The Doctor (or health professional) as healer

Introduction
Rather than just talk about the doctor-patient consultation between a GP(or any other doctor) and a patient, we recognise that every health care worker has similar contacts with patients which can (and should be) part of the healing process. If such contacts are approached lightly and thoughtlessly they may contribute to the dis-ease process. The healing encounter between a therapist and a patient lies at the heart of any medical model and involves the “Health Stories” of the patient.

The “Health Story”
Life may be considered as consisting of a series of “stories” which continue throughout a person’s life. Many of these stories concern the health and wellbeing of the person. Each story consists of three essential parts –

• The series of objective events which make up the story
• The subjective experience, reaction and interpretation of that story by the individual.
• The subjective experience, reactions and interpretations of others involved in this story, who later interact with the individual.

An “ill-health” story has several stages, and is usually still incomplete when told to a health care professional.

• There are some symptoms which provide the first indication that ill-health is possible – these may be pain, breathlessness, tiredness etc.
• The individual seeks on their own to explain and rationalise these symptoms so that they remain in the area of “normality”. They will “talk to themselves” about the stress and hard work undertaken recently, or whatever cause they can perceive to make these symptoms fit into a range of normality.
• If the problems persist they will involve close friends and trusted family by telling some or all of the story and seeking for their interpretation of events. The person is seeking both reassurance that these are normal, and also testing out whether they might constitute an “ill-health” story which requires further action.
• If an “Ill Health” story is suspected there might be a period of “research” to gain a better understanding of the issues involved. In the old days this would involve visiting a pharmacist and seeking advice (and invariably some medication), consulting with other knowledgeable friends, or these days by searching the internet.
• Now the person turns into a “patient” and consults a health care professional (usually a doctor, but may also be a nurse or alternative practitioner). The story they tell is now coloured by many interpretations and beliefs, and is also affected by their trust in the person to whom they are now speaking.
• The health care professional has now become part of the story, and can make a positive or negative contribution to the outcome of this story.
• The resolution of the story – its “healing” - now depends on: several sets of people (patient, carers and significant supporters, and health care professionals); an accurate assessment and understanding of what the true story is; and an appropriate course of management decided by the therapist and the patient.

  Many healing scenarios involve other team members
  The healing process within the medical model usually involves several members of a health care team. An essential part of the healing process is the ability of the patient to “make sense” of their illness, and this is helped by being able to tell their story in such a way that the true story emerges, is validated and then forms the basis of healing actions.
  It often happens that other health care professional rather than the doctor can give the patient time in which they can be heard. Often the doctor-patient consultation is more doctor led than patient-centred and so the patient is left without having told their story in a way in which they feel heard, accepted and able to make sense of their illness.
  A few years ago I was suffering from increasing shortness of breath which could have produced in several different ways. I had already consulted my GP who refereed me to a respiratory physician, a sleep disorder clinic, and “my” cardiologist. I had previously suffered from myocardial ischaemia and have a coronary artery stent inserted. None of the doctors consulted had made much sense of my breathlessness, and it seemed to me they all thought it was due to a combination of increasing age, lack of exercise and over-weight. I was sent for an echo-cardiogram, and whilst the test was being completed the technician got me to “tell my story” and for the first time I went through all of the associated symptoms. I felt heard and understood, and felt better able to cope with the symptoms because I better understood what had been happening to me.

  Spiritual healing process – steps
  1 Encounter between two people
  2 The purpose is to make the patient’s health story a more healthy one.
  3 Requires a trusting relationship
  4 The patient “tells a story”
  5 The therapist “listens” to the story
  6 Together they consider and seek understanding
  7 This is a spiritual encounter between two people, closes the circle and leads to better understanding, and so gives patient chance to take control of their own health story.
  
  TOGETHER we make a new story, each person listening to a story influences it and changes it in various ways. The more times the person tells their story the more truthful, accurate and representative it can become.
  
  TYPES of questions when listening to a story

  • Open questions – ones which invite exploring – inviting
  • Closed questions specific information gathering
  • Listening question – calls for expansion on something said – enlarges the story, indicates the listener is involved in the story.
  • Circular questions – invite the patient to go back and think about their story, like the listening question, but taking the patient further in exploring what they think and experience
  • Strategic questions – calls for an analysis of the situation – asks the patient what they think is wrong, and what they think is the answer
  • Reflective questions – gets them to look at their story in a new light, seeks new understandings, explores a common shared understanding of the situation
  • Grounding questions – allows a common agreement to emerge (Do you agree with me that this is not the answer to your problem?)

  STAGES of the healing encounter

  1 OPENING
  Purpose to start building a trusting relationship – indicate to the patient that the therapist is prepared for a significant  spiritual encounter  - not a religious encounter, but spiritual which involves
  1 sharing a common humanity,
  2 a trusting relationship 
  3 love and concern,
  4 a desire to help, 
  5 seeking for the growth and maturing of the other person 
  6 walking alongside – being involved,
  7  commitment to the person.

  2 TELLING THE STORY
  Patient talks, encouraged by the therapist to tell the story as the patient has experienced it, the first telling – enables the patient to explore exactly what has happened – allows remembering, exploring how details fit in and what is irrelevant.
              Issue of what is the true story – what are all the different levels and contributory factors in this story.
              You don’t know what your own story is until you have told it
              The more times you tell it the more “truthful” it becomes.
              It’s a different type of story to the  one detectives are seeking. They lay great stress on the first telling of a story – before the person can think, embellish or alter the story because of the implications – later they can weave lies into the story to suit their own ends. The health story is quite different – here the truth is hidden within the person. As they tell the story so they get revelation about what their thinking process is. Bringing thoughts from the sub conscious part of the brain into consciousness.

  3 LISTENING TO THE STORY
  The art of listening –

  • Hearing the patient’s words (including body language)
  • Exploring what lies behind the words
  • Sharing in the story
  • Validating the story from the health point of view
  • Helping the patient to summarise the story, exclude extraneous details, and get to the heart of the story

  4 ARRIVING AT A SHARED UNDERSTANDING
  Define health issues, agreement on story, understanding, implications

  5 DECIDING ACTIONS
  Inviting the patient to change their health story
  Giving them the tools to make these changes

  6 DEALING WITH FURTHER QUESTIONS
  Reassuring patient about health issues, being honest, allowing them to verbalise oth er issues (such as fears)
  
  7 CLOSURE
  Purpose: To bring a good conclusion to this encounter and pave the ways for other healthy encounters in the future. Giving the patient reassurance about future events

  CLASS EXERCISE
  On listening to the story
  Divide into threes – one patient , one therapist, one evaluator
  Choose a personal health or similar story
  Tell it, listen to it, explore it.
  Evaluator looks for the good things and what could be improved in the listener. Invites reflection on the process