context of teaching truth: “So he traveled throughout Galilee, preaching in their synagogues and driving out demons” (Mark 1:39). As He preached the word, people were drawn to Him and brought to Him their sick (such as in the healing of the paralytic, Mark 2:2-3).
Jesus’ compassion and focus on the whole person is beautifully recorded in the gospels, and serves as a high standard for Christians in the healthcare field. Jesus knew and understood the whole person’s needs, connecting both the heart and health in a compelling and personal manner. Many of the behaviors sought by patients in a physician are seen clearly in the life and ministry of Jesus. We would like to reflect on the ways in which these behaviors are seen in Jesus, and then think of practical ramifications for the life of Christian physicians.
Confident. The Mayo Clinic study, based on patient interviews, defines the confident physician as having an assured manner that engenders trust. Such confidence gives the patient confidence in his/her doctor and his/her diagnosis and treatment plan. In Jesus’ ministry, we see such confidence displayed in the healing of Jairus’ daughter after she died: “Don’t be afraid; just believe.... The child is not dead but asleep” (see Mark 5:21-43). Jesus’ confidence is based in His intimate knowledge of God’s world and His complete authority over the physical and spiritual realm. For the Christian physician, confidence is based in knowledge and experience, both medical and spiritual. Humility flows from the recognition that there is a God who is all-knowing and all-powerful, with much greater power than any we can claim in the medical profession. A delicate balance must be struck between a humility of spirit, dependent on God’s wisdom, and an assured manner which builds trust and hope with our patients.
Empathetic. Here the doctor tries to understand what the patient is feeling and experiencing, both physically and emotionally, and communicates that understanding to him/her. As both God and Man, Jesus understood the human condition better than we do ourselves, and therefore had ultimate empathy with humans. As Christian physicians, we can empathize with our patients because we are like them - mortal, frail, and in need of God. There are many examples of Jesus understanding a person’s condition and needs, and directing them in a way that could result in ultimate healing:
- Zacchaeus needed to stop cheating and give to the poor (Luke 19:1-10);
- The Rich Young Man needed to go beyond the letter of the law and give away his wealth (Mark 10: 17-27);
- The Samaritan woman, who had had many husbands, needed to drink the Water of Life (John 4:7-42).
Jesus said, “It is not the healthy who need a doctor, but the sick. I have not come to call the righteous, but sinners” (Mark 2:17). As Christian physicians, we seek to understand our patients at the level of their deepest needs as Jesus did, show empathy for their condition and their emotions, and give healing advice in order to point them in a healthy direction.
Humane. Patients desire a physician who is caring, compassionate, and kind. The personal virtues of Jesus—His care, compassion, and gentleness—are consistently reflected throughout the Gospels. Faced with the leper who had faith that He could heal, Jesus, filled with compassion, “...reached out his hand and touched the man. ‘I am willing,’ he said. ‘Be clean!’ Immediately the leprosy left him...” (Mark 1: 40-42). Before miraculously feeding the 4,000, Jesus told His disciples, “I have compassion for these people; they have already been with me three days and have nothing to eat. I do not want to send them away hungry...” (Matthew 15: 32). As Christian physicians, we seek to model the life of Jesus, living in the power of the Holy Spirit and manifesting the fruit of the Spirit (Galatians 5:22-23) in our interactions with our anxious, ill, and hurting patients.
Personal. The ideal physician is described as one who is interested in a patient as more than simply a patient, but who also interacts with him/her as an individual. This entails establishing a connection - one human to another - recognizing the person’s dignity and uniqueness as a human being. Jesus models this personal approach as He heals. When the woman with the flow of blood for twelve years touches His garment in the midst of a busy crowd, Jesus notices, turns, and speaks to her personally: “Daughter, your faith has healed you. Go in peace and be freed from your suffering” (see Mark 5:24-34). As Christian physicians, recognizing our patients’ unique traits is a way that we recognize the special attention God gives to each of us, made in the image of God Himself.
