Rereading one more time The doctor and the patient from Pedro Lain Entralgo I liked his expression of how the patient was considered by the doctor: “the patient becomes the sum of a scientifically knowable and modifiable object and a suffering and compassionate person”. This concept of the patient described by Professor Laín Entralgo has to make us doctors think now that we have to take into account that when a sick person is not only an organ that is affected by pathogenic agents, by degenerative mechanisms or by traumas, but all of her is involved from her body to her ability to think and reason, influenced by pain or the limitations imposed by the disease.
In this way we will come to understand that the patient is a person who has a name, a history, customs, an environment… that go far beyond symptoms, a diagnosis and a room number. Quite often and inappropriately, when we arrive at the hospital we ask our collaborators: “How is the cirrhosis of 214?” This is a great disrespect to the person suffering from cirrhosis who is admitted to room 214. Whoever acts in this way will undoubtedly be a great expert in liver diseases, but with little or no hability in doctor-patient relationship. The sick person needs that we also worry regarding him who is the one who suffers from the disease.
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“The sick person needs that we also worry regarding him who is the one who suffers from the disease” |
In the document The values of medicine who published the Collegiate Medical Organization and in which I had the pleasure of participating as a co-author, some ideas are addressed to recover the essential values of medicine and to be able to return to its humanization. In this document, it is proposed how to do it in three essential areas such as in the university, in research and in health care. Perhaps in the university a greater teaching ingenuity would be necessary to introduce the social sciences and the humanities in a transversal way, impregnating the biomedical contents in a way that is attractive for future doctors. On the other hand, thanks to the biomedical model of research and the application of scientific and technological advances to health sciences, indisputable advances have been made that have brought enormous benefits to humanity.
However, an exclusively biological approach has proven insufficient to respond to people’s health needs. It is important to consider that the interaction of biomedical and genetic factors with social and psychological influence the causes and development of diseases. Finally, the recovery of the humanistic dimension of the doctor-patient relationship is undoubtedly a decisive element in the quality of care. This, together with the availability of the necessary time, leads to a more satisfactory medicine for the patient, greater efficiency in the use of diagnostic tests and therapeutic strategies and with it less iatrogenia.
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“Technical advances and bureaucracy are separating the doctor from the patient” |
The medina must also be compassionate. To do this, we must bear in mind that compassion is much more than a feeling of sorrow or pity towards someone, because that would mean looking at the suffering person from above, considering that we are situated in better conditions and from greater strength. Someone who feels sorry for another will not want to be in that other’s place. Compassion requires feeling empathy towards the pain of the other, putting ourselves on their same level and understanding their problem as if we were the ones who had it. It is entering into the difficulty of the other person, trying to take charge of it. It is wanting to lighten her load, deciding to do something to lighten it, and moving to help. Compassion is the basis of the doctor’s understanding and empathy to what happens and worries the patient. If we use our professional competence with the application of our technical knowledge and with our compassion we will be doing well.
When we find ourselves before an incurable patient, we verify that the advances in medicine are no longer useful to them, but our compassionate attitude helps them a lot to feel recognized in their fragility and vulnerability and to cope with their illness. Although the compassionate attitude should always be an attitude in the care of the sick, in any of the stages of their illness, in the terminal stage this attitude should be intensified because it is needed more than the technique.
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“Compassion is the basis of the doctor’s understanding and empathy” |
We have to aspire to build a compassionate society and we will achieve it when we are all capable of helping those who need it. This is a true commitment of all of us who make up this society. The degree of responsibility of a society is measured by its commitment to care for those who are fragile, dependent, vulnerable, marginalized, suffering. This is why we must commit to a compassionate society that cares for its most vulnerable members and accompanies them in their suffering in order to alleviate it.
I want to remind you that all citizens have the right to a medical care of human and scientific quality. The medical profession and its institutions must collaborate with the representatives of society to generously promote the necessary reforms to achieve a technical, but also compassionate medicine.
It would be desirable for us doctors to be able to care for our patients from the medical science and from the human approach and to be able to say, following having cared for them, as the English doctor, born in 1689, Thomas Sydenham, wrote: “no one has been treated by me in a different way than I would want to be treated if I got sick with the same illness.”