Presence and medicine

In the opening chapel service for the school year here at Taylor University it was announced that the theme of the year for chapel and all of student development will be “presence”. This is to include an emphasis on the presence of God and our presence with him as well as presence with each other. Our chaplain, Randy Gruendyke, reflected on how technology tends to take us away from being fully present where our bodies physically are. Cell phones, tablets and other devices allow us to be focused somewhere other than where we physically are and tempt us not to be focused on the people who we are with. This seemed to interact in an interesting way with Susan Haack’s thoughts about sociable robots and how our identity is developed by our interaction with other persons. In order to have interpersonal relationships in their fullest form we need to be fully present with those we are with. We are complexly integrated material and nonmaterial beings and we interact most completely when we are physically, mentally, and emotionally connected with another person.

As my mind started free associating on these thoughts I began to think about how that impacts my daily interaction with patients as a physician. Am I fully present with them? Like in other parts of modern life technology can interfere with my presence with my patients. The laptop that I carry into the room gives me quick access to information about the patient that I need, but the screen and keyboard can pull my focus away from the person sitting in front of me. My smart phone lets me look up drug information rather than leaving the room to consult a book, but may interrupt the visit with a call that may be less important than the person I am with. But this problem existed long before these forms of technology existed. Leafing through a 3-inch thick paper chart used to take away from my presence with the patient and my old radio pager that announced its messages to everyone within earshot tended to distract as well. Some of our lack of presence has to do with barriers we construct ourselves. Susan referred to the tendency we have as physicians to distance ourselves by thinking of our patients as simply the bearer of the procedure we are doing or the disease we are treating so that they become the hysterectomy in room 213 or the diabetic who is next on the schedule.

Much of what physicians do requires interaction with the patient’s medical record and knowledge about the diseases which need to be detected and treated, but those who sit by us in the exam room or lie in the bed we stand beside are people and we are entering into their lives. We fill out consent forms and read their advance directives to show we are respecting their autonomy, but are we respecting them as people as we try to deal with the time pressures of all the responsibilities that we have and all the tasks we need to complete and document and justify. When do we have time to actually be present with those whom we care for? I have known a few physicians who had a particular gift for having patients feel that they are truly been present with them. At one time I had the opportunity to work in the same office with two of them who were as different as could be. Both were Christians. One was older than I and was nearing retirement. His visits with patients were like going out for coffee with an old friend. His patients loved him and he loved them and they knew it. He was also always behind and drove his assistants crazy. The other was younger than I and saw many more patients than I did, but somehow in his fairly brief visits seemed to find a way to connect very personally with each person and commonly found time to pray with them. I never quite understood how he managed to do that.

I am not either one of them. I am too compulsive to be the first and don’t have the personality to make immediate deep personal connections. So how do I make myself more present with my patients? One way is to pray before I start the day and before I enter an exam room for the person I about to see. It is harder to see someone as a disease or problem to be fixed when I see him or her as God’s child that he is concerned with. I don’t always manage to do that, but as we focus on presence with God and presence with each other this year at Taylor I hope to do that more consistently so that I am ready to take my focus off the tasks to be done and look my patients in the eye, really listen to them, and be present with them. By that I can show them that I respect them and that they are a child of God whom he loves.

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