Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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What makes a Physician a Healer?
Posted in Acute Lymphocyt... by Dr. Sharon Orrange on Nov 21, 2008

It is well recognized that physician's relationships with their patients can have healing effects, but not always. What are the core set of healing skills that make a physician a healer? I read with interest a recent study in the Annals of Internal Medicine which studied this question: What are the skills that physicians who have been identified as healers have? The relationship is crucial given that we as physicians probe into our patient's private lives, talk them in to enduring diagnostic tests, and convince them to take new medications that may be inconvenient and painful.   What makes those identified as healers different?

After interviews with Expert healers eight skills emerged as pivotal, and I'd like to give my take on them and hear your input:


1) Do the Little Things. This may seem obvious but is as simple as smiling, shaking hands acknowledging others in the room, and making eye contact. Did your physician remember these basic gestures when you met him/her? It is important for setting the tone.


2) Take Time and Listen: Many of you on Dailystrength wonder "will the doctor listen to me?" A physician's willingness to be still and quiet demonstrates there is space to talk. Taking off your coat, sitting down and looking relaxed were noted in this study to be helpful. Listening is the most important thing and letting people tell their story without too many interruptions can help in the healing process.


3) Be Open: The author of this study describes patients who come to their physician visits with their "damaged humanity" from previous experiences. Physicians need to be willing to be open and vulnerable patient after patient. Don't be afraid to shed tears or to say you are not perfect.


4) Find Something to Like, to Love: This manifests most authentically as compassion and understanding. A healing physician will seek in every patient a quality, achievement or mannerism that can be appreciated or admired. Your physician may relate to you as being similar to their spouse, parent, grandparent, and child and that may enable them to feel more empathy. To me this is why I love this job. I love the patients and I think you have to. A nice quote from one of the healers in this study was "You have to be willing to walk the wounded path with them."


5) Remove Barriers: These can be physical barriers (desks, etc) or attitudinal barriers. I try to stress to my residents you are not too good to open a door, roll a patient back in the room, empty a trashcan. Today I was tracking down ice chips for a patient and wiping his runny nose.


6) Let the patient explain: Physicians who are healers are insistent that patients are the best source of information on their condition, obvious to DS members I know. "An essential part of healing is allowing patient's understanding of their illness to be spoken and received" was a comment from this study that I really love.


7) Share Authority: A good physician tries to establish their expectation of shared responsibility for healing at the very beginning. I loved what one of the healers interviewed for this study said "Today's visit is about ascertaining how I can help you. I'll make some recommendations to you but you will always dictate what you want to do."


8) Be Committed and Trustworthy: Patients have a fear of abandonment and will stay connected if they feel you are trustworthy. An intentional plan to sustain the relationship and carry it forward is very helpful. It may be as simple as coming up with a plan which conveys you can count on me, you will always leave with a plan, even if it doesn't work right away we at least have a plan.


I write this blog in hopes that I fulfill these 8 "criteria."  I feel lucky to have worked with many physicians I felt were healers and would consider the physician who delivered my daughters a healer. I think we should all pay attention to this list and keep it in mind the next time you see your doctor.  It is the simple things, they don't take much time. I remember our pediatrics advisor on Dailystrength.org showing me a picture he took of a patient of his at lunch and with the look on his face, I know he loves these kids and loves his job. You can find that.  Seek out physicians who are healers because the benefits of mastering skills like these are repaid in many ways which leads to improved patient care. If only I could have all physicians drink the Kool-aid.


 "The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind."


Philipus Aureolus Paracelsus


Dr O.


 


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34
Thank you for this interesting article
I was lucky enough to find a great Dr.
My Haematologist set the scene at our first appointment - she saw me as a person not just a disease. During that first interview and examination we discussed all the possibilities (some were pretty scary) and at the end I left her office with something that sustained me for the whole 8 months of Chemo - HOPE

I am in Australia and the hospital is a training hospital .
My Dr's position also makes her responsible for selecting new residents and registrars every few months. She had a knack for selecting those young doctors who had those same positive qualities.
I trusted them all and know they all played a big part in my recovery
By blithe1  Jan 25, 2009
33
Unfortunately, I've seen hundreds of doctors starting at a very young age. The great ones are few and far between. When things got really bad and no one could figure out what was making me sick, I began to resent doctors and got anxious every time I had to go to another one. I was on 17 medications and still not getting any better. During that time I remember seeing one specialist who actually said "I am not sure what is causing this." I think I appreciated that more then all the doctors who threw medications at me even when they were not sure why I was sick or misdiagnosing me. When I think of a doctor walking in a room, not looking at me in the eyes, staring at their clip board or computer screen, I am taken back to how horrible I always felt.

Doctors are human beings just like everyone else. We, as patients, are like a customer is to any business. If I would not be rude to my customers then I do not expect my doctors to be rude to me. I understand their backs are against the wall with many issues, but we all have to fight battles in life. Doing it with some empathy and compassion makes it so much easier for everyone involved.

