Why It Matters
I’ve recently been giving a lot of thought to the difference between curing and healing. They’re related concepts, of course. Healing, however, can come in many forms other than cure.
Let’s say a patient, who has a longstanding relationship with his primary care physician (PCP), one day notices a small bulge in his groin area. He searches on the internet and starts to suspect that he has cancer. He’s frightened.
The first appointment he can get with his PCP is three days later. While he waits for the day of his office visit, the patient loses sleep, isn’t as focused as he should be at work, and is distracted at home with his family. He doesn’t tell his spouse what’s bothering him.
On the day of the appointment, the doctor does a physical exam. “You have a small hernia,” she says. “I’m not concerned about it now. If it grows, we may have to deal with it surgically, but for the time being we can just watch it. How does that sound?”
Suddenly, the patient doesn’t have cancer anymore. He never did, of course, but for three long, anxious days he thought he might until a doctor was able to assuage his fears.
When a clinician helps ease a patient’s mind — with accurate information, realistic expectations, and a humane touch — cure may not be involved, but healing can still take place.
False Hope Can Do Harm
It is widely acknowledged that hope is an important part of healing. In fact, clinicians are often concerned that telling patients who have an advanced illness the full truth about their condition will rob them of their hope. However, hope for a cure is not the only kind of hope clinicians can offer.
In a recently published article, (“Finding Hope and Healing When Cure Is Not Possible”), my coauthors and I refer to hope for a cure (or for future remission) as focused hope because it’s directed expressly at putting a stop to the illness.
But what if cure or remission is not possible? Clinging to the focused hope paradigm in such situations can give a patient false hope. That false hope may then lead to overtreatment.
Providing treatment that is not needed out of a desire to offer focused hope is especially problematic for patients with incurable conditions who are nearing the end of life. Consider a patient with late-stage cancer. Instead of using the time she has left to do what matters most to her — such as being with family and friends, traveling, putting her affairs in order, and even repairing broken relationships — she may spend her remaining days undergoing toxic treatments, with sometimes debilitating side effects, and getting secondary illnesses. Repeated visits to the emergency department, hospitalizations, and ICU stays are common in such circumstances.
Another Kind of Hope
My coauthors and I discuss an alternative approach: intrinsic hope. Rather than focusing on ending an illness, intrinsic hope centers on the present day.
For example, I can hope that my pain will be managed well enough to allow me to walk my dog in the park today. I can hope that I will go home from the hospital with my family today. I can hope I’ll see my grandchild today.
Intrinsic hope centers on bringing inner peace to your life. As we say in our article, “Intrinsic hope replaces unrealistic expectations for recovery with a more profound and resilient emotional foundation.”
Being Emotionally Present Heals Patients — and Clinicians
Offering hope and healing involves the spiritual and emotional aspects of care. Some clinicians may defer these (sometimes difficult) discussions about hope with their patients to social workers, clergy, or palliative care or hospice professionals. I believe, however, that all clinicians need to understand the different dimensions of hope and healing. After all, much clinical care occurs long before hospice or palliative care is indicated. Clinicians will face many instances when cure is not possible and focused hope is false.
Ignoring or devaluing these kinds of skills harms not just patients, but also clinicians. When clinicians actively distance themselves from the emotional and spiritual aspects of care, finding personal reward in their work can be more elusive. I believe that shutting yourself off from your own feelings — essentially, dehumanizing yourself — is contributing to the burnout epidemic in health care today.
Most clinicians did not go into health care, after years of training and hard work, to distance themselves from their patients and provide care as a robot would. They wanted to help people, to heal them. Consider this excerpt from our published article on the topic:
Compassionate clinicians feel their patients’ pain. The literal meaning of compassion is “suffer with.” But in highly charged situations, clinicians have a choice: either block out the emotional impact for the sake of self-protection (which sensitive parents and patients may perceive as abandonment) or allow emotional connection. Total immersion in patients’ . . . anguish isn’t necessary or desirable. Tearing the clinician’s own heart out is not the purpose of this exercise — empathy is.
Being a caring and compassionate health care provider today is not easy. There is no checklist to confirm that you’ve helped a patient move from focused hope to intrinsic hope. Clinicians and patients instead must build a trusting, dynamic partnership that involves pooling their knowledge: the clinician’s expertise and experience with the patient’s self-knowledge. The best health care outcomes — and the greatest healing — arise from that collaboration.
Leonard L. Berry, PhD, MBA, is an IHI Senior Fellow and a professor in Mays Business School at Texas A&M University. He studies service improvement in cancer care.