Thomas R. Egnew

The Meaning Of Healing: Transcending Suffering

PURPOSE Medicine is traditionally considered a healing profession, but it has neither an operational definition of healing nor an explanation of its mechanisms beyond the physiological processes related to curing. The objective of this study was to determine a definition of healing that operationalizes its mechanisms and thereby identifies those repeatable actions that reliably assist physicians to promote holistic healing. METHODS This study was a qualitative inquiry consisting of in-depth, open-ended, semistructured interviews with Drs. Eric J. Cassell, Carl A. Hammerschlag, Thomas S. Inui, Elisabeth Kubler-Ross, Cicely Saunders, Bernard S. Siegel, and G. Gayle Stephens. Their perceptions regarding the definition and mechanisms of healing were subjected to grounded theory content analysis. RESULTS Healing was associated with themes of wholeness, narrative, and spirituality. Healing is an intensely personal, subjective experience involving a reconciliation of the meaning an individual ascribes to distressing events with his or her perception of wholeness as a person. CONCLUSIONS Healing may be operationally defined as the personal experience of the transcendence of suffering. Physicians can enhance their abilities as healers by recognizing, diagnosing, minimizing, and relieving suffering, as well as helping patients transcend suffering.

Issues in end-of-life care: patient, caregiver, and clinician perceptions.

CONTEXT Review of published research indicates the need to better incorporate patient and caregiver perceptions when providing end-of-life (EOL) care. Although considerable research regarding patient and caregiver experience of EOL has been done, little research has studied patients, caregivers, and clinicians as a connected system. OBJECTIVE To study the perceptions of patients, caregivers, and physicians who are already connected with one another in an EOL care experience. DESIGN Qualitative study consisting of in-depth, open-ended, face-to-face interviews and content analysis. SETTING Community family practice residency programs in rural and urban settings in the Affiliated Family Practice Residency Network of the Department of Family Medicine, University of Washington School of Medicine. PARTICIPANTS Forty-two patients and 39 caregivers facing EOL were interviewed either alone or together after referral by their physicians. Additionally, results of previously published findings from interviews with 39 family practice faculty were included. OUTCOME MEASURES Perceptions of participants on EOL issues. RESULTS Participants identified four primary issues related to their experience of EOL care: awareness of impending death, management/coping with daily living while attempting to maintain the management regimen, relationship fluctuations, and the personal experiences associated with facing EOL. Participants expected their physicians to be competent and to provide a caring relationship. CONCLUSIONS Awareness of these crucial patient and caregiver EOL issues and expectations and how they differ from clinician perspectives can assist clinicians to appropriately explore and address patient/caregiver concerns and thereby provide better quality EOL care.

Suffering, Meaning, and Healing: Challenges of Contemporary Medicine

This essay explores the thesis that changes in contemporary society have transformed the work of doctoring and challenge doctors to be physician-healers. Medical advances in the prevention and management of acute disease have wrought a growing population of chronically ill patients whose care obliges physicians to become holistic healers. Holistic healing involves the transcendence of suffering. Suffering arises from perceptions of a threat to the integrity of person-hood, relates to the meaning patients ascribe to their illness experience, and is conveyed as an intensely personal narrative. Physician-healers use the power of the doctor-patient relationship to help patients discover or create new illness narratives with fresh meanings that reconnect them to the world and to others and thereby transcend suffering and experience healing. Physician-healers equipped with the attitudes, skills, and knowledge to assist patients to transcend suffering are indispensable if contemporary medicine is to maintain its tradition as a healing profession. In the process, physicians may discover meaningful connections with patients that bring new and refreshing perspectives to their work.

Integrating communication training into a required family medicine clerkship.

Persistent evidence suggests that the communication skills of practicing physicians do not achieve desired goals of enhancing patient satisfaction, strengthening health outcomes and decreasing malpractice litigation. Stronger communication skills training during the clinical years of medical education might make use of an underutilized window of opportunity—students’ clinical years—to instill basic and important skills. The authors describe the implementation of a novel curriculum to teach patient-centered communication skills during a required third-year, six-week family medicine clerkship. Curriculum development and implementation across 24 training sites in a five-state region are detailed. A faculty development effort and strategies for embedding the curriculum within a diverse collection of training sites are presented. Student and preceptor feedback are summarized and the lessons learned from the curriculum development and implementation process are discussed.

Medical Trainee Perceptions of Medical School Education about Suffering: A Pilot Study

BACKGROUND The relief of suffering is a fundamental goal of medicine, but what medical students are taught about suffering has been largely unexplored. OBJECTIVE This pilot study explored the perceptions of physicians in postgraduate training of their medical school education about suffering. DESIGN Survey research involving physicians in postgraduate family medicine training programs. RESULTS One hundred eighty-four of 304 surveys were returned for a response rate of 61%. Respondents perceived significant gaps in their education about the understanding and diagnosis of suffering and in their preparation to deal with the feelings engendered by caring for suffering patients. Respondents generally perceived that they were prepared to interact with suffering patients and were taught that the relief of suffering is an inherent function of being a physician, but perceived that more explicit teaching about suffering would have better prepared them for residency training. CONCLUSIONS Perceptions of the teaching about suffering at the medical school level are quite variable with significant curricular gaps in student instruction about suffering and its relief.

A philosophy for behavioral health integration in primary care.

In response to a call for a philosophy that transcends the professional boundaries that threaten behavioral health integration in primary care, this essay explores the thesis that such a philosophy exists in medicines core purpose. Drawing on the work of Eric Cassell, a philosophy may be determined that melds the values, themes, and constructs of individual models for behavioral health integration in primary care toward a single, overriding purpose. Effecting such integration challenges current trends in medicine by refocusing medicine on its ethical core. (PsycINFO Database Record

The Suffering Medical Students Attribute to Their Undergraduate Medical Education

BACKGROUND AND OBJECTIVES The purpose of this study was to explore medical student perceptions of their medical school teaching and learning about human suffering and their recommendations for teaching about suffering. During data collection, students also shared their percerptions of personal suffering which they attributed to their medical education. METHODS In April through May 2015, we conducted focus groups involving a total of 51 students representing all four classes at two US medical schools. RESULTS Some students in all groups reported suffering that they attributed to the experience of medical school and the culture of medical education. Sources of suffering included isolation, stoicism, confusion about personal/professional identity and role as medical students, and witnessing suffering in patients, families, and colleagues. Students described emotional distress, dehumanization, powerlessness, and disillusionment as negative consequences of their suffering. Reported means of adaptation to their suffering included distraction, emotional suppression, compartmentalization, and reframing. Students also identified activities that promoted well-being: small-group discussions, protected opportunities for venting, and guidance for sharing their experiences. They recommended integration of these strategies longitudinally throughout medical training. CONCLUSIONS Students reported suffering related to their medical education. They identified common causes of suffering, harmful consequences, and adaptive and supportive approaches to limit and/or ameliorate suffering. Understanding student suffering can complement efforts to reduce medical student distress and support well-being.

A Narrative Approach to Healing Chronic Illness

Many clinicians may feel poorly prepared to manage patient suffering resulting from the travails of chronic illness. This essay explores the thesis that chronically and terminally ill patients can be holistically healed by transcending the suffering occasioned by the degradations of their illnesses. Suffering is conveyed as a story and clinicians can encourage healing by co-constructing patients’ illness stories. By addressing the inevitable existential conflicts uncovered in patients’ narratives and helping them edit their stories to promote acceptance and meaning, suffering can be transcended. This requires that clinicians be skilled in narrative medicine and open to engaging the patient’s existential concerns. By helping patients transcend their suffering, clinicians claim their heritage as healers.