I appreciate you posting this. I thought about what it was that made me like one of my new doctors and many of the things you noted here play a big role. Thank you!
By Lioness816  Jan 12, 2009
32
I'm tempted to print this out for my doctor. I've only been going to him for 2 years after moving from another area. The doctor that I left, I'd been seeing for over 30 years, and sure do miss him and the staff.

What I miss most about my other GP is how the office was managed. Not just the smiles and respect, in my age it was a given. But they had a system where every call, every report, every prescription was filled before the office closed for the day.

Two days after my doctor received my x-ray report for spots on my lungs I still haven't a call. The receptionist told me he wouldn't call soon, he was busy with patients. Well, I'm a patient *s*! So with that said, I'll take mom's advice to shop around for a doctor, just like anything you do.

Wishing all of you a blessed New Year and a year filled with health and happiness.
By Meadow2345  Dec 30, 2008
31
I was run over by a drunk drive in Sept of 2001, and released from the hospital in May of 2005. I lost a limb, and suffered a TBI, and spent another two years in the process of recovery. In the last 8 years, I have come to despise medical personnel who think they have the right to take your rights away from you. It only takes a couple bad experiences with medical professionals and you learn to hate the whole lot. There is nothing more that I hate or gives me more anger, than to see you posting information on this website that I have been a member of for almost two years. I do not like you, and do not want you opinions posted, and that is how I feel about you and your kind.
James C Chivers PhD. P.E.
By Jiminator  Dec 27, 2008
30
Kool Aid - not like the acid stuff i took in the 60's? More seriously a lot of your points equal empathy and humility (not a very post modern virtue). I get a lot of understanding from my GP. I used to be a cousellor so I find myself counselling him some of the time, he's currently going thru a messy breakup so needs someone to trust. I know it's probably not totally standard ethics but I feel for him and also it's nice he trusts me enough to confide in me. I don't consider it a burden. What do you think? On a lighter note, see if you can find the lyrics to Cole Porter's song "The Physician". I think it's very witty! Mindy xxx PS Drs. in general don't take care of themselves aqnd need to have this instilled in their education and not just in words but in more up to date standards between life/work balance.
By mindlesley  Dec 24, 2008
29
How can a physician have an open mind and heal when their hands are tied as to what treatment, drugs and information they are able to give to a patient. You quote Paracelsus, who's methods were outlawed by the medical profession in his time and would be today as well. He believed in working with esoteric energies, natural remedies and methods that the 'all powerful' drug companies would hotly contest. The personal skills which you describe as necessary for a good relationship with patients are basic counselling skills, which I believe, all physicians and health workers should study as an important part of their training. During my work at the local hospital arranging courses for GP's to attend, it was precisely these sort of relationship development courses that were the most poorly subscribed to. As a patient, it is the doctors/nurses who have a natural ability to put their patients at their ease and to develop a supportive relationship that I am able to trust and benefit from the most. They are often frowned upon by their colleagues who are not prepared or willing to put in the effort required.
By Halli  Dec 21, 2008
28
I TRULY ENJOYED THE ARTICAL
By msvanelli  Dec 13, 2008
27
I like these eight skills listed. Last year while in the hospital getting dx'd with MS, I had two neuros working my case. A few days of their combined attitude which left me completely uninformed as to what was going on, I called them into my room for a "talk". I told them that they were both better fit to be veteranarians. I told them a vet treats their patient based upon symptoms only, never telling the patient anything or asking how their patient feels. They took offense to what I said, but what I said was certainly true. Hopefully, they've learned to change their "vet" ways and treat patients like human beings.
By BobbyJ  Dec 10, 2008
26
Medlab: so true about a doctor willing to fight for you. Whether it is for disability, life insurance that is denied, denial of a procedure or a medication....find a doc willing to fight for you
By DrOrrange  Dec 06, 2008
25
I once read a doctor's comment that he learned in medical school "Listen carefully to the patient as they are giving you the diagnoses" How true! I think we live in such a rushed busy world that its harder today for physicians to stop and listen.

I also think having a detective attitude. A willingness to solve the medical mystery that the last 3 physicians missed.

Another quality that would make a physician a healer would be Courage. Courage to take a stand for whats right and in the best interest for the patient. Not always the treatment the HMO believes in.
By MedLab1  Dec 03, 2008
24
You be on the right track DR O have a good holiday with your family!!
By BillyJackTurtle  Dec 02, 2008
23
The best thing I ever did was stop going to 'regular' doctors since they treat fibro patients with such contempt.

I used to always take notes for the doctor which I'd give him listing what I wanted to cover. One of the last times I saw my doctor one item on the list was that I was through fighting with them and felt like I needed to bring my cousin who is a criminal defense attorney with me as I always felt like I was on trial for my life.

