There is something more important than enumerating diseases one by one; something more important that we must deal with every day: people who are ill, who feel ill, who suffer … as a whole!
Sir William Osler, a Canadian physician and one of the four founding professors of John Hopkins Hospital, wrote many years ago: “The good physician treats the disease; the great physician treats the patient who has the disease…”
Osler created the first residency programme for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.
Physicians often forget the most important part of the picture: the patient, their lives and their families. Good doctors should consider the entire elaborate combination of factors that make each person unique.
The drugs that are available to treat the disease are relatively standard, but in treating the patient, we all should break the mould of how we were taught and learn that the patient comes first and the disease second. We must remember that, to make a difference in patients’ lives, the question of “quality of life” is just as important as “quantity of life”; maybe even more so for cancer patients, where we are often dealing with months, rather than years.
The medical profession has a long history of treating diseases rather than patients, and that tendency may be growing stronger over time, thanks to our increasing ability to address disease. When making medical choices, the most relevant thing is to remember that the goal is to maintain the patient’s quality of life and functionality.
Disease impacts everyone differently. It is usually assumed that there is a close correlation between changes as a result from disease and changes in quality of life. There are studies that show such an association, but the strength of that association is going to depend on the patient.
To care for the patient, not just treat the disease, doctors must ask the patients how they feel about the current symptoms, as well as potential future symptoms. Patients should answer sincerely and not omit their exact feelings. It is absolutely imperative for the doctor and the patient not to assume that the doctor knows what the patient is feeling.
A straight forward dialogue without misunderstandings is needed to achieve the goal, meaning to treat, not just “the disease”, but to manage the wellbeing of the whole person, considering the unique way the disease manifests in each unique individual.
Moving in the right direction
Fortunately, there is now strong evidence of a growing interest in treating the patient as well as the disease. This is especially evident in some areas such as cancer treatment. There are advertisements inviting patients to choose a cancer treatment centre because the doctors “focus on the whole patient”. Doctors at those centres are probably willing to consider complementary treatments such as meditation and counselling. I think that is a step in the right direction. It is like saying: “You are not a cancer, you are a person who has cancer, a person we will try to help who happens to have cancer.”
Giving tablets and injections is very important but supportive care is of extreme relevance. And all this goes for anyone and for every disease, not just for cancer.
Seeing our goal as treating the patient, not just the disease, is a simple change in perspective. But it is a change that can make a world of difference; it can change how effective we are at helping our patients to end up with happier and more effective lives. To achieve this, the patients also must understand and help doctors to be more effective in communicating.
The role of the family doctor
The model of the family doctor as responsible for patient’s management is of extreme relevance.
The competencies acquired in family practice training prepare family doctors for roles in the management of every stage of the natural history of any disease, even more for chronic diseases such as cancer.
The family physician is a generalist who takes professional responsibility for the comprehensive care of unselected patients with undifferentiated problems and who is committed to the person regardless of age, gender, illness, or organ system. They emphasise health promotion and disease prevention in a broad perspective.
Models involving them as team members in care coordination are lately starting to be considered by hospital medical teams as a guarantee to improve quality of care.
Supportive care is defined as services to meet psychological, social, pain and symptom management, informational, or practical needs resulting from disease and is considered a necessary adjunct to medical treatment for individuals with any type of disease, most specially for cancer patients.
Of course, doctors probably will not be able to become the patient’s emotional counsellor, but the act of listening helps. Trust, confidence, communication can make a significant difference in the patient’s quality of life.
Medicine has no meaning if it does not preserve the feeling of solidarity in the face of human suffering.
The portuguese poet Fernando Pessoa wrote:
Life is what we make of it…
The journey is the person
What we see is not what we see but what we are
Best healthy wishes,
Dr. Maria Alice