The heart of patient care: Remembering what matters

The holistic healer sees healing as restoring the balance between the person, their body, their relationships, the natural world and the spiritual world, including ancestors

I have recently reread some of the great works that informed my thinking about being a GP. Ian McWhinney, known as the grandfather of general practice, was a GP academic who had that rare quality of combining medical, social science and philosophical thinking with excellent writing. I first read his A Textbook of General Practice¹ over 30 years ago, cover to cover in one evening. The chapter “Illness, Suffering and Healing” put words to problems I encountered as a young doctor and gave me a map of how to “be” in these situations. This work still resonates with me.

McWhinney observes that the patient comes with a problem of their existence, perhaps a loss of connection, vulnerability, fears and anxieties, a disruption they cannot explain, or an existential crisis, but the doctor focuses on minute parts of their body. Suffering happens to people, not just bodies.

Healing is perhaps a restoration of equilibrium. It can happen in many ways, through biomedical interventions and the body’s natural healing powers, but often, healing is in meaning-making. Suffering can also create energy for a personal or collective quest for a better way to live. Sociologist Arthur Frank describes this response to illness as the quest narrative.

McWhinney asks us what makes a doctor a healer: expert use of knowledge and tools, self-knowledge of our wounds and stories, self-awareness, a non-judgemental attitude, trust, commitment to the person and the process, skill at asking and listening, facilitation of capacity, and creation of meaning.

“In the end, people are healed by love.” McWhinney describes this love as caritas, “to love in this way is to seek the good in the other person, unconditionally”.

Recently, a young GP told me the story of a person with unfathomable lifelong suffering and asked me what she should do. Interesting, I said. “Pray.”

I recalled Frank’s book The Wounded Storyteller2 and recognised the story I had been told was a “chaos narrative”. In these stories, “troubles go all the way to the bottomless depths…What can be told only begins to suggest all that is wrong…chaos is told in the silences that speech cannot penetrate or illuminate…those who are truly living the chaos cannot tell in words. To turn chaos into a verbal story is to have some reflective grasp of it… Chaos stories are hard to hear.”

Frank says, “Until the chaos story can be honoured, the world in all its possibilities is being denied…Getting out of chaos is to be desired, but people can only be helped out when those who care are first willing to become witnesses to the story.”

I read this many years ago and I have a sense of the embodied feeling of witness. It is a stillness, a willingness to sit in the chaos without judgement or distress or a drive to fix it. I wonder what is exchanged in that process.

I don’t pray as a usual thing, so why was that my answer? I think to pray is to surrender to something bigger than us. Pray means hope. Praying accesses the energetic state required to sit with the chaos narrative, to witness mute stories.

Cecil Helman was an anthropologist and GP. His book Suburban Shaman³ is ultimately about seeing the overlaps between the work of a GP and a shaman or traditional healer.

In observing an African shaman, he says, “He has all the skills of a shrewd psychotherapist and a clever social worker, combined with those of a religious exorcist…The shaman is not less than a psychiatrist; he is more.”

A shaman may not be able to cure, but they can heal. “The shaman’s job, like that of any healer, is to give meaning to suffering, to give it shape and form, to impose order on the random chaos of personal misfortune.” This sounds familiar to me as a GP.

Interestingly, the shaman’s work is often collective healing rather than one-to-one. A traditional healer, not a stranger, is integrated into the community and culture.

Shamans are often wounded themselves, so carry the mantra of someone who has transcended some spiritual challenge or disruption of self. Helman argues that for doctors, human dissection and autopsy could be seen as a confronting, if not bizarre, rite of passage.

The holistic healer sees healing as restoring the balance between the person, their body, their relationships, the natural world and the spiritual world, including ancestors.

I was fascinated by Helman’s observation that traditional healers answer the question, “Why? Why has this happened to me?” In Western medicine, we answer:

“What? This is what has happened to you.”

People can gather more meaning from “why” than “what”.

Amid 15-minute appointments, overflowing inboxes and reductionist quality measures, it is good to be still and remember what matters.

Lucy O’Hagan is a medical educator and specialist GP working in the Wellington region

Waiting for COVID

A podcast by Lucy O’Hagan

How well do you remember those early days of the COVID-19 pandemic when New Zealand watched in apprehension as overseas the virus spread uncontrolled. Specialist GP and writer Lucy O’Hagan remembers. In Waiting for COVID, Dr O’Hagan takes a personal journey back through her writings and observations of “COVID times”, reflecting on what the virus and the country’s reaction meant for primary care and beyond. You can listen to the podcast on Apple Podcasts or Spotify or download here tinyurl.com/WaitingForCovid Thanks for listening!