Physicianship II:

HOPE Grouops as Clinical Services, providing time to care in healthcare

 by Ken Hamilton, MD ~ Winter 2006 Edition

Is today’s physician a healer? Is today’s physician a professional? Is
s-he neither?… or both? The answers to these questions are of vital importance in today’s society. Tremendous societal pressures exist today that ask us to change the way we think about ourselves. They not only affect us as individuals, but as institutions and professions. Costly technologies have thrust medicine into the forefront of this change and they threaten to break the bank of the United States. Over the past half-century, business, politics, and technology have diverted our attention from medicine as a practice of “healing” to medicine as a “profession”. This diversion has led to a split in medicine that exacts great emotional and physical cost from the population it has served for thousands of years. Healing the split will create a profession of healers trained in and practicing “physicianship”.

Physicianship is a term coined by Doctors Sylvia and Richard Cruess at the McGill University Faculty of Medicine about fifteen years ago when Dr. Richard Cruess was its Dean. They were aware that a significant percentage of incoming North American medical students saw themselves as healers; they also knew that the pressures of training the medical student to be able to join the medical profession subjugated the healer.

Healers have been part of all societies for millennia. To heal is to make whole. Those two words derive from a Germanic root that also means holy. The implication that healing is a sacred function emphasizes the importance of the healer in medicine. Healing as a wholeness implies integrity, which, when coupled with the implication of sacredness, creates a richly psychospiritual appreciation for the whole of medicine.

According to Dean Cruess, the professional is “a means of organizing the delivery of complex services which (society) requires, including that of a healer.” Professions, per se, have been a part of Western society since the Middle Ages when society created guilds and universities. “Profession” has come to mean an occupation or calling that requires specialized knowledge which comes from extensive academic preparation and training. Cruess also says, “(The) members (of the profession) are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and to the promotion of the public good within their domain.” Codes of ethics that describe governance and commitment comprise the oaths found in all professions, including the medical profession’s Hippocratic oath (in its modern expression). Today, a host of societal attitudes and belief systems that challenge the governance and commitment of the oath create a need to appreciate the value of this clear description of a profession and to preserve it, for without it altruism and care cease to exist.

The Drs. Richard and Sylvia Cruess persuaded the McGill Faculty of Medicine to critically examine the concept of physicianship and create a curriculum thereof citing the need to sustain the profession’s ability to care. They succeeded, and the graduating class of 2008 will have been exposed to the precepts and concepts of physicianship from the very beginning of their McGill medical studies. Whereas these young physicians comprise only 167 new physicians out of a cohort of tens of thousands of practicing physicians, is there any hope for the thousands out in practice?

The reader can readily recognize the many harmful pressures on medicine and those whom it serves. Physicians need to spend quality listening time with their patients. To do so reduces risk of malpractice suits; it may also increase the effectiveness of their therapies. Medicine also needs to improve its abilities to serve those with chronic illness. The placebo effect seems to do its beneficial work in people who perceive that their doctors care for them. This all takes time; so the question is how to get that time.

Two ways stand out: first, let computers handle a database that is larger than any physician can possibly put in their own memory banks, and second, bring patients together in groups working on the HOPE Group model supervised by nurses or physician assistants who focus on helping patients understand and participate in their therapies, and who help their patients put these same therapies in the context of finding that which brings meaning, value, and purpose to their lives. Such groups promise to give both the patient and the doctor the time each needs to participate in the healing.

Dr. Larry Weed, former professor of medicine at the University of Vermont, developed a specialized computer program called Problem-Knowledge Coupling (PKC) that could bring a huge, continually updated medical database up against a comprehensive database of the individual patient to reveal diagnostic possibilities and therapeutic approaches for that patient’s symptoms and lab findings. PKC engages patients at every meeting in such a way that the health-care provider—physician or physician assistant— has more time to spend with patients examining (touching) and listening to them— healer functions.

Society needs physicianship for itself. The healer works when the professional can spend valuable time with the patient. The means for taking quality listening and touching time is not a dream but a manifest reality. Society needs to ask for it and medicine needs to provide it. We have the means. The result... health care reform.
 

Do you have a story or anecdote you would like to share with the readers of Ripples? Please send it to Ken at HOPE PO Box 276, S. Paris, ME 04281.

We would love to have your HOPE story for Ripples! Please send it to the HOPE office, PO Box 276, South Paris, ME 04281 or email it to hope-at-hopehealing.org. If you don't think you are a writer, record it onto a tape and send that to the office. The editor will transcribe and edit it for you!