In a recent column I wrote about Christopher Kerr, a doctor who is the director of a hospice in Buffalo, NY, and the book he wrote about end-of-life dreams. I focused in that column on the hope and meaning he gives to people at life’s end.
In that book, “Death Is but a Dream,” Kerr also provides an important perspective on today’s medical care, especially the care (and caring) that a doctor gives—or doesn’t give.
Kerr’s thoughts on the medical care doctors give today apply not just to doctors whose specialty is palliative care for dying patients, but to all doctors. Kerr tells his readers that he is writing his book primarily for doctors, as well as about them.
I appreciate Kerr’s perspective. In my 78 years, I have seen many doctors provide medical care — both good and bad — to me, my parents, my wives, my sisters and my brother. In so many ways I agree with Dr. Kerr, which is why I’m writing a second column about his book, specifically on what he says doctors should–and shouldn’t — do.
Dr. Kerr’s main point is that a doctor should treat each patient as a person, not as a cog in a medical assembly line. Even early in his career, as an intern and a resident, Kerr writes, “I had become increasingly discouraged by a hospital medicine that processed people like they were paper.”
He became frustrated. “I was disillusioned,” he writes, “with the bureaucracy and impersonal nature of the medical profession.”
He noticed that “many doctors merely completed tasks and filed forms and dictated notes.” He was concerned that “a widening bureaucrat gap” was separating doctors from their patients, so much so that “many of my colleagues stopped finding personal meaning in the work.”
Kerr recognizes the value of medical advances, but he also knows there’s a downside: “The acceleration of the science of medicine has obscured its art, and medicine, always less comfortable with the subjective, has been more concerned with disproving the unseen than revering its meaning.”
Today, he goes on to say, “Healing is replaced by treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures.”
All of this leads to a plea: “We need,” he says, “to bring doctors back to the bedside, to their roots as comforters rather than technicians.” This is not only true not only for doctors who treat terminally ill patients, but for all general practitioners and specialists.
Kerr emphasizes over and over the need for doctors to listen–listening to the whole person, their subjective feelings as well as their objective pains. “Patients’ inner experiences matter to them,” he writes. “Therefore, they should matter to doctors.”
Dr. Kerr values an honest and holistic approach to medicine, especially when “health care resembles an assembly line of highly technological and specialized medical interventions whose fragmented workings can leave families guessing.”
All of Kerr’s concerns are magnified when a doctor is caring for patients who are nearing the end of their lives. “Doctors often see end-of-life experiences (and their dreams) as irrelevant to their craft,” he writes. “Medical students and physicians are trained to dismiss anything that cannot be measured, imaged, biopsied or removed.”
Once a doctor realizes he can no longer help a patient improve and recognizes the patient is in the process of dying, he often excuses himself, thinking he can do nothing more for the patient.
Often, however, terminally ill patients need a doctor more than ever to comfort them. “Amid the current madness of medical excess,” Kerr writes, “there is a need for spiritual renewal that medicine alone cannot address. By exploring the nonphysical experience of dying, there is an opportunity to reframe and humanize dying from an irredeemable grim reality to an experience that contains richness of meaning for patients and loved ones alike.”
Dr. Kerr realizes that in some ways a doctor feels helpless when dealing with an end-of-life patient. But Kerr came to understand from his time at Hospice Buffalo, that, “as caretakers of the dying, we know that sometimes the best help we can offer our patients is not to interfere at all, but to merely be present.”
He understands that “all I could offer them was my presence and a desire to bear witness.” And when patients share their near-death dreams, “medical staff should lead the way instead of denying or merely medicating those powerful end-of-life experiences and should simply “validate their dreams, not necessarily interpret them.”
He understands, after being near thousands of patients as they were dying, that “palliative care is about being wholly present as we are brought to witness the unique essence of each person’s light, no matter how faint it is or how different they are.”
The lessons that Dr. Kerr has learned as a hospice doctor apply, I believe, to all doctors treating all patients: treating each patient as a person, not a piece of paper; listening carefully to them; valuing their subjective experiences and feelings; being honest with them; caring about them; being a healer not just of the body but of the spirit.
I have known doctors who practice medicine in the same caring way that Dr. Kerr does, including physicians in Los Banos and surgeons in San Francisco. I have also known doctors who have been the opposite–impersonal and bureaucratic.
I also realize doctors who listen and truly care about their patients are going against the tide of medicine—and the insurance companies that often dictate how medicine should be practiced.
But doctors who conscientiously care for each patient as a unique individual should know they are deeply appreciated.
John Spevak’s email is john.spevak@gmail.com
