The doctor–person relationship

“It’s like I wasn’t even there,” was the complaint of a patient whose arthritic knee had just been replaced. The operation was a complete success as evidenced by the 70-year-old woman’s recent golf score. The surgeon was courteous and compassionate and their discussion was not rushed, but still the clinical encounters left her “cold.” What, if anything, was missing? And how cold did she feel after her encounters with me?

A central idea in Whole Person Care is that physicians are simultaneously involved in two therapeutic relationships: one with diseases and another with the patient. Treating diseases involves noting that a patient has rheumatoid hands, while healing the person requires noticing that hand used to bear a wedding ring. But Whole Person Care is not a collection of tips for seeing the person; it is an entreaty for physicians to rethink what they are doing and why.

The book left the image of a Greek mosaic burned into my mind: a weary patient approaches the physician Hippocrates for treatment in the foreground, while in the background Asklepios, the god of healing, steps off his boat towards the patient. The patient’s gaze is fixed on Asklepios who is centrally framed such that Hippocrates is less prominent despite being in the foreground.

The Hippocratic and Asklepian sides of the dichototomy have complementary goals and approaches: survival versus growth, curing versus healing andholding on versus letting go. While these ideas resonated with my desire to provide more holistic care to patients, the lack of practical tips in the book made me wonder how whole person care differs from less holistic care in practice. Chapters such as “Whole Person Care on a Busy Medical Ward” held the promise of useful instructions, but instead delivered a reiteration of the central thesis of the book among moving narratives. These expertly told patient stories emphasized the need to consider the Hippocratic-Asklepian dichotomy. The lack of concrete advice left me wondering, however, if only gods like Asklepios can understand healing.

The “Prevention and Whole Person Care” chapter provided the most concrete, important and interesting implications in the book. This chapter contrasted whole person preventive strategies, such as exercise promotion, which has multiple short- and long-term benefits that are congruent with the values of patients, with conventional cholesterol screening, which focuses on life-expectancy and disease prevention.

Future iterations of the book might include a chapter on family medicine since preventive care (or health promotion) is just one aspect of primary care and, if any Canadian physicians are going to bring whole person care to the masses, it will likely be family doctors. The Royal College of General Practitioners in the United Kingdom recently released a report entitled Medical Generalism: Why expertise in whole person medicine matters1 that emphasized the multiple essential roles that primary care providers and other generalists play to ensure people get the care they expect and deserve.

The subtitle suggests that whole person care is “a new paradigm for the 21st century.” I suspect that this is not an entirely novel paradigm and so a historical perspective that filled in the gap between Hippocrates’ time and our own would have been a welcome addition to the book. A richer historical context would have helped to frame the valuable and sophisticated discussions of topics such as the implications of whole person care for medical education and professionalism.

Asklepios (centre) arrives at Kos unnoticed by Hippocrates (left).

Image courtesy of Tedmek

Parts of the book are valiant efforts to articulate complex ideas and some passages, such as the following one, passed far above my head: “A person is an embodied, purposeful, thinking, feeling, emotional, reflective, relational very complex human individual of a certain personality and temperament, existing through time in a narrative sense, whose life in all spheres points both outward and inward and who does things.” “Who does things” was the only part of that sentence that (I think) I understand, but its significance still eludes me.

It is likely that I will never fully grasp the ideas buttressing whole person care, but I feel I still benefitted from the elucidation of the Hippocratic-Asklepian dichotomy and the powerful stories in my struggle to provide better and more holistic care for the people I call my patients. Perhaps a clear understanding of whole person care is not needed to provide it. In the Greek mosaic Hippocrates’ view of Asklepios is obscured so that the healer arrives without the knowledge of the physician.