D. Joy Riley, M.D., M.A.
Executive Director
To Health Care Professionals: We have a problem. Our health care systems typically have multiple levels of health care “providers” who see and treat patients with or without physician input or oversight. The interposition of electronic medical records and automated systems add another layer of complexity to the health care arena. Young trainees — medical students and others — have, due to various pandemic policies, been “trained” online. The distance between health care professional and patient has increased by many of these factors. The problem we health care professionals have is with the second word in our title: CARE. Actually, it is a problem with the oft excluded (at least in practice) second word in our title. A recent example will suffice. I share it with the patient’s permission.
A family friend developed urinary retention, necessitating a visit to the ER of a large metropolitan health care system. The ER provided excellent care; our friend was outfitted with a Foley catheter, and sent on his way. His way included extensive travel, and the catheter was removed more than a week later by a “mid-level provider” at a urology office. He was instructed to contact that person with any problems. There was no telephone number he could use to do so; he would have to contact her through the patient (electronic) portal.
When he developed symptoms of a urinary tract infection on Thanksgiving Day, he sent several messages to the “provider” through the patient portal, including the request for a phone call to his cell (number provided). No answer. He contacted physician friends, who talked at length with him, and one prescribed an antibiotic. Later on that same day, he again experienced urinary retention. He sent more messages through the patient portal. Again, there was no answer. He returned to the same ER, and received the same excellent treatment as he had on his first visit there.
He sent further messages through the patient portal, to update the “provider” as to the events of the day. He reached out several more times over the succeeding days – through the patient portal. SIX days after his initial message, he received a phone call from her, and now has an appointment scheduled for her to remove the Foley catheter. He has yet to be seen by a urologist. This is NOT in a rural setting, but a metropolitan area, where many well-trained health care professionals are available. This is not “inadequate” care: at some level it is almost no care at all.
Our friend needs help, and he is not alone. Many people as patients are similarly stymied by health systems and/or health professionals that lack care. There are several interventions that could improve our practice, but I will propose a basic one to begin the process. We need to view others, particularly patients, differently. Here, Dr. Margaret E. Mohrmann’s work can serve as an aid to correct our vision.
In her book, Medicine as Ministry: Reflections on Suffering, Ethics, and Hope, (Cleveland, OH: The Pilgrim Press, 1995), Mohrmann insightfully reminds us that while getting a correct diagnosis is important, there is more to medicine. “It is no less important to recognize that for the sufferer the name of the disease, spiritually speaking, is humiliation or fear or malaise or endless pain or loneliness or despair or the end of a career or the end of a life. It is no less important to recognize that this is a human being to whom a terrible thing is happening and, whatever other name this terrible thing bears, its name is tragedy.” (p. 69).
In the midst of their struggles, however, Mohrmann says, “We must not take away from them their chance, despite their suffering, to remain fully human by being persons who can still give even while they are most in need of receiving.”
What can patients give us, as health care professionals? Mohrmann finds that there are several gifts patients provide. First of all, they give us “the opportunity to love and to serve.” They allow us to receive their “deepest and most feared secrets, the parts of themselves they guard most closely.” This, says Mohrmann, is the “unparalleled gift of entry into the hidden life of another human being” (p. 47).
Secondly, our patients have mercy on us by teaching us the “natures of their illnesses and the meanings of their sufferings. They teach us our craft and our vocation. . . . Most of what we know about our jobs we have learned from those we have served . . .To whatever extent we are healers, it is because our patients have made us so” (p. 48).
Thirdly, patients “shape our lives,” Mohrmann writes. “They form an integral part of who we are; they take a major role in forming our stories as they supply and populate the chapters that follow one another as the narratives of our lives unfold” (p. 49).
Would that our family friend, and patients everywhere, be seen — and welcomed — in this way!
Worth Your Time: Selections from the Bioethics Library
C. Ben Mitchell, Ph.D.
Distinguished Fellow
The Tennessee Center for Bioethics & Culture
Wes Siscoe, “Flourishing as a Physician,” in Virtues & Vocations: Reimagining the Character of Professional Education, a newsletter of the Center for Social Concerns at Notre Dame University
A brief and encouraging story about the work of Lydia Dugdale, MD, and colleagues who have started the Columbia Character Cooperatives, small communities of students and faculty that thoughtfully examine how to become good and thriving healthcare professionals. Ideas are here for physician faculty members in other medical schools.
David N. Beckmann, Life with the Professor: The True Story Behind The Lion, The Witch, and the Wardrobe (Logress Books, 2020)
Fans of C. S. Lewis will love this very brief volume and might even make it a stocking stuffer at Christmas. Inklings scholar David Beckmann and his wife, Shiela, were live-in hosts at the Kilns, the Oxford home of C. S. Lewis, his brother Warnie, and others. This is an historical, behind the scenes account of how a great intellect like Lewis got to know children and their imaginations well enough to pen captivating children’s stories that have more than passed the test of time. The volume includes pictures and even the floor plan of the Kilns.
Don W. King, Inkling, Historian, Soldier, and Brother: A Life of Warren Hamilton Lewis (Kent State University Press, 2022)
This award-winner is the first full-length biography of Warren Lewis, the brother of C. S. Lewis. Warnie, as he was known, fought in France during World War I and suffered both physically and mentally from that traumatic experience. After the war he lived at the Kilns, the Lewis home in Oxford. Although not a well-known Oxford University don like his brother, Warnie was an accomplished amateur historian and wrote a number of significant books of his own. King, who has written extensively on Lewis, including biographical works on both Clive Staples Lewis and his wife Joy Davidman, brings his considerable wealth of knowledge and depth of research to bear on the life of a figure who was more important to his brother, Jack, than most people realize. Those who are interested in Lewis or military history will find this volume fascinating.
