Tuesday, April 17, 2012

Family Medicine Activist: Let's Cry Together

"Dear God, sometimes I feel uncomfortable when someone cries in front of me.  I know you've provided tears for times when words aren't adequate to express the depths of pain and suffering.  Jesus wept.  Teach me to embrace the tears of those who are hurting and at times even to weep with them.  Amen."       from Don't Sing Songs to a Heavy Heart by Kenneth C. Haugk, PhD p.65

Meandering through life exploring various aspects of the human condition, one easily finds joy and grief.  Tears may denote both states of being.  When do we learn how to cry?  When do we learn adult crying?  When do we learn to avoid crying?  When do we learn to suppress the tears of others?

Physicians may be as comfortable or uncomfortable with tears as the general population early in their career but should develop strategies over time to enable them to find a balance between caring and working.  We have a certain "physicianly" presence/power that evolves with our training and experience that may add to or detract from our compassion.  How might one explain this power/compassion contradiction.  How might a physician understand, learn and even manifest compassion for/with a crying patient?  

I found some clarification in The Healer's Power by Howard Brody, MD, PhD (1992, Yale University Press).  While the White Coat Ceremony in medical school serves to help students to understand the obligations and potential separateness of our profession, the virtue of compassion (as demonstrated by countless Family Physicians) "is integrally linked to the ethical use of power in the physician-patient relationship. Surely, being with the sufferer and helping him find his own story to attach meaning to his experience is a prime example of shared power. Few things that the physician can do have the capacity to empower the patient to a similar degree.... To be compassionate in response to the suffering of the patient is therefore one of the most powerful things a physician can do: but this is possible only to the extent that the physician is willing to adopt a position of relative powerlessness, to acknowledge that the patient's suffering has incredible power over him and that he cannot remain unchanged in the face of it. This is a major irony of the physician-patient relationship, in which a sense both of one's own healing power and of one's necessary humility forms a synthesis of the apparent contradiction of power and powerlessness." 

Those words of Dr. Brody imply that comfort with tears might be at the confluence of  the physician's "healing power" and their humility.  Some physicians may not feel ready for this type of struggle in their professional development, quickly offering tissues to the crying patient in an effort to stop them.  Other physicians may tear up in acknowledgement of the power of the patient's suffering.  We need to more readily share our humanity with our patient.  Let's cry together.

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