Training to Provide a New Kind of Medicine
Your patients teach you a lot.
As a young MD in a small Idaho town, David Rakel shared all on-call duties with another doctor at a 14-bed hospital. That situation, he says, spurned an interest in practicing medicine in a way that tries to find the root of medical problems, rather than just writing out prescriptions for symptoms.
“If you have been awakened at 3 a.m., you don’t want to be awakened again for the same thing two nights later if you can help it,” says Rakel, chair of the Department Family and Community Medicine at The University Of New Mexico Health Sciences Center.
Rakel’s patients were his neighbors. He started to listen to their stories, and began to see how migraine headaches sometimes sprang up after abuse or the way arthritis flare-ups could hurt family relationships, leading to guilt and resentment.
“In that small town you could see the complexity behind presenting symptoms,” Rakel says. “It wasn’t the case for every patient or every diagnosis, but there were many times when it was.”
Those beginnings led to his new book, The Compassionate Connection: The Healing Power of Empathy and Mindful Listening.
“I became interested in looking at the research on how our therapeutic process, our presence with another human, being can actually be one of the most powerful healing tools we have,” he says.
He authored a study showing that patients who feel a connection with their medical provider actually produce increased levels of disease-fighting immune cells. “Everybody thinks it’s the prescriptions we are writing that cure, but research has shown that they are often just a small percent of the healing effect," he says.
Statins, for example, are one of the most effective medicines – yet the only reduce the chance of a second heart attack by 15 to 20 percent.
“Most of the medicines we prescribe have specific effects that can be enhanced by how the medicine is given. The majority of the healing comes from the therapeutic ceremony we create, the expectations, hope, belief that a patient can get better.”
Those ceremonies, rituals and processes can benefit both the patient and practitioner, he says, and they are enhanced by empathy and compassion.
“The main goal of the book is to provide powerful tools people can use to have a positive effect on others – be they patients or family members – to help someone get to a better place,” Rakel says. “The beauty in doing that is that the healing goes both ways. There has actually been research that shows compassion increases energy and empathy can decrease it.”
Rakel explains, “Empathy sees us as two different people. Say you are having terrible back pain, I might emphasize by saying, ‘I see your back pain and I have to do something to help you.’ I am seeing us as two separate people, and I am putting a lot on myself to take on your back pain and fix it. If I cannot fix your back pain then I am going to start feeling inefficient, like a failure.”
In contrast, compassion implies people suffer together as part of a larger whole, that we are interconnected. “If I help you, I help myself,” Rakel says. “If I cannot fix your problem then we can at least open up a dialog and hopefully go to a place that energizes both of us.”
Rakel says the trust that builds between provider and patient leads to what the psychologist and theologian Dr. James Findley teaches as the circles of suffering.
“We call it the therapeutic dance,” he says. “For instance, if I stay aware of the fact that I went into medicine because I wanted to serve and do something altruistic, that grounds me, gives me energy to put a foot in their circle of suffering.
“Hopefully, my patient realizes he or she is not alone and have someone they can trust. Then they are able to take a step outside of where they are. That is the beginning of this therapeutic dance. Sometimes you lead and sometimes they lead, and it is a beautiful dance as it goes back and forth.”
Rakel knows his stance can be controversial, because many people are only able to survive terrible things by being able to detach themselves from the process, yet he contends even one conversation can be helpful if it leads the patient and physician to new insights about what is needed for a symptom to resolve.
“There is a degree of triage here,” he says. “Not everyone needs this approach, but so many people who do need it are not getting it.”