There’s an elephant stomping around in the room and its name is Death, medical practitioners attending McGill’s fifth World Congress on Whole Person Care were told recently. But doctors, like their patients, don’t much like to talk about it, even though they know, as everyone does, that no one can stop it.
“Death is inevitable,” Ira Byok, MD, of the Dartmouth Geisel School of Medicine
in Hanover, NH, told the conference.
“Suffering is not.”
Dr. Byok, a leading palliative care doctor and advocate for improving care through the end of life, reminded the audience, “We are whole persons, caring for whole persons. We can build skills among physicians so their conversations aren’t so darned awkward. Our work as doctors is to work through all stages of life, including death.”
About 125 people attended the three-day, biennial conference, organized by McGill’s Programs in Whole Person Care (WPC) and held from October 19 to 22 in Montreal. McGill’s world-leading approach dates to 1999 and ensures the teaching of medicine includes considerable attention to empathy and healing, not just fixing and curing. Sparked by former Dean of the Faculty of Medicine and Health Sciences Abraham Fuks, MDCM, and palliative care legend Balfour Mount, MD, the programs seek to redress the balance between what can be measured (some might say quantity) and healing (which could be characterized as quality).
“That balance between measurable actions and outcomes and healing relationships in healthcare needs to be radically shifted in the direction of healing relationships,” conference chair Tom Hutchinson, MD, Director of McGill’s Programs in WPC, said in a brief interview.
There are many elephants in many rooms, the conference heard. They have names: hospital bureaucracy, time pressure, lack of staffing, longstanding culture and practices, patients, burnout, a lack of sympathetic leadership, human resources departments, government bureaucracy, managerialism. It is a long list, as a poster of an elephant outside the conference festooned with yellow sticky notes identifying many of them made clear.
“People are more and more preoccupied with tasks,” Dr. Hutchinson said. “And more tasks are being added. Those of us promoting Whole Person Care feel like we’re paddling upstream. There are huge challenges.”
New support for an age-old approach
So do conferences like this just preach to the converted when other targets might be more in need of being clear on the concept? “The main extra step needed would be to have more support from governments and bureaucracies,” Dr. Hutchinson said. “We have had good support within McGill’s Faculty of Medicine and Health Sciences and this support needs to continue and expand.”
“McGill has been fabulous,” in supporting WPC, Barry Slapcoff, MD, a family physician and Assistant Professor of Family Medicine at McGill, said in an interview. Until recently Director of the Physician Apprenticeship program, Dr. Slapcoff is a fervent devotee of WPC. It’s nothing new, he said.
“I think it’s always been there. I remember growing up watching Marcus Welby, MD, on TV and he was the quintessential Whole Person Care doctor,” he said. “I think having a name for something that’s always been done allows it to become more part of mainstream thought.”
He continued, “I think there have always been healers whenever healthcare has been delivered in whatever culture and in whatever time in history. And people who are good at it just always practised Whole Person Care. We just now call it that. When I was a medical student, we used to call it the biopsychosocial approach.”
And there is value in conferences like this one, he said. Those who need to be reminded of the importance of WPC are themselves empathetic and understand its importance, but they have become prisoners of their responsibilities, time pressures and stress, he said. “They need to be reminded that this is important. I really believe that we’re preaching to that group – the very large number of people who enter medical school with the best of intentions for being good caregivers, but because of the stresses of the workplace they lose it along the way. And having these types of sessions helps reinvigorate people and allows them to reconnect with their younger selves.”
There is a notion that curing and healing are different things, and there’s no denying 90% of what is taught in medical school is about the curing and the fixing of problems, Dr. Slapcoff said. “And sometimes you forget that there’s a person who’s receiving all of these treatments.”
“But I think it’s been really nice that at McGill and other places there’s been attention paid to the fact that people need to heal as they’re going through these medical journeys. … Most of us need to feel like we’re being heard and cared for if we’re going to get better.”