The past 18 months of the pandemic has taught us many lessons about health and disease. Illness can rob us of our sense of safety, wellness, and joy, but even the threat of a disease we haven’t had can do the same. That threat alone can cause significant symptoms of chest pain, headache, nausea, numbness and tingling, palpitations, and shortness of breath. Nearly half of the thousands of patients I have treated in the emergency department over the past 3 decades have had negative tests, but that doesn’t diminish their sense of dis-ease. We spend the more money on healthcare than any other country yet our outcomes are amongst the worst. Why? What are we missing?
When I was 4, I had a bad case of chicken pox. My fever was sky high, the itching was terrible, and I had no idea of what was going to come next. Then, the treatment for high fevers was an ice bath. When mine hit 106.4 after my parents came home, they did their best by plunging me into that knife sharp water. I still remember it to this day. We’ve learned since that ice baths don’t work very well and are miserable. My fever didn’t break.
So they called my doctor.
Instead of packing me up to go to his office, he came to me. He was tall, strong, smart, and kind. He always wore a tie. He carried the iconic black bag which to me at that time held magic. He took out his stethoscope and put it on my chest. He put a mirror on his head and looked into my throat and ears. He checked my reflexes with his rubber hammer. And he laid on hands. No fancy lab tests or CAT scans. No intravenous fluids. No EKG or x-ray. His presence made me feel better. He somehow transferred his healing power and I trusted him. I still felt pretty lousy, but I knew I was going to get better as he walked out of the house.
I vaguely remember reading a case report exploring the relationship between a caregiver and care receiver while having a healing conversation. A patient and her trusted physician were each undergoing a PET scan as the physician was speaking with her patient. As the spoke, the same area of their brain lit up on their respective scans, indicating that neuronal activity was present in the same region of the brain in both during a caring conversation. They were connected. It makes me wonder how much my doctor felt better when I felt better. I know from my own experience that when I connect with a patient and they tell me they feel better, I can FEEL it as well.
Our current healthcare system is often driven by metrics: patients per hour, patient satisfaction scores, price per procedure, checklists, and outcome measures. Value based care, copays and deductibles, are the names many have come to associate with the health system. Somewhat lost in this is our relationships. Many of the patients I have treated, and many of my friends, bemoan the loss of connection they have with their doctors. We ask our patients to come to us, often dragging their over-stressed and over-worked families with them. We ask them to sit in waiting rooms, undergo perfunctory exams by hurried workers, get undressed in overlit and sterile strange rooms, give them “johnny coats” without ties in the back, revealing our least favorite part to the wind, stick sharp objects into their skin, put them in beds or stretchers with the rails up so they don’t fall out, and then ask them to rate our kindness and ability to listen! Often, patients leave this experience confused and frustrated. Then the final injustice of receiving bills that are difficult or impossible to understand with amounts that are shocking and outrageous.
I have heard that many doctors and nurses are suffering from the effects of the pandemic: masks that block our view of our patients and ourselves from them, uncertainty about a disease that we are still trying to understand and cure, all while being overburdened by documentation and algorithms. Many are thinking of leaving their practice. It is no surprise to most of us in the healthcare system that the healing connection appears to be fracturing for too many.
There is a better way. With the power of time, touch, and the healing conversation, supported by caring healers and improving technology infrastructure, we have found that we can become that country doctor from the past, but this time as a team of caregivers. We have learned that we can meet our patients in the comfort of their homes or at work, perform thorough exams, obtain blood and lab results in minutes, start IV’s and give medication, without their having to come to us. Some of our healthcare scientists have shown that as a result people heal faster, costs are less, and their satisfaction with the process is so much better than the alternatives.
Certainly, our hospitals, urgent care centers, doctors’ offices will continue to serve important roles in our healing journeys. But for the right patient at the right time with the right team and the right treatment, there is often a better way. Maybe this is what has been missing. It doesn’t have to be. We have a better way.