Kindness as Medical Treatment

(This originally appeared as one of my columns in Emergency Medicine News, in 2001.)

Before me on the exam table was a young woman in her mid- to late 30s. She was a little anxious. Her chart indicated that she had back pain, neck pain, headache, chest pain, and insomnia. I took a deep breath, rolled my eyes, and began to take a history. I tried my best to tease out what things might be serious and what was not. No injuries, no weakness, no shortness of breath, no history of heart disease, no thunderclap headaches, no, no, no. Her exam was almost as unremarkable. Until we went a little further.

As her history continued and she opened up, I learned that she was working third shift at a local factory, raising three small children and caring for a husband on dialysis who was awaiting a kidney transplant. No wonder she had insomnia. She didn’t have time to sleep.

It would have been easy for me, once serious problems were ruled out, to brusquely explain that the emergency department was not the place for her multiple complaints. That she should see a primary care physician. That I had nothing to offer her. Some nights, with other patients, I have doubtless done this.

Fortunately, I didn’t say that to her, although I don’t recall many details of our visit. I may have been busy, or maybe not. Her name escapes me. I may have given her some hydroxyzine for sleep, or a referral to mental health, or a suggestion that she turn to a church for some assistance. But that’s irrelevant.

I know that I let her vent, and told her that many of her symptoms were probably related to stress and fatigue. I think she needed that. The truth can be liberating, and too often we fail to give it to patients. We dance around, inventing diagnoses and ignoring the obvious, when they look to us for honest answers. Honest answers can be uncomfortable, but also are one of the greatest prescriptions we can give. Even though her problems remained (even though I couldn’t write a please excuse from life note), I think that she went away a little reassured. Maybe all she needed to hear was that she wasn’t dying.

I’m not writing about honesty, though, or about meeting the cornucopia of psychosocial needs that present to us every day in busy emergency departments. We aren’t psychologists, pastors, counselors, or rabbis, although occasionally we’re forced to act like them. We’re physicians trained to intervene in life- and limb-threatening medical emergencies. The demands of modern emergency care are so great that it is an unusual day when we can sit and delve deeply into a patient’s life, beyond asking ‘ are you hearing voices or thinking of killing yourself?’

Of course, we are constantly reminded that in addition to providing state-of-the-art medical care, attempting to know the drug interactions between the dozens of bottles of prescriptions our patients take, reducing our rate of errors, avoiding litigation, billing Medicare correctly, and participating in political advocacy, we also should take a little time to counsel our patients (customers) about domestic violence, immunizations, alcohol abuse, and other issues. Small wonder that patients’ hidden agendas and subtexts slip past us; we simply can’t do it all.

But there’s one thing we can do, and that’s what I’m writing about. We can treat everyone with kindness. This is harder to quantify; it isn’t easily studied in double-blind, placebo-controlled, crossover studies. It can’t be readily evaluated on satisfaction surveys. It doesn’t lend itself to quality assurance meetings. Administrators aren’t comfortable with sending out a memo saying, ‘Let’s all be a little kinder.’ Furthermore, kindness is difficult. It can require a major effort of the soul to step out of the single-minded vision of our own schedule, or our own anger, and slow down long enough to speak gently or to touch a child with a reassuring hand.

But that’s the beauty of it. Kindness, an unquantifiable quantity, helps us to care for our fellow humans with compassion as well as competence, and the combination is powerful. Kindness is voluntary, so those physicians who opt for it will, in the end, rise above their peers although not necessarily in ways that lead to position or profit, which too often favor cruelty or cold efficiency.

They will rise in ways imperceptible to the concrete markers of professional life. They will rise up in the hearts of the patients they care for, and (I believe) in the estimation of their Creator, whose children they are charged with healing and helping. My college physics professor at Marshall University in Huntington, WV, Dr. Elwyn Bellis, put it perfectly when he said, ‘Ah, but the reward for virtue is not in this life.’

Early last year, I came across a quote from another very wise man. His name was Philo of Alexandria, and he was a renowned Jewish scholar who lived at the beginning of the first millennium. He said, Be kind, for everyone you meet is fighting a great battle. He knew something about battles. In 40 B.C. he was sent to the Roman Emperor Caligula, whose disposition was far worse than anyone from our own federal government, to plead the case of Jews mistreated by Gentiles. He lived in a time when conquest and cruelty were the norm. Doubtless he experienced a fair amount himself in the 70 years he lived. Still, he came to the conclusion that everyone’s life is difficult, and that one of the best ways to treat people well is to remember that we do not always know what lies beneath the surface, behind their public faces.

Although it is often very, very difficult, I’ve tried to remember these sage words that came to me down 2000 years. Some nights, with some people, it’s as if Philo himself had said those words to me, to help me have perspective. Because I sure can complain. And in my complaining, I too often believe that my life is dramatically more difficult than the lives of my patients. But at the end of the day, I get in my car, drive to my home and see my family. That alone separates me from untold numbers of persons whose lives are total disarray and daily tragedy. Furthermore, although I see a lot of patients for free, I’ll still receive a good paycheck each month, and have money in retirement, insurance for my family’s illnesses, and a little extra for luxuries and vacations.

I fight my battles, but they’re mostly skirmishes with inconvenience. My job puts me in touch with persons whose battles are, without question, to the death. They battle with the world, and more often with themselves. The one thing I can do is show a little kindness, whether or not I make them better. In the end, it will help them and elevate me. And if I can finish a shift having accomplished this, my patients and I will all have profited.

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