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Happiness and the art of care and conversation on the cancer ward

The gift of time makes patients happy. Number1411/Shutterstock

This article is based on an essay from the collection On Happiness: New Ideas for the Twenty-First Century and is part The Conversation’s series on what happiness means.

When asked to contribute to On Happiness I readily agreed because I had been mulling over the meaning of happiness that whole month as I cared for a patient nearing the end of her life. She had young children, a supportive husband and, most of all, an abiding faith that allowed her to imagine heaven as a better place now that treatment was no longer possible for her advanced cancer.

It struck me as extraordinary that she could muster such unflappable peace in the face of something as momentous as death. But I also thought that if everyone shared a drop of her equanimity, the inevitability of dying would be so much easier on all of us, the deceased and the ones left behind.

The week I sat down to write the essay was the week she finally died, peacefully, surrounded by her family as she went to meet her god. All I could think about was her child about to start school whose mother would not be present to see her on her first day. With my child about to do the same, I wrote the story from a deep and affected place, not as an oncologist but as a mother who happened to be an oncologist.

Some days on the ward, happiness is avoiding the fate of many of my patients. Everyone who works in oncology is only too aware of the flick of the wheel of fortune that transforms happiness into its opposite.

But if being an oncologist is sobering stuff, it’s also a job where happiness steals into your life in unexpected ways. My working week is filled with diverse roles, including reading interesting research and fine literature, writing health columns, public speaking and mentoring, but my favourite moments in medicine are those spent in direct patient care.

I am at my happiest at the bedside of a patient, explaining a diagnosis and coming up with ways to navigate through a difficult time. Much of the fear of cancer arises from a total lack of control, so I am at my happiest when a patient with a new diagnosis comes in bewildered and shaken and leaves my office feeling a modicum of control.

Much of the fear of cancer arises from a total lack of control. Anan Kaewkhammul/Shutterstock

Once or twice a week someone is vocally appreciative towards my colleagues and I. “People say the public hospital is no good, but, to me, you are all angels,” one patient recently said of her encounters with nearly half a dozen different nurses and oncologists. It’s impossible to describe how much happiness such compliments bring into our lives when we often feel we are short-changing the tide of patients that confronts us.

But lately, I have been hearing a lot about disillusionment in medicine. How doctors would not recommend the profession to their children. How doctors are burning out amidst skyrocketing rates of drug and alcohol abuse and mental illness.

Medicine is just another form of consumerism, doctors sigh, as they rush from pillar to post to satisfy the urges of a consumer society fuelled by unrealistic expectations and diminishing personal responsibility. Bureaucrats breathe down our necks, tired of our inability to distinguish cost-effective measures from plainly wasteful ones. Patients no longer regard us with the level of respect, or even affection, that they once did.

As an oncologist working in a public hospital system that attracts a large share of the educationally deprived and the socioeconomically disenfranchised, I find myself at the heart of these experiences. They have me wondering how to recapture the joy of medicine for myself and convey it to the next generation of doctors.

Here is what I have realised. More beds, shiny wards and more scanners don’t make anyone happy. More beds without more staff means more patients per overworked doctor and nurse. More scanners mean more scans but not necessarily better care.

I have rarely met a patient who felt better for being on a new ward that was staffed by jaded doctors and nurses. So while pouring money into medicine is usually well-intentioned, it’s a stretch to say that it makes doctors happy.

What does make doctors happy is happy patients. Nothing puts a spring in a doctor’s step like the sight of a satisfied patient. In a profession where established beliefs are routinely turned on their heads, this seems to be a fairly irrefutable one. In fact, the capacity to make a palpable and immediate difference to the human condition is what sets medicine apart from any number of prestigious jobs. Corporate lawyers, management consultants and investment bankers tell us this.

While pouring money into medicine is usually well-intentioned, it’s a stretch to say it makes doctors happy. weedezign/Shutterstock

But how can the modern doctor make the modern patient happy? In this age of unrelenting dissatisfaction with every aspect of our life, is it even possible to aim for a happy patient, or should doctors just accept that customer service delivered with civility, efficiency and accuracy ought to be enough?

I think this would be a shame because the wonder of medicine really lies in its human touch. The rest Google keeps getting better at.

Take the example of a skin rash that a patient took to Google for a diagnosis. Google reassured her that the rash should get better by itself. It took the triage nurse’s radar to sense that although Google was right about the rash, it couldn’t possibly diagnose the patient’s distress at remembering that a similar rash had heralded the death of her mother from leukaemia when the patient was merely seven years old.

I often see that what makes a patient happy is the gift of time. I have met some wonderful doctors in my career, loved by patients and their colleagues. They all have something in common – they have honed the art of communication.

These doctors look at their computer screen less and their patients more. They smile, wince, celebrate and commiserate with their patients and they look them in the eye. They show empathy without losing their professionalism. Through their words and their gestures they show that they care.

I asked a very busy GP once how he managed to keep so many patients happy. “I behave as if for those ten minutes the patient before me is my only concern in the world,” he said.

When patients feel listened to they tend to engage in decision-making and the management of their condition. Patients come to doctors for a diagnosis and treatment but also for comfort. A kind gesture, a soothing word can be as therapeutic as a prescription.

“If only she’d stop trying to be extra clever and just be a little nicer,” an old lady once grumbled. For many doctors this is a difficult pill to swallow and one that is the obverse of what the profession has traditionally valued. But I am convinced that for medicine to deliver happiness we must not forget the human dimension.

As far back as the fourth century BC Hippocrates observed, “May you cure sometimes, relieve often and comfort always.” This may be the one prescription in medicine without an expiration date.

On Happiness: New Ideas for the Twenty-First Century is available this month from UWA Publishing.

Read the other articles in The Conversation’s happiness series here.

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