Reconnecting with the Patient in Era of ‘Mechanized’ Medicine
The healing path leads to therapeutic alliance with patient
Jan Bonhoeffer, MD, comes across as a spiritual physician, one who knows all the exactitudes of the medical profession, but thinks it has profoundly lost its way.
Bonhoeffer is a pediatrician at the University Children’s Hospital in Basel, Switzerland. In 2015, he realized the training he received at medical school did not prepare him to experience true healing moments with patients. As a result, Bonhoeffer founded Heart Based Medicine, a global network of healthcare professionals exploring the natural healing potential of the healthcare provider and the patient. Last year, Bonhoeffer published a book on his new approach to medicine and healing.1
Hospital Employee Health spoke to Bonhoeffer about his search for a healing path back to the patient, which was inspired partly by an epiphany he experienced with a comatose child. This interview has been edited for length and clarity.
HEH: You talk about making a “compassionate connection” with the patient, something you believe has been largely lost in medicine.
Bonhoeffer: When we talk about compassionate connection between humans, then that is where love comes in. Love as in agape, as in love of God, love of creation, whatever the culture might be that we grew up in. Whatever the route of access, we have to have something that is bigger than ourselves. In my experience as a clinician, these were the moments in 20 years of bedside care where I was serving life and the patient was serving life. And together, a healing process kind of emerged between us rather than just me being a well-educated professor knowing all sorts of [traditional medicine].”
HEH: Many issues in healthcare are being reconsidered due to the pandemic. Do you see this as an opportunity to integrate some of your ideas about patient care?
Bonhoeffer: If not now, when? What else does it take for us to wake up from our fairly arrogant take on a human-centric, data-centric approach to healing? We have all the fantastic successes that came about through evidence-based medicine, but all of those amazing breakthroughs and successes have led us to forget about the human part of healing.
HEH: Can you give an example of how you treat or view patients differently than before you came to this new concept?
Bonhoeffer: A compassionate connection between the healthcare professional and the patient may actually arise from a sincere interest. Learn from the patient what they actually want and what they actually need. That’s not an attitude that we’re trained on in medical school. We are kind of trained to ask that question, but it’s a bit of a rhetorical question. We’re trained to ask an open question; for example, “What brought you to the hospital?” It doesn’t actually reflect a heartfelt interest, but it’s part of a strategic questioning.
HEH: In the book, you described a profound experience with a patient.
Bonhoeffer: Rebecca, a comatose adolescent child, arrived in the intensive care unit, and we didn’t know why she was comatose. We were doing all the things that modern medicine can do to figure out why she’s comatose and what may have happened. We couldn’t figure it out. Everything quieted down at night and I was alone with her, sitting at the bed, and I was devastated. I was responsible for her at the time, and I was devastated because I didn’t know what she actually needed. I sat next to her, pulled my chair up to her, and actually held her hand. She is this unconscious child with all sorts of intensive care support, and I’m just asking her, from the bottom of my heart, “I would so much like to help you.” I said that in despair. It was like a prayer, like Lord, make me see what is it that I’m missing here for this girl. In that moment, she actually turned around, opened her eyes ever so slightly, and said, “Really?”
HEH: Maybe part of that was taking her hand and touching her, but it almost is a spiritual moment. That is powerful.
Bonhoeffer: It was one of those moments where I learned that I scientifically cannot explain what happened. We can hypothesize, but I can’t really explain this. But what I learned from it is that there are things we don’t understand. There’s something that connects the healthcare professional with the patient in a way that we’re clearly unaware of as [providers]. It was unplanned, it was a non-strategic communication with the patient — just showing up as a full human being with all humbleness and not knowing, and this actually helped her to find the path toward the healing that followed.
HEH: Can you practice this form of medicine without the pressures of turning over patients, making money, and all the bureaucracy inherent in the U.S. healthcare system?
Bonhoeffer: It’s been part of my training with residents for many years that taking time with the patient in the beginning saves time and money. If we’re strategic and we’re trying to save time, we’re busy with ourselves, we’re basically trying to meet our own needs, standards, and all the hospitals requirements — standard operating procedures, financial targets, you name it. When we’re actually sitting with the patient and really take genuine interest in what they need, and what they are expecting, we create a therapeutic alliance that creates trust. Trust not on a head level but on a heart level, they feel, “This person really cares for me.” It saves hours of unnecessary diagnostic work, chasing the results, requesting specialist consultants to show up and give their opinion on top of everybody else’s opinion. It saves tremendous resources.
HEH: Another section of the book describes self-care tips and reconnecting with your values. Are these applicable to healthcare workers?
Bonhoeffer: Very much. In several ancient traditions — let’s say, Ayurveda or traditional Chinese medicine — there are forms of medicine where self-care is an integral part of being a healthcare professional. In corporate medicine today, it’s not. We have been objectifying patients, we have been objectifying disease, and we have taken the healer out of the equation. The healer has become a broker of medicine and surgery. If you want to learn how to play the violin, would you go find somebody who knows everything about the history of the violin, the way they’re built, and the harmony and the theory behind it — but they’ve never played a violin? You wouldn’t — why would you?
But here, it’s OK. In healthcare, we get away with it. Look at the health of the healthcare professionals, with their depression and burnout rate at 50%. Every second, every fourth healthcare professional is actually in need of healthcare. Look at the rate of suicide and depression among healthcare professionals. We know it’s very high. It is [the result] of being in a highly stressful environment. It’s being in a quite inhumane environment. It’s being driven into a profession that has become more and more objective and [has less appeal] as a life’s purpose. More than 90% of healthcare professionals start enthusiastically, but at the time of final exams, 50% have signs of burnout. At the end of their career, 70% of healthcare professionals advise their children not to enter the profession. That doesn’t sound like a healthy profession to me. In the book, we make a few very simple first proposals for healthcare professionals to integrate self-care so that they learn about what it means to be on a path of healing themselves, and they can respect and support their patients.
HEH: How do you start your day on this path of healing?
Bonhoeffer: For me, the day starts with meditation or prayer. There are many different variations on a “heart-opening” practice, whether it is meditation, sitting in silence, just letting the mind settle, letting the dust settle, to actually opening up to something that is bigger than myself and to be in service of this creation, rather than to impose my own little ideas on it.
REFERENCE
- Bonhoeffer J, Ardagh A. Dare to Care: How to Survive and Thrive in Today’s Medical World. 2020: Heart-Based Medicine Foundation. Basel, Switzerland.
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