Forthright. Patients desire straight talk from their physicians; telling them what they need to know in plain language and in a direct manner. There are many examples of Jesus being quite clear and direct in His message, amidst many examples of people not understanding His meaning. Jesus works specifically with His disciples, translating the meaning of His parables, and He is very direct with those He intends to heal. Consider the rich man asking “What must I do to inherit eternal life?” Jesus responds that he is first to obey all the commandments; when the man stated that he had done this since his youth, “Jesus looked at him and loved him. ‘One thing you lack,’ he said. ‘Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me” (Mark 10:17-24). Jesus teaches very clearly in the temple, “‘Repent, for the kingdom of heaven is near’” (Matthew 4:17). Jesus divinely connects the physical state with the spiritual state of those He heals: when He heals the paralytic let down through the roof, He proclaims, “Friend, your sins are forgiven” (Luke 5:20). As Christian physicians, we must strive to communicate clearly, sensitively, and effectively with our patients - clarifying diagnoses, prognoses, and treatment options. And we must seek to understand any underlying spiritual issue that may exist and prayerfully seek to address it as part of our treatment plan.
Respectful. Respect is demonstrated in forging partnerships with our patients, taking their input seriously and working with them to arrive at a therapeutic plan. A physician shows respect by taking a patient’s preferences and values into consideration as he or she applies medical expertise to a problem. This is a clinical encounter, different in context and setting to the ministry of Jesus. Jesus did care for the individual, yet He also had a clear sense of the individual’s need from a divine perspective. Jesus balanced authority with respect for individual modesty with the deaf and dumb man in Mark 7:33: “After he took him aside, away from the crowd, Jesus put his fingers into the man’s ears....‘Be opened!’” As Christian physicians, we can help to bear our patients’ burdens by listening to their perspectives in order to tailor our recommendations.
Thorough. Our patients expect us to be conscientious and persistent in pursuing their healthcare needs. Complete explanations of a clinical condition or therapeutic plan, careful attention to detail during therapy, monitoring outcomes, and dealing with any issues in a timely fashion all convey competence and care to a patient. As Christian physicians, this thoroughness is a means of doing “all for the glory of God” (1 Corinthians 10:31).
The Attributes in Action. Interpersonal skills are not simply inherent in a physician’s personality, nor do they simply flow from the strength of his or her faith; just like the spiritual disciplines of prayer and Scripture study, they require studied attention and practice. Specific skills and interpersonal attributes can be learned and acquired.2,3 And one key to acquiring and practicing the skills that our patients value most, thus emulating the Ultimate Healer, is to consider these from the patient’s perspective, as expressed in Table 2.
We encourage readers to prayerfully examine their own behavior, and to seek the input of fellow physicians and patients with regard to these qualities. In areas where they are lacking, we encourage readers to seek out people and courses (for example, courses in nonverbal communication, active listening, giving bad news, and so forth) to help acquire skills which will strengthen their practice of medicine, and ultimately help them to draw others towards the True Healer, Jesus Christ.
1 Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patients’ perspectives on ideal physician behaviors. Mayo Clin Proc. 2006;81:338-344.
2 ABIM. Project Professionalism. Available at: www.abim.org/resources/publications/professionalism.pdf; Accessibility verified October 13, 2006.
3 ACGME. Outcomes Project. Available at: www.acgme.org/Outcome/. Accessibility verified October 13, 2006.
ABOUT THE AUTHORS
Keith A. Frey, MD, is Professor of Family Medicine, Mayo Clinic College of Medicine, and practices and teaches Family Medicine at the Mayo Clinic Arizona. He received his MD from the Medical College of Virginia, a MBA from Duke University and completed his family medicine residency at the USAF Medical Center, Scott AFB, Illinois.
Elizabeth A. Boatwright, MD, is Assistant Professor of Medicine, Mayo Clinic College of Medicine, and practices and teaches in the division of Women’s Health Internal Medicine at Mayo Clinic Arizona. She received her MD from Harvard Medical School, an MDiv at Andover-Newton Theological School, and completed her internal medicine-pediatrics residency at Georgetown University Medical Center in Washington, D.C.