PubMed · 5182323
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D J Wolk. Sensitization seminars for students.. https://doi.org/10.1111/j.1744-6163.1967.tb01181.x
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The message of this essay is that love can be regarded as an essential feature of the practice of medicine. One of the doctor's tasks is to build a bridge between medicine as an "objective" science and the patient as a unique and vulnerable individual. In most medical encounters, the doctor-patient relationship needs not reach down to an existential level. The bridge between medicine and patient may then be minimalistic, based on general competence and respect. On other occasions the nature of the patient's problem requires a bridge able to withstand far stronger emotional forces in order to enable effective and health promoting communication. Building such a bridge is a unique challenge that requires the doctor to invest something of himself--which may be seen as an act of love. The doctor has to be open for whatever the patient has to say and willing to encounter the pain that is hidden deep in many patients' lives. The article includes a patient story (from psychiatry) that illustrates how helping a person reveal a traumatic story from the hidden past can be the first step on the path of recovery. Another aspect of practising medicine with love is not hurting the patient or violating his integrity. This even applies in settings where the doctor-patient relationship is supposedly "neutral". The article contains a second patient story (from maternity care) that illustrates how routine use of advanced medical technology may put the patient (here: her unborn child) in an unforeseen and stressful "risk" category upon which the patient has no possibility to act. The story illustrates the importance of the doctor taking on the responsibility of interpreting such diagnostic uncertainties in a language that the patient can handle intellectually and emotionally. The author suggests the concept of "the grandpa' factor" to describe a working tool in relation to such patients: The "medical grandfather" does not withhold information but deliberately ends his explanations by summing up his view of the situation with an optimistic "prophecy" for the future.
The doctor has a personal relationship with his patient, while at the same time being authorized to manage the resources allocated to health and social services. This is a demanding position and it is difficult to act justly. A patient with whom the doctor does not easily identify may risk becoming a victim of injustice. The doctor may himself be subject to unjustices. Many people think that doctors earn too much money, and it is getting more common that doctors fear sanctions or the role of scapegoat. Having a good education implies a strong position in our society, because rational argumentation is widely accepted as the more valuable in discussions. Thus, those who know how to argue rationally have important influence on the definition of justice. This is paradoxical, as those who have been treated unjustly will tend to argue emotionally. Emotions are a prerequisite for the concept of justice. Therefore, empathy is an important ability that doctors should use in order to contribute to justice. This is illustrated by four examples; which patients should be given priority, should we treat self-induced disease, how much money should doctors earn, and what sanctions should be imposed when fatal medical errors occur?