The Medicine Man in the ancient tribal society was next only to the Chief, and sometimes even the Chief was greatly influenced by the opinions or instructions of the Medicine Man. The influence acquired by the medicine men came mainly through their understanding of human psychology which they used effectively to comfort or "cure" people ill-at-ease or with "disease". Their repertoire of medicines, rites and chanting was not really as effective as the care and consideration they bestowed on the afflicted. The patients mostly healed by themselves. Even today, in remote parts of the earth, "Shamans" exist who still cure patients by similar techniques. Alas, the modern ‘Medicine Men" tend to try and master the Science of Curing, but are fast losing the Art of Healing. We all have both a body and mind, so when ill we need both curing and healing. Actually they exhibit a synergy since one helps the other. The most effective treatment of the sick should therefore include both.
We now know that in recovering from any abnormal condition our immune system, regulated largely by the secretions of the many endocrine glands and the chemicals produced in our brain, plays a very important part. It is no wonder that there are many recorded cases, where in the absence of real effective drugs, placebos have functioned as well to give relief or even to cure patients with serious illness. The mind of the patient has a role to play in strengthening the immune system. A fact medical practioners would do well to always remember.
In my younger days, I remember right up to the early fifties, we had our "family doctor". We used to call him for a home visit whenever someone was too ill and unable to visit his dispensary. Our Doc on his visits took time to examine the patient very carefully, listen to him or her very patiently and provide the necessary reassurance. He never showed irritation or annoyance even when someone doubted his diagnosis or line of treatment, but took pains to explain the facts. The family doctor generally had time to observe and advise on our diet and lifestyle to make these more health giving. The family doctor was a friend and guide. He inculcated faith in our minds and this facilitated healing.
Those were the days when specialists and "super-specialists" were not available. The family doctor did all the minor surgeries and referred the patient to a general surgeon for any major ones. We had never heard of a psychiatrist; when a patient showed abnormal stress or depression the family doctor tried to talk him into comfort and health. In most cases he was successful. We first heard of bedside manners of doctors when in the nineteen-sixties, these started vanishing. I firmly believe that all practising doctors, from G.P.'s to Surgeons and Super Specialists, will be more effective in their practice if they do not just relieve aches, treat an illness, and remove a tumour, but effectively heal a human being. Both the doctor and the patient will be happier when there is real care, consideration and kindness. This is what bedside manners are about.
Institutional medical care now involves receptionists, secretaries, paramedics, nurses, ward boys, lab assistants, cleaners and watchmen in the larger medical establishments. The need for all these to show consideration and kindness to patients and their relatives is even greater, which could motivate them to trust the care-givers and cooperate fully. The stress on both sides will be reduced and both will be happier. There is enough research done on this subject and a mass of evidence that shows how kindness can help healing. What's more, the care-givers too will find their work easier and more satisfying. It will always be a win-win situation.
Dr. James R. Dykes, M.D., who teaches at the Duke University in the U.S.A., relates a personal experience in his youth about the role of kindness in healing: At 14, he had severe acne vulgaris that spread from his face to the entire back, chest and arms. He was taken to a dermatologist, who asked him to remove his shirt, and when he saw the condition just took one step backwards after a disparaging remark. Revulsion showed on his face. He then prescribed antibiotics, lotions and other medicines and promptly dismissed the patient. The treatment was not at all effective, and soon the affected area was infected with staphylococcus, and the irritation and pain increased very much. He was now taken to another dermatologist. When he removed his shirt this new doctor examined the afflicted area carefully, put his hand on Dyke's shoulder and said in a reassuring tone " I know how much you are suffering, but we shall soon end it, and you will be back to normal". Dyke immediately felt a warmth inside him, and his hope for speedy recovery was rekindled. This second dermatologist prescribed the same medicines, but Dyke recovered from the infection and became perfectly healthy very soon.
Dyke says in his article on Teaching Kindness: "Now I teach Duke medical students. I tell them that although "objectivity" is important in the practice of medicine, it is often misunderstood. When the great physician Sir William Osler (1849-1919) wrote his treatise on the importance of "objectivity," he used the Latin term "aequinimitas," which can be translated as equanimity. To practice with equanimity, we must cultivate inner peace. I teach my students that medicine is a service, a sacred service in my opinion. I teach them the value of listening not only with our ears, but with our hearts, being ever mindful not to lose sight of the innocence and the wholeness of those we serve. I teach the value of kindness."
