In traditional societies, so different from our own, elders and religious leaders, healers and political leaders are respected authorities. They are believed to have the perspective, the experience, the personal gifts and the education that give their opinions weight. Their decisions are assumed to be correct, and are therefore binding. Traditional healers are viewed as individuals with special talent, talent further cultivated by deep immersion in the arts and sciences of health. The healers' trade is traditional wisdom.
Traditional wisdom is wise indeed when it expresses a truth about human nature and that truth transcends time and place. The old Yiddish saying, "Ask the patient, not the doctor," is such a sound-bite of wisdom. It is the mantra of every good clinician, from shaman to shrink, and all brands of specialties in between. The best clinicians are those who can observe and connect with the phenomenon of a patient's lived experience. How do today's gifted healers "ask the patient"?
The past 30 years have brought a sea change in health writing; both the tone and the authorship of books on health and illness have changed. Since the breakthrough "Our Bodies Ourselves" back in 1973, patients have written an increasing number of books and articles about health. And the change goes far beyond writing: support groups educate, motivate and comfort patients and their families with the unique understanding of "I've been there, too." In addition, lay people have discovered entire syndromes and coined new concepts; think of Melanie Beattie's "co-dependency, " and the revitalization and widespread adaptation of Bill W's 12-step program to a range of compulsive and addictive conditions. Patients have made a great deal of progress in their struggle to be heard.
The truth is, patients and clinical professionals need one another's expertise. In the ideal health care world, doctor and patient would be partners, working together in a synergy of trust that enhances the possibility for recovery, and when recovery is not possible, ensures the ongoing presence of comfort.
Good therapists, good doctors and good patients grope our way toward this ideal therapeutic relationship. The way is fraught with obstacles made of hard and thorny, slippery and fluid substances: time, money, and emotion. We are often confused and unclear about which way is forward. This week Atul Gawande, M.D. shed some light on this journey in his thoughtful and sensitive - yes, wise - article, "Letting Go" in this week's New Yorker magazine (August 2, 2010). In it, he introduces the reader to the emotional complexities of the doctor-patient relationship that are in play when a patient is deathly ill. It is an important article to read, a serious issue to think about, and a vital topic to discuss. Perhaps we can start discussing it right here.
I hope to hear from you, and I'll look forward to your comments.
