practice partner
doesn’t mean you’re listening to them
ing.” Did doctors understand Jerry’s
fully,” he says. That requires probing,
unique history and personality? Did
and sometimes getting at the patient’s
Jerry know how desperate surgery was,
“If
you’re
not
real agenda (or getting beyond your
that there was no chance of a cure?
own initial views).
Was he aware of the possible complicainterested in a
“If you’re not interested in a patient’s
tions? Everything was being done to
patient’s story,
story, you’re not interested in medicine
keep Jerry alive, says Dr. Hébert, “but
you’re not
frankly,” he says. “Medicine requires
sometimes communications is the
really caring about a patient. It’s a core
clinical skill needed most.”
interested in
ethical skill.”
He tells another story about a
medicine frankly”
woman he calls Mary. She felt unwell,
Show that you care
with slightly enlarged neck glands
and red spots on her torso. The spots
He learned that not only as a doctor
spread to her limbs and itched. Her
but also as a patient. Dr. Hébert was
GP wondered if Mary had bedbugs. One dermatolodiagnosed with Parkinson’s disease in his 40s, and from
gist told Mary she had neurotic eczema (and later
2005-2009 underwent six major surgeries for serious
suggested that she meditate). A second dermatologist
back problems. His illness and disability caused him to
said Mary must have hidden psychological issues. A
retire from practice (but not from medicine).
fourth doctor (“This is the last!” said her referring GP)
The experience was instructive. Dr. Hébert didn’t
said Mary had an uncommon rash called dermatitis
always feel empathy from the health-care professionals
herpetiformis.
treating him. For instance, they didn’t grasp the extent
Even when the rash improved, Mary was listless. She
of his suffering and how it was affecting his life, his
lost weight, felt swelling in her neck and had severe
ability to do things and his relationships.
back pain. Now her GP prescribed anti-inflammatory
“They sometimes have a superficial approach to pain,
pills and pain medication. Finally, Mary got a referral
and don’t understand the multidimensional aspects,”
to a hematologist, who ordered a battery of tests. Two
he says. “I learned how deep despair can be, and how
years after Mary first saw her GP about the rash, she
terrible it is when people don’t listen to you. I’m now
was diagnosed with non-Hodgkin’s lymphoma. A large
more attentive to the stories of people’s suffering, not
lymphoma-related mass was pressing on her spinal cord.
just the physical pain but the psychological. It’s so
Today, Mary is fine. Dr. Hébert suggests that Mary’s
important to have a health-care professional acknowlinitial practitioners “failed the empathy exam”. They
edge that. It shows that someone cares about you, and
didn’t imagine themselves in her shoes or ask how her
is concerned about your condition as a whole.”
symptoms were affecting her life. They neglected to
There’s much talk about personalized medicine,
fully consider symptoms that didn’t fit their diagnoaround diseases and more tailored treatments. That’s
sis. And they didn’t tease out Mary’s views about her
the technical notion of personalization. “Personalcondition.
ized medicine also means understanding the patient’s
Without Mary’s strong voice, only the voices of the
unique needs, wishes, beliefs and values. That’s somedoctors were heard, says Dr. Hébert. What would it
time harder to do.”
have taken to figure out she was seriously ill? Not necYet it’s essential. On the last page of his book, Dr.
essarily more time or resources, he writes, but following
Hébert circles back to the thought he introduced at the
this mantra: “Know thy patient well.”
outset. “No matter how simple or complex our illnesses
Dr. Hébert submits that at least 80% of diagnoses
may be,” he writes, “the empathic connection between
can be made simply by talking with a patient, not by
patients and physicians is the moral core of medical
tests or procedures. “You can hear somebody, but it
care. It is the art of good medicine.”
MD
34
Dialogue Issue 3, 2016