The Healer's Art: A New Approach to the Doctor-Patient Relationship by Eric J. Cassell (review)

The Healer's Art: A New Approach to the Doctor-Patient Relationship. By Eric J. Cassell. Philadelphia: J. B. Lippincott Co., 1976. Pp. 240. $8.95. Wisdom is a rare quality and, when added to knowledge and compassion, the sum is a treasure. The Healer's Art contains all ofthese ingredients in a marvelous and optimistic statement of what could be in the doctor-patient relationship. Dr. Eric Cassell shares with us an intimate, articulate description of what being a physician means to him. He cares—enough to have continued to study the science of this profession and to have reaffirmed that essential concomitant of medicine, concern for the patient as a person—to see in the suffering of others oneself. He likens this role in part to that of the clergy ("both walk in the very different world of the sick and dying") but also differentiates it by noting diat "the clergyman offers a comforting exit but the doctor [also] offers a chance to return." Cassell adds a new dimension to the art of medicine—an art that places demands on both patient and physician. Requisite goals are to enhance healing, ameliorate pain, prognosticate and plan the future together. Familiar ends reached via a new process. The physician is advised to comprehend the inevitable fears and anxieties associated with illness—the physician's fears, not simply those of the patient—and incorporate these in the treatment relationship. Several purposes can be served by conscious recognition of the intense emotional components ofdisease. Awareness ofone's own internal response lessens hidden errors of omission in the doctor-patient relationship. The dependency of the patient on the doctor can be more readily accepted and, in fact, purposefully integrated into a therapeutic partnership. Communication between the two is enhanced. The physician, in learning more than just medical history about the individual who has sought help, increases his facility to interpret clinical findings. The patient, in comprehending the role of the physician, is able to take an active part in the healing process. This is not armchair advice—these ideas did not develop in an academic cloister . Cassell came of age as an internist in one of the great hospitals of the 1950s, Bellevue. His role models included an extraordinary group of scholarly, dedicated voluntary faculty. His patients were demanding in several dimensions —most were seriously, acutely ill and often chronically undernourished in addition to being estranged in the alien environment of the large municipal hospital. Circumstances required the mobilization of all available hospital and patient resources to achieve even a routine therapeutic result. Whatever his academic interests, Cassell has continued to devote a significant portion of each day to the private practice of medicine, constantly engaging patients actively in their own healing. As I read the book, two reasons underscored the motivation to a partnership. First, it works, it is effective. Second, it avoids patronizing the patient. Cassell adheres to the role of the doctor as expert but, at the same time, demands that patients serve as more than passive recipients of instructions. Cassell incorporates many fundamental notions of behavioral science while avoiding the jargon of the discipline. Almost every page instructs without the irritating style of the pedant. Every section emphasizes his definition of a doctor—one who is willing and able to care for another. Let me give a sample: It is difficult to teach young doctors and nurses how to tell the truth [to the dying patient]. Perspectives in Biology and Medicine ¦ Spring 1977 | 461 In that setting ofsickness and misery it is too easy to fall in with the families' or the patient's desire (perceived or spoken) not to know the painful facts. At the bedside it takes a full acceptance of one's responsibility in order to bring difficult words to the lips, and a full inner realization that to tell someone of his cancer or impending death is not the same as giving him his cancer or causing his death. Rather, we hear the criticism of denial at meetings, seminars, or discussions about medical care far removed from the scene of the dying and voiced primarily by healthy laymen. The farther away from the bedside we...