I had one doctor tell me he realized he wasn't God after missing the fact that I'd been suffering from subclinical hypothyroidism for years. Course, had he done his job, he would have caught it, he just wasn't the brightest light in the sky.
By hayleydaniels  Nov 26, 2008
22
Whatever makes a physician a healer it's a hard thing to do an hour at the time.
By SmileyGator  Nov 23, 2008
21
good article with high expectaions for healers.
What I look for? Patience is number one. There are some well-educated docs out there, but some are on a power trip. Talk down to patients, not patient, haha, and don't recognize they work with people, not ameba.
By deeee  Nov 23, 2008
20
This is a great article. I have had some wonderful doctors as well as some horrible ones. I think patients need to be educated further as what to expect and this article helps with that. I have told friends in the past to think of going to doctor as paying for a service like having thier carpet cleaned. If they don't like things (ie:not listening or feeling rushed) then find a new one. If the carpet was still dirty would you call that cleaner back?

I know the doctor is much different but it's the principle. A great doctor listens, validates concerns and addresses the treatment plan as what "we" need to do. The fact that you take the time to come here and try to help us tells me that you are one of those great doctor. Thanks for all you do.
By Robbimom  Nov 23, 2008
19
This is a wonderful list, and reminds me how blessed I am. I have multiple healthcare providers, some of whom are relatively new to me, but I feel so very blessed to have them. My rheumatologist started with me a year ago, and is now the most "senior" of the group. Intense but compassionate, she earned my trust early on and has set the bar for the rest of them. Several months into our "relationship" I was discussing my difficulty in coping wtih the pain I was experiencing, and started to cry. Without a word, she moved from the stool across from me to the chair next to me, with a tissue, and waited. She has the "8."

Dr.Orrange, I've never met you, but having read your blog, it's very difficult for me to believe anything other than that you also have the "8." I believe that the desire you demonstrate to serve and heal your patients honors them and you. You, too, raise the bar.
By kaydi8  Nov 22, 2008
18
Hey AKAMonet: Those interviewed were anonymous but here is the article from the Annals of Internal Medicine"
Healing Skills for Medical Practice Larry R. Churchill, PhD, and David Schenck, PhD 18 November 2008 | Volume 149 Issue 10 | Pages 720-724

Also: we dont do 5-7 minute visits in our practices at USC and we all still make a living thank goodness. I agree with you 100% on your last thoughts as well...thanks for the comment!

Dr O.
By DrOrrange  Nov 22, 2008
17
Dr. O--

Do you mind giving the reference html for the list of healers? I would greatly appreciate it.

Also, I think you are probably inundated with clients--the average visit HAS TO BE 5-7 minutes max? For every one doctor, there is ~50 patients and it is predicted to worsen with more patients and less available licensed health care workers... And all of in the field know folks are pursuing ER care rather than healthcare... And what I admire about physicians the most is their level of commitment after years of medical training...

On the opposite side as a research scientist Ph.D., we need to work together to increase technology, information and access to superior health resources and services. When given the chance, I find that EVERY physician I have asked to present "their favorite topics du jour", the layperson response has been incredible--they actually DO learn!!! And they become proactive with their healthcare! I need to do a clinical trial to see if it really makes a significant difference...

Anyhow, I admire your work on this and keep up the great strides...

Peace and blessings,

Dr. G-
By AKAMonet  Nov 22, 2008
16
well, i was extremely lucky to have the pediatrician that i had because she was so awesome!! she was actually a NP, not a MD, but she was way better than any doctor i ever had. she would take the time to listen to me and believed me when i gave her my symptoms and would trust me when i told her i had bronchitis cause i got it every year. she was there for me when i had a lot of mental health problems and started cutting myself. she told me what to do if i started getting too depressed and gave me her personal office message phone so i could contact her directly if i ever needed an emergency appointment or needed someone to talk to. when i was in my teen years, she talked to me about rape and date rape and told me what to do if that ever happened and stuff like that. she always made sure i understood things and didn't just leave me with questions unanswered. i wish she was a general family doctor so i could see her now, but i did see her until i was 21 and finally got kicked out, lol. she made sure i got referred whenever she wanted me to get checked out by a specialist and then she would call that doctor to make sure i kept the appointment and contacted me right away with whatever results they had. i think that she was truly there to care.
By Val  Nov 22, 2008
15
No Feelingrough,
You are absolutely right, I experienced exactly the same problem. With Lyme not only are you really ill,
the Doctors basically tell you that its "all in your head"
Doctors forget being good at their job is, all about listening to their patients, and not just assuming that we are trying to get attention. They need Patience, Empathy, Good Listening,clear communication, and the ability to
get to the heart of the problem, without patronizing. We know Doctors are clever individuals, but then some patents want more than just a cold clinical analysis. we want respect.
By ponder44  Nov 22, 2008

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