Sunday, April 4, 2010


When we pass the talking stick around the cancer support group and people say what they need to say, a theme often emerges. Three, four or five out of twelve present raise the same issue—maybe it’s anxiety, unclear medical information, death, or spirituality. That issue then dominates the discussion.

A theme has arisen increasingly in my non-group world, so I guess it’s begging closer attention. It is this: physicians generally don’t recognize the benefit of psychosocial support. Several instructors of communication and psychosocial support recently confided to me their frustration that doctors just don’t seem to get it.

I’ve wondered about that a long time. It was only a vague abstraction to me, though, until a chief of oncology summoned me ten years ago. He said, “Dr. N.’s complained about you. He says what you’re doing is witchcraft, you know, quack stuff.”

“But I…”

“Yeah, I know. Don’t worry, I have faith in support groups. But go and do what you can to smoothe his feathers, okay?”

When I visited Dr. N., he said, “There’s no evidence that support groups work.”

“What evidence would convince you?”

“How about length of survival? I can show that chemo extends survival. Can you show anything like that for, what, conversation?”

On his desk was a framed photo of him with his family. I asked, “Do you love your wife?”

He put his palms on his desk. “Of course I love my wife!”

“Can you prove it?”

Maybe I shouldn’t have said that. He showed me the door, but at least he left me alone from then on.

He loves his wife, but he can’t prove it. Who can? We can show our feelings only by our behavior. The axiom, “Actions speak louder than words” actually underrates actions. For much of our behavior, language fails utterly. Words only beat around the bush; what we do is the fullest truth. That is, fundamental human processes—love, wisdom, humor and suffering, for example—can’t possibly be measured. The Easterners say, “The Tao that can be spoken is not the Tao.”

As a scientist myself, I can understand colleagues insisting on scientific corroboration. But good grief, not for everything. It shouldn’t be news that we scientific, objective types lead lives every bit as irrational as anyone else. We fall in love, fall out of love, hold contradictory values, entertain embarrassing fantasies; but once we put on that white coat, suddenly the objective numbers need to add up or we don’t buy it.

Remove the coat, and things look a little different. A half-dozen medical doctors have, over the years, been in cancer support groups I’ve facilitated. That is, they themselves had cancer. Every one of them marveled that their medical experience and Patientland were nations alien to one another. Most told me, “I had no idea.” I knew them all as remarkably kind physicians, personable and compassionate with their patients, yet none had ever thought to refer one to a support group.

Why don’t doctors see support as a natural, obligatory aspect of medical care?

My initial assumption was that docs might be threatened if they weren’t a full-service operation, if they couldn’t provide all the treatment their patients need. Yet they routinely refer patients to surgeons, radiation oncologists and other subspecialists.

Some will even refer to psychotherapists. A neurologist told me, “I always ask my patients how they’re doing emotionally. If they tell me they’re okay, well, fine, then, and if they tell me they’re having trouble, I send them to a psychiatrist.”

Excuse me, but who isn’t vastly upset by a serious diagnosis, whether or not they recognize their turmoil? The truth is that most patients, at least at first, suffer so amorphously as to be verbally inarticulate. (Indeed, support group newcomers often simply cry at their first meeting.)

I don’t believe this neurologist is unusual in his naïveté about emotions. In fact, it’s a deliberate result of medical training.

You need to know that medical school features two simultaneous curricula. The official one is the Practice of Medicine. The other, How to Be a Doctor, is taught by example. We’re rewarded over our years of training for emulating our medical elders, and at last we get inducted into our profession’s exclusive subculture, a group bound by language, outlook and manner. (Believe me, it’s a profound personality changer. Author-physician Rachel Naomi Remen reports a tombstone bearing the epitaph, “Here lies George Brown, born a man, died a gastroenterologist.”) We current practitioners hold medical science in awe to the degree that if we did anything to diminish our status as scientists, we’d be shamed in front of our peers.

So it is that we’re obsessed with objectivity. If our fellow docs were to peek into our toolbag and discover subjective skills like disciplined irrationality, artistic license, spirituality and unconditional love, we’d be embarrassed. Dr. Touchy-Feely. Dr. Woo-Woo.

But here’s a professional secret: all docs are a little closet woo-woo. I routinely ask my colleagues, “Have you ever made a medical decision that contradicted the results of your objective tests?” If I ask them privately, one hundred percent answer in the affirmative. In the doctors’ lounge they’d deny it till they were blue in the face.

I believe change is in the wind, though. I know a few outliers, cultural pioneers, docs who wear their readiness for intimacy openly...and they remain scientists. They’ve just expanded their concept of science to see the world through a wider-angle lens, declining to limit their senses to the measurable. When they ask the quintessential medical question, “What’s going on here?” they get a fuller, far more useful answer. As for the docs who say, “I’m sorry, but I can’t deal with what’s not measurable,” we’ll wait patiently for them.

No comments:

Post a Comment