Despite the increasing specialization in medicine, some doctors are advocating an approach to care that focuses on the entire patient rather than on a single section of the body or biological process that needs to be fixed. While this concept may not technically meet the criteria of alternative or complementary medicine, viewing a patient as an entire person can still require a shift in the traditional approach taught in medical school.
"If you go back to the history of medicine, René Descartes established this dualism between mind and body, and it brought into our time a mechanistic approach to the body, where doctors would treat the body like a mechanical object," explains Dr. Mark Stafford, associate professor in the department of medicine at UAB. "What we've learned in recent years is that there's an intimate connection between the brain and the body."
Stafford, an internist, applies that whole-patient approach in his practice at Kirklin Clinic. "As I talk to patients, I realize that I'm treating a whole person; I'm not treating a set of lungs or a heart … none of those things exists in isolation. Those are all part of a person. And that person is a part of a community. What happens in a person's environment has a direct physical impact on their health."
Stafford says his approach is one he has developed over 25 years of practicing medicine. When he entered into private practice with the intention of treating biological processes, he says, "I found myself frustrated at every turn, because instead of having somebody coming to me with a disease, they came to me with their life. Their health was not working and their life was not working, and I was trying to treat their body in isolation. I was frustrated, and they were frustrated.
"You'll have patients that come in with a multitude of symptoms, and you'll do all your tests and the tests come out normal," he continues. "Well, it's no reassurance to a patient to be told all your tests are normal when the patient feels horrible. Unfortunately, what most doctors do in that situation is blame the patient. The truth of the matter is that those patients represent that interface where medicine has not figured out the connections between mind and body. And limitations in medicine should never be blamed on the patient."
Stafford says that learning to listen to patients can be a total breakthrough in approach. "I began to listen to patients without judgment and without feeling like I had to fix them. We're trained as doctors to fix people. If you go to the barbershop and hang around, you're going to get a haircut. If you go see doctors, you're usually going to get a prescription or a test. It's what we do. One of the hardest things to do is to realize that you can listen to a patient and you don't have to always give them a prescription."
Dr. Fred Griffin, UAB associate professor of psychiatry, also acknowledges the importance of listening to patients. As a passionate advocate of narrative medicine, he takes the listening a step further and encourages physicians to actually write the stories of some of their patients. Like Stafford, Griffin emphasizes the physician's role in the relationship, as well at the patient's, and he has found that practicing medicine with this approach is more fulfilling for doctors, in addition to being more effective for patients.
"Narrative medicine has to do with creating stories from what patients tell us and letting that information impact us," he says. "When we translate clinical experience into written narratives, we bring the physician-patient relationship to life. The act of writing helps us to restore our own humanity, and the act of seeing ourselves with our patients on the written page reminds us of what led most of us into medicine in the first place. It is only through being more fully human ourselves that we may convey convincingly to patients our intention to heal."
Griffin suggests that physician burnout is the result of the dehumanization of medicine. "The life of a doctor is a very difficult life in so many ways. I appreciate this. The only thing that makes it all worthwhile is the human contact. Most beginning medical students say they want to be a doctor because they look forward to the relationship with their patients that they imagine they will have."
Griffin has taught narrative medicine to other physicians, and he has found that the concept is well met. "We physicians don't sit down and talk about what it is like to be doctors. [When I would lead a workshop], even before I had them writing, they would tell stories about a patient 25 years ago that touched them and taught them something. You could see them coming alive!
"I began to believe that one way to help both doctors and patients was to enter from the doctors' side and to help them improve their lives and remind them of why they came into medicine in the first place."
Many physicians believe that such a whole-person approach can be time-consuming, but Stafford and Griffin disagree. "I see probably as many patients or more patients than anybody else over here," argues Stafford. "It's not the quantity of the time you spend with the patient; it's the quality of time. You don't do patients favors when you let them ramble on. You have to listen and be focused and you have to give your patient your undivided attention when you're listening. You can only see one patient at a time, so when you're with that patient, don't try to be with somebody else at the same time."
"Adding a narrative medical approach to objective medicine may not actually require that you spend more time with the patient," agrees Griffin. "Rather, it's a way of listening and of responding that can help you see who your patient is and to understand the illness in the context of the patient's life. Because it may assist you in finding the correct diagnosis and may help you design treatment approaches that better fit each patient, it may even end up saving you time.
"If you discover who the patient is in which the illness lives, if you understand the context, you're going to pick up diagnostic cues that you can't from lab tests. And once you recommend treatment, you can better tailor the treatment to the patient, so the patient is actually going to follow up.
"If physicians can realize how enlivening this is and how it helps them, diagnostically and therapeutically, and also helps them in terms of their own pleasure in medicine, they'll do more of it."