In an article in Natural Health (October 2003) Jill Neimark says: Imagine getting a prescription that reads, "100 milligrams of love, twice daily, unlimited renewals." Caring, of course, can't be put in a capsule, but it can heal as powerfully as medicine. "Love is a basic human need," says Dean Ornish, M.D., author of 'Love and Survival: 8 Pathways to Intimacy and Health'. "When we don't get it, we pay a price in how long we live and how likely we are to get sick." We may also pay a price if we don't give love. According to Stephen Post, Ph.D. professor of Bioethics and Religion in Ohio's Case Western University, research shows that loving acts neutralize the kind of negative emotions that adversely affect immune, endocrine and cardiovascular function. Studies published over the past five years show that loving and helping others has health benefits, says Post. Social support appears to prolong life, in a hospital the best social support will be that given by the hospital staff, medical and others. A Duke University study of 1,400 people with heart disease found that those with a spouse or confidant died at one-third the rate of those who felt isolated in a hospital.
Fresh medical graduates used to be initiated into the profession with some version of the "The Hippocratic Oath", and we often find a framed version displayed in some doctors' clinics. This oath which was originally a prayer to the Greek gods of healing and medicine, seeks to define the physician-patient connection to be the true nature of the healing relationship and the essence of medicine. Its principles are reflected in the physicians' code of ethics: treat the patient to the best of one's ability, preserve the patient's privacy, teach the secrets of medicine to the next generation, and so on The American Medical Association's Code of Medical Ethics holds that, "The Oath of Hippocrates has remained in Western civilization as an expression of ideal conduct for the physician"
Sarah Jane Bryant in her Seniors Project at the St. Olaf's College, Northfield Minnesota, U.S.A. states: "The work of compassion requires a just healthcare system structured for its work". In any hospital or healthcare facility, two different worlds coexist side by side: the highly physical, technological world of busy health care professionals and the spiritually fearful, uncertain world of the ill patient. Compassion creates a bridge between the two. When compassion is present, a patient feels supported and cared for as a human being in the midst of a threatening situation.
Karen and Simon Fox, developers of The Medicine of Compassion, identify four principle elements of compassion that make it possible to bridge the void of isolation that commonly surrounds the patient in distress, especially from a serious or chronic illness: attention, acknowledgement, affection, and acceptance. Attention involves being ready to observe the signs that indicate what is important to the patients. Acknowledgement is letting the patients know that they are respected and appreciated as unique individuals. Affection is the typical human behaviour infused with warmth, humour, comfort, and kindness. Acceptance is tolerance of the real situation without assigning blame when the care giver cannot improve it. When these four elements are practiced in the health care field patients are put at ease, feel encouraged and begin to trust, open up and cooperate.
Finally, I would recommend the excellent paper, "Literature and Medical Ethics", by D. S. Sheriff of the VMKV Medical College, Salem, Tamil Nadu - 636 308, presented at International Bioethics Workshop in Chennai: Biomanagement of Biogeoresources, 16-19 Jan. 1997. He opines that the teaching of Medical Ethics is not being given due priority and suggests ways and means of teaching ethics effectively. He suggests preclinical seminars for medical students, for example with title like ‘A smile is a charity' is suggestive of general qualities that go to make a physician who understands that:
Little acts of kindness,
Nothing do they cost.
Yet when they are wanting,
Life's charm is lost.
It teaches the simple truth that a pat or a smile or personal concern shown by the duty doctor brings back the confidence into the patients admitted in the ward. This personal reassurance expressed in the form of small acts of kindness play a very important role in revitalizing the patient and his hope to fight the disease or mentally prepare him to face the awaiting surgery or sometimes reconcile himself to a poor prognosis. Suitable material could be extracted from a book like Cancer Ward and could be discussed in the light of the title.
When treated with compassion, patients are more likely to muster their own intrinsic resources for healing and also take greater responsibility for their own health. The care givers also get more job satisfaction and experience less stress when working in a healthy and dynamic partnership with patients, rather than in the one-way, provider-consumer model of care. Compassion has a definite role in treatment and can positively influence successful healing. So patients who do not have many visitors are in dire need of support from the hospital Staff. Tenderness and care are necessary when preparing patients for surgery; if they enter the operation theatre in the proper frame of mind it will be easier for all concerned.
Of late, many small and large hospitals in India seek to get ISO 9001 Certification. The documentation of procedures required for this is supposed to ensure that the "customers", in this case a patient or his accompanying relatives, are served to an acceptable level and they are satisfied. Unfortunately with all the labour and money spent in documentation, training and statutory audit, one can find a very high number of sorely disappointed "customers" at such institutions. Perhaps a "Kindness" Training Programme could effectively remove this kink. Such a programme can improve the situation entirely on its own even if there are no plans for ISO 9001 Certification. The programme should be designed to touch the hearts of the trainees, with just sufficient theory and plenty of items like acting skits (role playing), debates, audiovisuals, real life stories, etc.
The author asserts that his organization is willing to collaborate with any hospital ready to implement the idea. (Ed)
* Vasant S. Kalbag
Chief Coordinator and Founder Trustee,
(A Non-Profit Charitable Trust)