PURPOSE Medicine is traditionally considered a healing profession, but it has neither an operational defi nition of healing nor an explanation of its mechanisms beyond the physiological processes related to curing. The objective of this study was to determine a defi nition of healing that operationalizes its mechanisms and thereby identifi es those repeatable actions that reliably assist physicians to promote holistic healing. METHODSThis study was a qualitative inquiry consisting of in-depth, openended, semistructured interviews with Drs. Eric J. Cassell, Carl A. Hammerschlag, Thomas S. Inui, Elisabeth Kubler-Ross, Cicely Saunders, Bernard S. Siegel, and G. Gayle Stephens. Their perceptions regarding the defi nition and mechanisms of healing were subjected to grounded theory content analysis. RESULTSHealing was associated with themes of wholeness, narrative, and spirituality. Healing is an intensely personal, subjective experience involving a reconciliation of the meaning an individual ascribes to distressing events with his or her perception of wholeness as a person.CONCLUSIONS Healing may be operationally defi ned as the personal experience of the transcendence of suffering. Physicians can enhance their abilities as healers by recognizing, diagnosing, minimizing, and relieving suffering, as well as helping patients transcend suffering.
Awareness of these crucial patient and caregiver EOL issues and expectations and how they differ from clinician perspectives can assist clinicians to appropriately explore and address patient/caregiver concerns and thereby provide better quality EOL care.
This essay explores the thesis that changes in contemporary society have transformed the work of doctoring and challenge doctors to be physician-healers. Medical advances in the prevention and management of acute disease have wrought a growing population of chronically ill patients whose care obliges physicians to become holistic healers. Holistic healing involves the transcendence of suffering. Suffering arises from perceptions of a threat to the integrity of personhood, relates to the meaning patients ascribe to their illness experience, and is conveyed as an intensely personal narrative. Physician-healers use the power of the doctor-patient relationship to help patients discover or create new illness narratives with fresh meanings that reconnect them to the world and to others and thereby transcend suffering and experience healing. Physician-healers equipped with the attitudes, skills, and knowledge to assist patients to transcend suffering are indispensable if contemporary medicine is to maintain its tradition as a healing profession. In the process, physicians may discover meaningful connections with patients that bring new and refreshing perspectives to their work. Also, I would like a doctor who is not only a talented physician, but a bit of a metaphysician, too. Someone who can treat body and soul.Anatole Broyard 1(p40) * D uring 30 years of teaching family medicine residents, I have witnessed many changes in medicine and the image of physicians. As refl ected by television, the warm and understanding Dr Marcus Welby (whose program debut was the year family medicine became a specialty) has morphed into the arrogant, cynical Dr Gregory House. Whereas Welby helped patients struggling with transformations in their lives through the strength of his humanity, House condescendingly rescues them from death by sagacity and technology. This evolution seems to mirror changes in medicine grown more technically sophisticated and powerful while physician morale has plummeted and public trust eroded.2-4 What happened? Contemporary society has entered a postmodern era in which economic, philosophical, and technological advances have transformed medicine, doctoring, and the doctor-patient relationship.5 A growing service economy rendered physicians "providers," patients "customers," and medicine a "product." A belief in the relativity of knowledge categorizes biomedicine as but one of a variety of legitimate healing models that vie for patients. The authority of the patient's story of illness now competes with the doctor's story of disease. Doctors are confronted with medical information garnered from the Internet, often of dubious quality and unrelated to the patient's clinical condition. A colleague recently reported having a 171 SU F FER ING , ME A NING & HE A L ING9-year-old patient request a hypnotic by brand name, thanks to television advertising. The world of contemporary doctoring has changed! It seems today's physicians are expected to be an amalgam of Welby's warmth and House's brilliance. As advance...
Persistent evidence suggests that the communication skills of practicing physicians do not achieve desired goals of enhancing patient satisfaction, strengthening health outcomes and decreasing malpractice litigation. Stronger communication skills training during the clinical years of medical education might make use of an underutilized window of opportunity-students' clinical years-to instill basic and important skills. The authors describe the implementation of a novel curriculum to teach patient-centered communication skills during a required third-year, six-week family medicine clerkship. Curriculum development and implementation across 24 training sites in a five-state region are detailed. A faculty development effort and strategies for embedding the curriculum within a diverse collection of training sites are presented. Student and preceptor feedback are summarized and the lessons learned from the curriculum development and implementation process are discussed.
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