Four tenets of care

William Howe, M.D.

Saint Philip’s Health Cabinet is comprised of health professionals who are also members of the parish. The volunteers meet monthly to design programs to promote the health, education, and well-being of Saint Philip’s parishioners.

This month’s article was written by Dr. William Howe, Chair of Saint Philip’s Health Cabinet.

Our human family has been through a rather significant plight over the past three years with a pandemic like we have not seen since the beginning of the 1900s. With that have been struggles to maintain our normal daily activities as students, parishioners, family members, and also as healthcare practitioners.

Some folks have asked me over the past several months what is expected between the doctor and the patient as far as that relationship anymore. It seems that the whole system has been watered down to the point that it feels cheap or mechanistic. I write today to discuss my traditional training and values and how I feel medicine should be practiced.

The foundation on which I was trained was based upon four major tenets of the doctor/patient relationship. Those are: care, concern, respect, and cooperation. It seems so logical to think that these are what go into this relationship. However, they seem to get lost in translation at times with the trials that our society has faced. This is the spiritual philosophy which is deeply rooted in doing more in the name of God, termed Magis, as described in the writings of St. Ignatius Loyola.

Care
To look after someone, to want to ensure a person’s safety, namely acting as a protector.

To be entrusted with the care of someone who is vulnerable, scared, or truly has nowhere else to turn is a privilege like no other.

We care for our children, our aged parents, our pets and friends—both near and far. To care for patients is truly a gift and there is a vocation that goes into this––not seeing somebody in a five minute time slot and then ultimately shoving them out the door. It is about deeply understanding the intimacy of the relationship where their trust is vested in you as a fellow person. It is something that one as a provider of healthcare should never forget. Especially when I see new patients, I ask them their perspective as far as how the illness impacts them in order to get the human side of how they are feeling to invoke that emotion within me of the caretaker.

Concern
Concern in its most innate form is to be anxious or to worry about something. From my perspective, concern is where I look at the patient as a matter of interest and importance to me as the physician.

Patients are the ultimate focus of what I do as a physician. I am trained to take interest in their health, quality of life, and their future ambitions. I am also called to recognize that life is dignified and when to make recommendations that are not always the most comfortable but the most right and just—mainly end-of-life decisions.

At times, physicians and healthcare delivery systems are seen as concerned mainly about reimbursement, protocols and efficiency, and procedures. I do not neglect the fact that medicine is a business; however, our goal of keeping the patient first and concern for their well-being should always be at the forefront of our decision making.

Respect
This is a feeling of admiration for someone, revering their qualities, abilities, and training. It also calls into account being mindful of other people’s feelings and wishes. This is incredibly important in any relationship in life, whether it be a marriage, between parents and children, or among friends. Without respect, relationships will fall apart or be highly dysfunctional.

I deeply respect my patients, my colleagues, my family, and those around me whom I deal with on a day-to-day basis. When respect is returned, it allows for a deeper understanding and cooperation with whom I interact. This is a two-way street within relationships.

There is also a certain respect that the patient must show for the physician. In times of burnout and enormous amounts of stress within the environment in which we currently practice, patients need to be mindful of the duress that healthcare providers face on a day-to-day basis. As providers, we also must understand the frustration with which patients have to navigate through a somewhat broken system. Without this respect within a doctor-patient relationship—or any relationship for that matter—there is a fracture which is difficult (if not impossible) to repair.

Cooperation
Working together towards a common goal. As a physician my goals are to ensure that the health and safety of the patient are prioritized and their wishes are heard and acknowledged. The patient’s duty in the cooperative is to take recommendations and enact compliance so that the outcome can be as best as can be expected. Once again, there is a give-and-take with this part of the relationship. Recommendations are no use without proper compliance. Doctors’ recommendations can be one-sided if the patient’s perspective and questions are not acknowledged. Both parties must look at one another as working towards the common endpoint of a favorable/safe outcome.

As stated in my opening remarks, all of these qualities/concepts seem so logical. However, with the daily stressors of medical practice, the administrative overreach, liability and difficult personalities entering into the equation, these qualities/concepts can become rather obscure and sound trite.

From my perspective, I remember the day I opened my acceptance letter to Loyola University Stritch School of Medicine and the mission that was ignited in me that day. The challenges of the past several years have been unsurpassed. I have seen a lot of my colleagues quit for various reasons. You can barely find a nurse in the hospital any longer because of the challenges aforementioned.

In times of duress, I turn to the fundamentals that I have described above in the working relationship with the patients that I have and that I will meet. The concept of Magis goes beyond my professional life, and is ubiquitous in all of my proceedings with others. It is with this deep spirituality that I go through my life on a daily basis, with which interactions can surely be made beautiful and whole. My profession is a privilege; interactions with patients a gift. I have been called to do this. Plain and simple, there is a higher purpose in what we as physicians do. I strive to do more.

In service to the Lord,

William Howe, M.D.
Chair, Saint Philip’s Health Cabinet