By Farhad Ismail-Beigi, M.D.
I would like to share with my colleagues my accumulated knowledge on principles of healing the sick. This knowledge is based on my education, the teaching of my mentors, and my own experiences of practicing as a gastroenterologist at UPMC, Presbyterian and Shadyside Hospitals in Pittsburgh for the past 43 years, and two years in serving as a Major in the U.S. Army at Fort Bragg, North Carolina.
It has been truly a privilege, challenge and joy to practice medicine, and also to teach medical students, residents and fellows in training. It is mentally stimulating and rewarding to treat sick persons and see them recover from the illnesses. Currently, I continue to practice with the same enthusiasm which I’ve had since the beginning of my career.
The purpose of this writing is to allow us to re-visit the principles of healing that we all have learned in our training periods and to try to apply them as best as we can to today’s medical practice and climate. Or goals as physicians are to treat each patient with respect and great concern, and to apply our best efforts to treat their illness and restore their health as much as possible. Also, remember the old principle of “do no harm,” in the process.
The knowledge and science in all medical specialties have dramatically increased and expanded in the last 50 years, since I became a physician. This increase has become possible from the rapidly increasing medical technologies, our increased understanding of patho-physiology of disease processes, and to ever-expanding and improved treatment options. These in turn have led to improved ability to recognize and diagnose illnesses, and to the discovery of more effective and new treatment options of disease, leading to improved outcomes.
The principles of healing disease and interaction with patients and their families have not changed in over thousands of years. For relearning these principles, we have to look back to the great physicians of the past. Such examples include:
- Medicine of Ancient Egypt dating back to medicinal records, 3000 BC
- Hippocrates of Greece, 377 BC
- Saint Luke, 1st century AD, “The Magnificent Physician”
- Avicenna of Persia, 1037 AD
Also, we should try to emulate our superb mentors from our training periods and of the currently practicing physicians.
Most illnesses are composed of two essential components: a) physical symptoms and manifestations; and b) the emotional reactions to the illness. It is important for the physician to recognize and be aware of these components in attempting to treat individual patients. The practice of medicine also consists of two parts. The first is the knowledge and science of medicine, and second, the art of practicing medicine.
The physician’s education, updated knowledge and experiences guide the doctor to recognize possibilities of disease states leading to a tentative diagnosis and treatment. The art of medicine allows the physician to explain and deliver information and treatment options to the patient and family in such a manner that would result in the patient’s acceptance and cooperation.
The physician must have the desire and motivation to heal the patient, and express this feeling in a very positive manner, so that the patient understands. The physician must show compassion, empathy and kindness to the ill patient. This will allow the patient to realize that the doctor is truly concerned about his illness and is interested in finding the solution to the patient’s problem. This will create a feeling of trust and partnership between the patient and the physician in dealing with the illness. These same principles also apply to patients in whom the disease state is deteriorating or at best remains chronic and stable.
It is essential to be able to recognize and tentatively diagnose the illness as best as possible, and as early as possible based on initial history and physical exam, and the needed laboratory and imaging techniques. The physician should attempt to “feel” the patient’s symptoms and how it is affecting the patient. Physicians must spend an adequate amount of time with their patients so that the patient would feel that their concerns and fears have been heard and understood by the doctor.
The initial plan of treatment should be presented to the patient and the family with the attempt to get them involved in the process of decision making. The physician should keep an open and flexible mind to the progress of illness and treatment and be willing to alter the course and treatment as needed. Positive encouragement verbally, as well as “laying of hands” on the patient, such as touching the patient’s shoulder or hand shaking, is a gesture of positive support and very powerful tool for healing. It is known that our bodies and tissues have innate strengths to self-heal certain illnesses. Also, the element of passage of time could be a healer providing that there’s patience on the part of the patient and physician. It is also known that there is a strong connection between the mind and the body. Praying, asking for help in dealing with an illness, and sharing with others can help the healing process. Positive attitudes of the patient, towards their illness, generally lead to better outcomes.
Medications and treatments that are prescribed are most effective when the patient believes that the particular medication or treatment is going to help their illness. This belief is generated when there has been trust developed between the patient and the doctor providing the treatments. Also, the benefits of treatment have been adequately explained by the physician and, most importantly, that the physician believes that the treatment is going to be effective in most cases.
Establishment of follow-up visits soon after the initial visit is extremely important in the healing process. It allows the physician the time and opportunity to review with the patient any new symptoms, test results, response to treatment, and any need for changes in diagnosis or treatment. Most importantly, it will stress the fact that the physician is interested in the progress and recovery of the patient. Frequent visits are necessary as part of the healing until the patient’s condition is stabilized.
We, as physicians, should remember and apply these principles in our daily approach in order to deliver the highest quality of care. It is extremely important that we be allowed the adequate amount of time needed with patients, so that the individual feels that we have heard and understand their concerns regarding their illness. As physicians, we should be striving to, and be motivated by, our patient’s satisfaction in the care they received.
With the widespread use of computers and electronic healthcare records, we have to be very conscious that the patient feels that we have given them adequate time and attention to their care, while using computers to record. It is possible to accomplish this goal by use of proper techniques while using a computer, and the allowance of time for direct patient contact and interaction to deliver high quality patient care.
Our healthcare experts and payers have a continuous challenge of providing plans that would preserve high quality medical practice without sacrificing the efficiency and productivity of delivery of healthcare.
In summary, the essentials of healing include adequate and current knowledge of medicine by the physician, use of appropriate tests, establishment of a positive doctor-patient relationship, good communication, and practice of ethical and high-quality medicine. Compassion and empathy are the cornerstones of an outstanding doctor-patient relationship. In addition, maintaining a positive attitude and encouragement by the physician prescribing the appropriate care is important. Flexibility by the physician is essential to alter care as needed and close follow-up visits until the patient has recovered. In essence, the physician’s role is to guide and nurse the patient towards wellness.
In summary, the essentials of healing includes adequate and current knowledge of medicine by the physician, use of appropriate tests, establishment of a positive doctor-patient relationship, good communication, and practice of ethical and high quality medicine. Compassion and empathy are the cornerstones of an outstanding doctor-patient relationship. In addition, maintaining a positive attitude and encouragement by the physician prescribing the appropriate care is important. Flexibility by the physician is essential to alter care as needed and close follow-up visits until the patient has recovered. In essence, the physician’s role is to guide and nurse the patient towards wellness.