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Doctors cure, should they also help recover?

11/1/2022

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Does your cure end with your surgery, dressing your wound or restarting your heart? Or is that just the beginning of your recovery? Guess what, they don’t teach recovery and convalescence in medical school.

“Many of my tutors seemed to assume that once a crisis of illness has passed, the body and mind find ways to heal themselves,” Dr Gavin Francis, the author of Recovery: The Lost Art of Convalescence recently wrote in The Guardian. “But nearly 20 years as a GP has shown me time and again that the reverse is true: guidance and encouragement through the process of recovery can be indispensable.”

Dr Mazda Turel, a neurosurgeon, agrees. “We are not taught this in medical school,” he says. “But if you are attuned enough as a student while you sit in the clinic or OPD with your mentor you can learn it from your teachers in the way they respond to a patient’s needs in the recovery phase, from their ability to patiently answer umpteen questions (most of them repetitive). Eventually you imbibe care and concern, and that’s enough.”

Dr E K Ramanandan, a senior ayurveda physician too thinks most doctors pick up on their own how to help a patient through recovery.

Dr Nagesh Simha, Medical Director at Karunashraya, considers helping the patient and family through recovery a matter of compassion. “Yes, the doctor’s personal values matter. However, I believe compassion is something that can and ought to be taught.”

Recovery matters in an infected world

As new strains of coronavirus continue to give us all a physical and emotional pounding, the concepts of recovery and convalescence require deeper contemplation.
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Convalescence is anything but passive. It’s an action that needs us “to be present, to engage, to give of ourselves.”

Anyone who has been through the viral infection is aware of the fatigue that follows. Physiotherapists encourage those in post-viral recovery to push the limits of physical effort. Else, “sufferers can become trapped in a cycle of effort followed by collapse,” with each collapse requiring lesser effort.

Recovery must act in concert with natural processes. Florence Nightingale believed that “nature alone cures.” She said what nursing had to do was to “put the patient in the best condition for nature to act upon him.” Nature's healing touch apart, people recover more quickly if they think their physician is sympathetic and there for them.

Dr Simha remembers the time he was recovering after a major surgery. “There I was, flat on the bed and everyone would be looking down upon me. Except for one doctor who always made it a point to sit so that he could have a conversation at my level. That made a big difference.”
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“Every illness is unique,” Dr Francis points out. It follows every recovery is unique too. There is no easy solution or a formula. “It’s a landscape we all have to visit sooner or later. From time to time, we all need to learn the art of convalescence.”

Thou shall not abandon

AETCOM, a manual on attitude, ethics and communication published by the Medical Council of India for the Indian medical graduate, cites a case study. It is a letter to the oncologist from the husband of a patient who succumbed to breast cancer. Here is the gist.

“As you may recall, Alka was diagnosed with breast cancer 5 years ago. We rushed to you knowing your reputation as a talented oncologist and we were not disappointed. Your aggressive approach to the disease made all the difference. Alka beat the disease and she lived disease-free for 2 years. We were very happy and still are very grateful to you.

“Then the disease came back with a vengeance. Even at this time you did not give up hope and took on the disease like a warrior but then there came a time that it was clear that the disease had won. We were devastated.

“Alka looked up to you as a doctor to provide her with support, but it looked like that you were unable to confront the failure. While you did prescribe pain medications and your office helped us find a home nurse, you were reluctant to meet Alka or talk to her. When we called for appointments, your office would tell us to contact our family doctor for pain medications.

“When we did get to see you, you would not even look at Alka’s eyes. You would distractedly talk to her, refill her pain medications and dismiss us quickly. It was as if we were seeing a different doctor than the one we had seen when all was well. And when Alka was admitted to the hospital where she breathed her last you would not even come and see her.

“We made so many requests for you to come and visit with her. I even called and told you that it would mean so much for her to see you before she departs but you did not. Would it have been too much for you to come and hold her hand for a minute or say a kind word?
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“We come to you not with the expectation that a cure is always possible but always with the expectation that you will support us in coping with the disease and the tremendous effects it has on our lives. We don't always expect you to succeed but we always expect you to show us care and compassion. You abandoned Alka and us at the time we needed you most. You, sir, abandoned us when we were most vulnerable.”

Image by Renzo D'souza on Unsplash 
3 Comments
Dr Priyadarshini Kulkarni
11/1/2022 09:37:58 pm

You have asked a very important question.. Should doctor help you recover? technically, the answer is yes, but practically, it is not always possible with busy practitioners.
Reducing suffering and adding comfort should e the goal, when you cannot cure a patient. Helping family members of such patients to heal through their experience of loved ones suffering is also very important. Palliative care professionals are trained to help people recover - for patients it may be accepting their illness, or for families, helping them accept the nature of the illness, learning that their loved ones have reached the state, from where it is difficult to bring them back, and help them cope through that situation.
The lost art of Convalescence can be brought back with training and keenness to help other fellow human being

Reply
Suprabha
14/1/2022 05:52:38 pm

I read this blogpost atleast thrice. The story of Alka is not uncommon. Some of the less fortunate ones, have at some point in time sat in front of a doctor’s desk desperately looking for comfort but all that we received was a dispassionate “nothing more” or just a blank shrug and lack of even basic eye contact. When I was in the receiving end of this, I was overwhelmed by the lack of empathy of the doctors. ‘You don’t have a cure that’s okay, but don’t you have the time to even help me fathom this news?’ was what kept ringing inside my head.

Once I came to grips with my situation, I began to ponder about it from the physician’s point of view. In most cases of Oncological or Neurological conditions, the patients really cured are just a small fraction of the total diagnosed cases.

The ability to digest that- the fact that they are unable to cure the patient - is far more difficult for the doctors than one might imagine. So their behaviour I believe is not lack of empathy but possibly a lack of acceptance for them, as that patient lost is a failure in their minds.

Is it fair? Aren’t these doctors also just human and only trying to find a solution rather than shouldering that responsibility of a cure.

The pivotal question therefore is, should our very learned physicians “unlearn and relearn” that they are also only human and cure isn’t in their hands. But an empathetic approach towards patients in terminal situations matters far more than the cure in itself?

PsS: Mr. Vijayakumar, I ended up writing more than what I wanted to pen down. But found this articulate very close to my heart and took the liberty to express.

Reply
Pushkar Khair
16/1/2022 09:47:02 pm

Nicely expressed Vijay sir. Thanks for bringing up this topic, so relevant in the times today.
Just recently, a very senior physician who recovered after a severe covid illness expressed, "every doctor should be a patient at least once in life, to know what a patient goes through". He had experienced some unimaginable emotions.
The need of helping a patient recover, more that just repair a defect, is beyond any debate.
The question is "how".
How do we empathize with the doctor as well?
Is it the system, where each doctor is in a "ME" zone, trying to take all responsibility on the self, in turn being overwhelmed by the lack of hours beyond 24 in a day to attend to the needing patients?
Where is the family doctor? Hausarzt, as they call in Germany, who has the social, emotional, medical connect with not only the patient, but the whole family tree.
The superspecialists (the correct term actually is subspecialists) would perform much better if they work in a collaborative way by including and giving equal importance to the family physician in the communication, and delegate the recovery process to them.

The bigger question is where is the family doctor?
In the capilltalist world, a socialist profession like healthcare needs a serious revamp.

It is the ' healthcare' system that needs to recover of capitalism. The patient then will recover subsequently for sure..

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