Patient
What?
- A patient is a person who undergoes care in a relationship with a healer. In its older sense, suffering means undergoing, whether or not it feels distressing. Seeking care places the patient in a position of dependence and trust.
- Clinical medicine begins in a personal encounter. The patient brings a body, relationships, values and sources of meaning to that encounter.
So What?
- Healing aims at the good of the whole person. Physical recovery matters, but it does not exhaust the patient’s emotional, personal, and spiritual needs.
- Compassion, justice, and attentive communication help clinicians understand what illness means for this particular patient. A cheerful manner or a reassuring clinical result may leave important suffering unrecognized.
Now What?
- Listen before reducing a patient’s story to biomedical facts. Ask what matters most, what has been lost, and what the patient hopes care can restore.
- Attend to the four dimensions described in the outline: biomedical good; the patient’s own understanding of good; the good of the patient as a human being with dignity and reason; and spiritual good. Work with others when a need exceeds your expertise.
Clinical Case
Sammy was one of those patients that you couldn’t help but love. She was quick witted and had a way of making everyone in the room laugh, smiling often in spite of the pain of her severe internal organ lacerations from a traumatic car accident. Everyone on the floor took an instant liking to her and you were no exception. You wondered at her ability to stay not just positive, but actually act as if nothing at all was the matter. As you enter her room for prerounds early in the morning, you’re surprised that she is awake, looking at a picture of her husband. You’re reminded again of Sammy’s traumatic admission to the ICU after they had both been in a serious car accident. She wipes a tear, a little embarrassed. “You really loved him,” you say, trying to interrupt the awkward pause. “Yes, I did,” she says, wincing a bit and then smiling once more. Seeing this glimmer of something deeper, something beneath Sammy’s smooth exterior, you break from the preround routine, asking, “How do you do it, Sammy? How do you keep going as if everything’s okay?”
“I’ve had a lot of practice, a lot of hard time,” she almost sighed. “The way I see it, I have the choice to complain that the universe isn’t fair, that he shouldn’t have died, that I shouldn’t be in so much pain right now, or that I could accept the difficulties.” After you report to your attending, Dr. Michel, he asks “and how is she healing?” “The tissue is rebuilding as it should, but she doesn’t seem to acknowledge her state or her pain ,” you say, “it’s hard to tell if she’s delusional or a saint.”
Discussion Questions
- How should we assess Sammy’s response to suffering? What would we need to understand before judging it?
- What does it mean to be a good patient? Must a patient always be positive?
- What is Sammy’s good here: physical recovery, pain relief, emotional healing, spiritual peace, dignity, or some combination?
- How might her understanding of her good differ from the team’s? How could they discuss that difference?
- What responsibility do clinicians have for suffering beyond biomedical illness? What are the limits of their competence?
- How does this prerounding encounter reflect, or fail to reflect, the patient as a whole person in a healing relationship?
Sources
Based on the linked LearnWorlds lessons.
Source outline: Original Drive outline