Issue: 2020 > March > letter to the editor

The book of Genesis and physician-patient communication



LETTER TO THE EDITOR
Schattner , A
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Dear Editor,

Much can be learned from the book of Genesis. Surprisingly, a profound piece of advice applicable to all patient encounters can be found hidden between the lines. After being sold by his brothers, Joseph, son of Jacob, is brought to Egypt and finds himself in prison together with two of King Pharaoh’s noblemen (Genesis, 40). One morning, he notices that they seem different and sour [Observation]. They do not say anything, and Joseph goes on to ask them if anything is the matter [Curiosity, actively pursued; Initiative]. Upon hearing that they both had disturbing dreams, Joseph encourages them to narrate their dreams, suggesting that he may be able to help [Interest, Commitment], and then ably interprets their dreams for them [Support]. When later, Pharaoh himself has a hard-to-decipher recurring dream, the nobleman who was reinstated remembers Joseph and recommends his abilities to the king. Joseph is duly brought before the king where, due to his clear interpretation and bright idea for dealing with the looming crisis revealed by the dreams, he is freed and appointed a prince, second only to the king.
All of this would not have happened had Joseph not demonstrated constant mindfulness, sensitivity to nonverbal clues, curiosity, and other essential qualities (above in square brackets) identified by research as being widespread among exemplary humanistic clinicians.1-3 Unfortunately, these qualities are often neglected and missing in most settings;4,5 a neglect associated with suboptimal care and health outcomes for patients, and with missed information, hampered meaning, and increased burnout for physicians. Conversely, the potential rewards of Joseph’s attitude are symbolised by his rise from prison to prince. With the current time-constrained, information-packed encounters, and patients’ common use of subtle cues to try and surface highly significant emotional and contextual issues,4 the onus is on us, as providers, to observe and notice, be curious, ask, and react, displaying empathy and commitment – as Joseph did according to the text of Genesis.


REFERENCES

  1. Churchill LR, Schenck D. Healing skills for medical practice. Ann Intern Med. 2008;149:720-4.
  2. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014;89:1252-8.
  3. Schattner A. Curiosity. Are you curious enough to read on? J Royal Soc Med. 2015;108:160-4.
  4. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021-7.
  5. Zimmermann C, Del Piccolo L, Finset A. Clues and concerns by patients in medical consultations: a literature review. Psychol Bull. 2007;133:438-63.