A healer must have a large heart coupled with a strong and well-trained head

Richard Smith, a former editor of the British Medical Journal, once wrote in an editorial about the poor communication skills of doctors in general and their incapacity to deal with the uncertainties in medicine. Doctors have been attempting to predict unforeseeable outcomes of their interventions. This oracular tendency among doctors is at the root of patients’ loss of confidence in doctors. If one is well and healthy at any given time, it is because of chance; on the contrary, if one is unwell, it is again because of chance.

The solution lies in training medical students to accept that doctors are fallible like anyone else and can make mistakes. Being honest about mishaps and sharing one’s joys and sorrows with the patient could ease the situation and enhance communication. The crux of the healing process is the coming together of two human beings: one who thinks he/she is ill and the other in whom the former has confidence. This coming together of two human beings, with mutual trust, is the summit of medicine from where all other aspects like diagnosis, therapy, future management, etc, follow. It is here that the patient gains confidence in his/her doctor.

In the past half century, technology has deified the medical profession, leading patients to expect the moon from their doctors. One of the reasons for the burgeoning consumer suits against doctors and hospitals in the West is precisely this. The holy doctor-patient relationship has become that of a seller and a buyer, resulting in market forces uprooting medical ethics. “Cure rarely, comfort mostly, but console always” was good Hippocratic advice. It is not what the doctor tells the patient that counts but what the doctor does that impresses the patient. Once the patient realises that his doctor does walk his talk, patient confidence is easily won.

William Osler said that a doctor needs two great qualities—imperturbability and aequanimitas. If the doctor can communicate well, diagnosis becomes a pleasure at the bedside. “If you listen to your patient long enough, he/she will tell you what is wrong with him/her,” wrote Lord Platt in 1949.

Confidence is built by the doctor’s ability to listen to the patient. Listening is a difficult art. Every medical student should be trained to master the art of listening. Henry David Thoreau wrote, “To affect the quality of the day—that is the highest of arts.” The art of listening to the patient is the capacity of the doctor to enhance the quality of the patient’s day.

Listening to the patient is not confined to listing the patient’s symptoms, past history, his social and family history. The crux of the art of listening is to understand a patient’s fears, his religious, spiritual and social beliefs, his cultural upbringing and, more than all that, even his irrational obsessions in terminal illnesses. Even if the doctor is a rationalist and thinks that medicine is a pure science, he/she will have to try and understand the irrationality of the patient’s thinking to respond to the patient satisfactorily.

Healing is universally possible while curing is rarely an attainable goal in medicine. A healer must have a large heart coupled with a strong and well-trained head. Combining humility and wisdom is not impossible, but it is difficult. A book that I’d recommend to doctors is On Doctoring by Richard Reynolds and John Stone (Simon and Schuster, New York).

My personal experience, since I first started seeing patients in 1956 as a medical student, has been that if I have a genuine interest in the patient’s welfare, the patient would have full faith in me. This matters a lot in the final outcome of illness, uncertainty notwithstanding. Faith heals.

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)