To heal or to cure?

Al-Imari, Lina

During my clerkship as a medical student, I rotated from one setting to another on a daily basis like I was going through a revolving door. I felt anxious, overwhelmed, and excited at the beginning of each rotation. I welcomed the challenge and marched on!

I began my clerkship with general areas of medicine and then I transitioned to more focused specialties of medicine and surgery. Towards the end of my core rotations, I joined the Ophthalmology Clinic team as they assessed Mr. M., an elderly man who was referred from the Emergency Department. In a short ten minute period, we learned his symptoms, his medical, surgical and social history, and we performed the appropriate physical examination. It was clear that he struggled with a hearing impairment, and that he had few social supports. The ophthalmologist addressed the eye infection with the appropriate treatment, and asked me to book the elderly patient a cab to go home.

As my exposure to specialized areas of medicine and surgery grew, my assessments became more focused. I learned how to organize a wide array of symptoms into a list of “issues” and address the issues that were relevant to the specialty that I was rotating in. From the previous encounter, I worked on developing my role as a scholar and a medical expert by acquiring knowledge about eye infections and their respective treatments. I also learned how to be efficient by focusing on the presenting complaint that is pertinent to the specialist whose hat I wore that week.
So why did I not feel good about this encounter?

As I helped this frail elderly man use his walker to leave the clinic, I knew that his “issues” were multi-factorial and stretched more than an eye infection. He needed a hearing assessment, a home safety assessment, among several other issues that would have been identified if we probed further. I am well aware that the ophthalmologist— a specialized and costly commodity in our healthcare system— already had a long waiting list and that his expertise involved one specific system of the body. I did not expect the ophthalmologist to address this man’s other health issues or determinants of health. Nonetheless, I could not but wonder that if I was Mr. M.’s gateway to the healthcare system at that moment, I could have had a significant impact on his life by at least connecting him with community resources. I would have acted as a health advocate on an individual level. I wondered what Mr. M. thought about his care, and I wanted to ask, but well, we were on our way to assess the next patient, also to be seen in ten minutes.

As I moved from one highly focused specialty to another, I felt as though I was becoming more of a medical expert. I was becoming a physician. However, my encounter with this patient left me feeling like I was becoming a doctor of a medical or surgical health problem, and not a doctor of the person.

A few weeks later, I did an elective in Family Medicine. I encountered a patient, Mr. Z., who presented with dizziness. Having just completed my Otolaryngology rotation, I performed my assessment and diagnosed him with BPPV. I was quite content with myself for making the diagnosis and suggesting
an appropriate treatment plan. Towards the end of my interaction, I noticed his flat affect, and before I began to address it, the Family Physician entered the room. The first question he asked Mr. Z was regarding his wife. As the conversation carried on, I learned that Mr. Z’s wife struggled with severe
Alzheimer's disease and was recently placed in a nursing home because she was struggling with dysphagia. The Family Physician listened with empathy, offered support, discussed the role of anxiolytics, and emphasized frequent follow-up appointments, in addition to BPPV treatment.

As Mr. Z. disclosed his fears and concerns, I reflected on his story. While his complaint of dizziness is an important issue, it was certainly not the most pressing matter in his wellbeing. Given my recent focus of training in specialized medicine, I primarily focused on the presenting complaint and missed the elephant in the room, that is, the man’s slow and painful slow of his beloved to a brutal disease. Perhaps I overlooked this because the minute this man said he was dizzy, I immediately delved into my approach for that chief complaint and I put on my ENT hat.

This encounter made me reminiscent of the person I was when I first applied to Medical School. I wanted to be a doctor to help people in the way that I felt was the most suitable for my skills and interests. I wanted to be a doctor of a person. So why did I feel like a doctor of “dizziness” or a doctor of an “eye infection” in those incidents? In other words, how did I become a doctor of a medical or surgical health problem?
As Mr. Z. spoke with the Family Physician, I realized that the patient physician relationship is in fact the heart of medicine. In that moment when the patient disclosed his innermost fears, I understood the essence and integrity of the physician-patient relationship. Beyond the tasks of medical management, a physician’s job is to support the patient and his or her caregivers. We do this by
translating our knowledge into mobilizing resources in the form of non-pharmacological and pharmacological means, connecting patients to allied health professionals and community resources, and by exercising empathy and excellent listening skills.

When I interviewed for Medical School four years ago, I was asked, “Which of the two do you think is the more important role of a physician: to cure or to heal?” At the time, I was not entirely sure how to answer the question. Towards the end of Medical School however, I think that I can safely say that while both roles are important, to heal is probably more significant. To cure is to eliminate all evidence of disease, whereas to heal is to restore a person to health. According to the World Health Organization, health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. For example, successfully removing a cancer is a cure. But supporting that person to come to terms with the diagnosis and the implications of the treatment and the connotation of being a cancer survivor is to heal. In my previous example, to provide BPPV treatment would cure Mr. Z’s vertigo symptom, but it would not heal him. By providing support as he deals with this difficult period in his life will hopefully heal him with time.

At this early stage of my medical training, I sometimes feel like a hamster endlessly running on a wheel as I attempt to master all of the CANMED roles. The encounter with the Family Physician taught me not to miss the big picture. I am on a journey to become a healer. The goal is to heal a person, not just to provide a cure to a medical or surgical problem.

Theme: Family | Famille
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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