Sometimes as doctors, we can all get too wrapped up in the medical aspects of the patient, focusing on just the medical history, the examination, the medicines that the patient can take to fix their ailments, and so on.
In medical school, we learned about the “biomedical” model. Essentially, this model assumes that illness can be explained by likening the human body as a machine. If something is wrong with the machine, you implement mechanical fixes, so in humans, if something goes wrong, you can do surgery to fix the problem, or you can give medicines to treat the underlying causes of disease. This model however, is not the best model in that it ignores the human mind and the fact that illnesses can be made worse by a patient’s poor state of mind and social situation.
A much better model then, would be the “biopsychosocial model” which also considers a patient’s state of mind and their social situation. It looks at the patient holistically, seeing how their health can be affected by diseases and by both their mind, looking at the interactions between the two to contribute to a patient’s state of health.
But throughout medical school, we learn all about the fancy disease names, the mechanisms and the pathways for producing the disease. There is some education about psychosocial issues, but by far, there is way more emphasis on the “biomedical” model, where the pathology, physiology, and anatomy are honed in on, and which students spend more time studying.
We are trained to view patients in terms of their medical illness. Doctors may refer to a patient when presenting to another doctor as “that guy with appendicitis”. The name isn’t given, but the disease he has is given instead.
In focusing on the medical illness, it can be too easy to forget the human aspects, such as how the patient is feeling, how they are dealing with their illness. In fact, the other day, I saw a patient who had recurrent chest pains, had anxiety attacks, and had a lot of social stressors lately. After excluding possible cardiac chest pains with an ECG, and taking a history, it sounded like this patient was just very stressed. The patient was teary throughout, and spoke in a soft withdrawn voice. To be honest, I couldn’t offer much treatment other than referral to mental health, and just some paracetamol for her headache. In the meantime, by offering a listening ear, a box of tissues, and a cup of water, the patient became more settled, and their partner was full of gratitude at just these simple gestures. In medicine, sometimes just showing compassion and having a listening ear are therapeutic in themselves, and really does help to show the patient that we are not just treating their medical illness and seeing them as a machine, but as a genuine human being with stressors and problems, and with feelings.