Most people enter the healing arts with a genuine desire to serve others.

The long educational journey and the realities of both the workaday world and the various business models of health care often strain our abilities to act in an empathic manner.

We have to pay the bills, after all.

“No money, no mission,” is a refrain I’ve often heard in the non-profit corners of the health care world, justifying business decisions that on their face seem less than patient-centered.

I hear stories all the time from patients, families and friends about just how far we have to go to truly become patient-centered in our approach to providing the best in health care.

 

In most businesses, customers can vote with their feet (or their wallets) when they don’t like the service or the way something is presented to them. If a restaurant is too slow, too expensive, or the food is below par, you can simply choose not to go back.

But with health care, thing are different.

You may really like your doctor, but hate the systems set up around her:

• Scheduling.
• Phone calls.
• Email?
• Waiting, endless waiting: Waiting rooms. Waiting for ‘vitals.’ Waiting in the exam room. Waiting for referrals and checkout.

Why not go somewhere else? You might, but then you’re starting over with a new doctor. A new system. Having to fill out all those forms again.

Your insurance (if you’re lucky enough to have it) constrains you in your choice of which doctor or group is “in network.” Your location is important, too. No one wants a doctor or hospital that’s too far in an emergency.

Emotionally, we know there’re advantages to having a continuity relationship with our doctors. Someone who knows us and our history, and understands our health beliefs and preferences. As a practicing primary care doctor (a vanishing breed if you go by recent statistics on graduates), one thing I value is these long term relationships. Otherwise, medicine is boiled down to its mere technical aspects (no small thing, to be sure).

I find the long-term relationships more emotionally satisfying for me, which is important in keeping me engaged in the work I do. Engagement allows me to be more in touch with my empathic side, which is the reason I became a doctor in the first place.

There’s usually a group of doctors at any medical school who become, shall we say, less enamored of the processes of health care delivery. These folks, and I am one, look for ways to connect our work to ideals, the higher purpose(s) to which we aspired when we entered the profession.

Rachel Remen, a doctor and the author of Kitchen Table Wisdom, has promulgated “Finding Meaning in Medicine” groups for doctors looking to re-connect with their highest ideals all across the country.

One of the parables that she often retells beautifully illustrates this issue.

You come upon three stone cutters at work:

You approach the first man and ask him what he’s doing. Angrily he turns to you and says, “Idiot! Use your eyes! They bring me a rock, I cut it into a block, they take it away, and they bring me another rock. I’ve been doing this since I was old enough to work, and I’m going to be doing it until the day that I die.”

Quickly you withdraw, go the next man, and ask him the same question. He smiles at you warmly and tells you, “I’m earning a living for my beloved family. With my wages I have built a home, there is food on our table, the children are growing strong.”

Moving on, you approach the third man with this same question. Pausing, he gives you a look of deep fulfillment and tells you, “I am building a great cathedral, a holy lighthouse where people lost in the dark can find their strength and remember their way. And it will stand for a thousand years!”

Guess which of the stone cutters finds the most satisfaction in his job.

It’s not just doctors. Nurses struggle mightily to integrate service and empathy into the day-to-day responsibilities that their profession has developed for them. In the book Switch, authors Chip and Dan Heath tell the story of a smallish community hospital that struggles with a high rate of nursing turnover. Rather than focus on incentives as a way of attracting newer nurses, the smart change agent in the story turns to the core of nurses that seem to weather the storms of daily drudgery to stay at their jobs because they find them satisfying.

“What motivates them?” she wonders.

Turns out that those nurses with strong senses of empathy are the ones that weather the daily grind best and find reason to stay. It’s the connection with the higher calling of healing that allows them to find purpose in the more mundane tasks.

They are the cathedral builders of workaday medicine, not simply stonecutters.

John Schumann is an internal medicine physician at the University of Chicago who blogs at GlassHospital.

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