Wednesday, February 21, 2024

'For My Small Ailments'

Empathy, in some quarters, is becoming quite fashionable. Clearly, my doctor has been benefiting from professional development. When he enters the examination room we shake hands, he moves a chair to face me and sits almost knee-to-knee. This is to eliminate any suggestion of hierarchical intimidation. He looks me in the eye when I answer his questions and nods his head approvingly. I don’t mean to make fun of the guy but he’s a middle-aged physician acting like an earnest, eager-to-please resident. It’s faintly comical but I appreciate the effort. It beats the alternative – the doctor who appears impatient, distracted, bored or even contemptuous. Years ago, I expressed to a doctor my displeasure at undergoing a digital rectal exam of the prostate. His response, without a trace of irony or wit: “You better hope you stay out of prison.” Good advice, Doc.

While researching a story I’m putting together at work, I reviewed several medical journals and happened unexpectedly on “Clinical Empathy for the Surgical Patient: Lessons From W.H. Auden’s Prose and Poetry,” published in 2021 in Annals of SurgeryBefore they get to Auden, the authors endorse the practice of “‘emotional resonance’ with a patient’s symptoms and suffering [and] the action of ‘checking back’ with the patient to confirm or correct this shared understanding.”


Auden’s father was a physician and the poet often expressed interest in medicine and respect for good doctors. In 1932 he published the long poem The Orators: An English Study, from which the authors of the journal article extract “Letter to a Wound,” in which the speaker addresses his wound as though it were a jealous lover. His visit to the doctor doesn’t go well. “The surgeon,” our authors write, “his only source of hope, excused himself from the narrator’s experience of suffering. In contemporary terms, the surgeon failed to co-author the narrative of illness with the patient and the narrator is dominated and defeated by the narrative of this experience.” In the vernacular, the surgeon is an uncaring jerk. “Letter to a Wound” is a failed satire, not a good poem.


In 1969, Auden published “The Art of Healing,” dedicated to his recently dead personal physician and friend, Dr. David Protetch. In the ninth stanza he writes:


“For my small ailments

you, who were mortally sick,

prescribed with success:

my major vices,

my mad addictions, you left

to my own conscience.”


Protetch represents the opposite approach to treating patients from the one described in “Letter to a Wound.” “Dr. Protetch’s understanding that he cannot fully comprehend or cure the most intimate of his patient’s torments,” the authors write, “is the essence of clinical empathy—the choice to surrender and support, rather than overpower and control the patient’s narrative of illness.” That “narrative” business is a little heavy-handed, a lapse into academicese, but we get the idea. As a patient, I want treatment suggested, not mandated. The best doctors’ touch is simultaneously light and authoritative – one of several reasons why I generally prefer nurses to doctors. Under the entry for “Medicine” in A Certain World: A Commonplace Book (1970), Auden writes:


“I can remember my father, who was a physician, quoting to me when I was a young boy an aphorism by Sir William Osler: ‘Care more for the individual patient than for the special features of his disease.’ In other words, a doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.”


Auden was born on this date, February 21, in 1907 and died in 1973 at age sixty-six.


Richard Zuelch said...

My former doctor - now retired - was a wonderful man and a very good doctor. He saw both my late wife and I for many years. I'll not see his like again, I'm afraid.

My current doctor is OK, I guess. He's a competent physician, I'm sure, but not like my old guy at all. Unlike the wealthy, who have much more control over their medical choices, we peasants get tossed into HMOs and you take whom they offer to you.

Gary said...

Would that empathy would be fashionable and stay that way. That's at the heart of secular humanism.

Thomas Parker said...

It's amazing what people will say when they know they don't have to worry about the patient/customer/victim looking them in the eye and saying, "You're fired."

Faze said...

Patients need to have more empathy for doctors. Your case is just a fraction of one day in a career that may last more than 40 years and include tens of thousands of patients. Physicians have to do so much work in addition to patient care, to ask them to signal empathy to ever patient is not a good idea. Empathy isn't going to cure you, but your doctor's technical expertise may.

Tim Guirl said...

I had forgotten that Auden's father was a physician. He was also of friend of the late Dr. Oliver Sacks. The new breed of doctors are trained to partner with patients in their medical treatment. Perhaps the style can best be described as authoritative rather than authoritarian; it is medicine as a science and an art. The practice of medicine is difficult, but if practiced with skill and kindness and hope, like Dr. Vera Gangart in Solzhenitsyn's novel, 'Cancer Ward', it can be a partnership that brings healing.

Regarding the dreaded digital rectal exam, my DRE, in addition to a blood test and biopsy, resulted in a diagnosis of early, curable prostate cancer.

mike zim said...

Re: digital rectal exam / "You better hope you stay out of prison.”

Norm MacDonald: "That's what prisons are most famous for."