Guest Post from Deborah L. Benzil, MD, FACS, FAANS
Member, AANS Board of Directors
Chair, AANS/CNS Communications and Public Relations Committee
Columbia University Medical Center
Mt Kisco, New York
One obvious but often-overlooked thing constantly challenges practicing physicians: DEATH. While we all know that death is inevitable, death intrudes into every physician interaction with their patients: fear of death, threat of death, grief after death, pain before death, need to communicate about death to mention just a few. And of course, physicians have their own personal encounters with death-in family, friends, and colleagues as well as their patients. It is not a subject that lends itself to easy discussion and as such is too often pushed aside, hidden in the corner. The skills required to appropriately deal with this are thus too often under-valued.
Recently, one brave neurosurgeon, Dr. Paul Kalanithi, wrote a cogent, gripping, and highly personal piece in the New York Times, about his own diagnosis of lung cancer. The universal response I heard from other neurosurgeons touched intensely by this piece was how it put all else in our lives into perspective. It also highlights several underappreciated skills that physicians utilize in addition to the expected diagnostic and treatment interventions:
- Highly skilled communication skills
- Well honed listening ability
- The knowledge of when to be silent
- The skill of conveying information without getting lost in the details
- The ability to give hope
- The capacity to comfort
Too many Americans feel that death is negotiable creating a medical system that will be unsatisfactory and unsustainable to patients and physicians despite incredible scientific advances (TED Talks: Nate Garvis: Change our Culture, Change our World). While certainly some physicians may exhibit greater talent in using these skills than others, it is instructive to realize and remember the incredible intrusiveness of this American attitude toward death on out healthcare system. As this system hurdles forward into risk and value-based contracting, the critical importance of these interactions and the very personal nature of each must also be honored. As the eloquent Dr. Kalanithi writes:
What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.
This, then, is the under-valued Art of Medicine, the perfect and necessary complement to its Science.