Not All Ills Can Be Cured with a Pill - Fixing The Primary Care Crisis

Today, there is a difference between being a physician and a healer. All societies have healers - wise men and women, shamans, medicine men and people of other names. The "old time practitioner" like my grandfather - I use him in my books as a touchstone of how medicine was practiced in the past-was almost always a healer but today, many physicians are not. It is an issue of interest, training, time and prioritization.

Most individuals who aspire to be physicians (and other healthcare providers for that matter) aspire to be healers. But it requires just as much training to be a healer as it takes to learn how to do an examination or an endoscopy. Learning to become a healer requires mentoring, unfortunately in short supply these days-the standard post graduate training programs or residencies seem to "train out" rather than "train in" the healing skills.

Years ago while in oncology training I was on night duty when a patient of one of my colleagues was having severe penile pain.

Arthur had received a new investigational chemotherapy and it turned out to have an unexpected effect of damaging the lining of the bladder and urethra. I found a medication to give him some relief but I soon learned that this pain had a much deeper meaning for him. He had developed a close rapport with a long-time evening shift nurse. She told me that in college his girlfriend became pregnant; she had borne the child but he had abandoned them. Now nearly a decade later, married to another woman and with two children, Arthur had developed testicular cancer. That diagnosis plus tonight's pain was, he believed, God's punishment and he was wracked with guilt. His physician had never learned this because he had only focused on the cancer, not his patient. It was the nurse who sat quietly and non-judgmentally with Arthur in the evenings and learned of his inner turmoil.

Treating the disease, even successfully, will not heal the underlying issue and it will ultimately re-manifest itself as a recurrence or as a new symptom. Deep non-judgmental listening is the essential first step in healing. From there begins the therapeutic exchange. The nurse listened but did not judge and as a result that patient was able to open his heart to her.

As one primary care physician expressed it, "It's the alleviation of suffering through personal contact alone applied skillfully [which] can transform the medical examining room from the utilitarian cubicle it's become back into the intimate sanctuary it once was, a healing temple arguably more potent than drugs or surgery."



Copyright (c) Stephen C. Schimpff, MD