Authors discuss ‘The Chief Concern of Medicine’ on the Jefferson Exchange

by Phillip Witteveen on January 11, 2013

“Every patient has a story, and every doctor has to know it” said the host of the Jefferson Exchange as he announced his guests, doctors and authors of The Chief Concern of Medicine, Ron Schleifer Ph. D. and Jerry Vanatta, M.D. The book, as they explained, was a product of the collaboration they had been doing teaching a class about the medical humanities.

” I had a remarkable experience in my office”, explained Jerry, “which led me to wonder, if we could put together a course on literature and teach it to medical students.” He went on to tell a story about a patient he had, an elderly black woman. After her examinations, he began interacting with her, explaining her condition and all of the bio-medical information that it entailed. What he found, however, was that he had no connection to the patient. This prompted a question that doctors don’t usually ask: “So why don’t you tell me about your life?”

So she did. She told him about how she grew up in East Texas, daughter of a sharecropper, and had 17 children. She told him about her hardships, and she told him about what she loved. The relationship that this story established helped Vanatta have a stronger doctor-patient interaction, and helped him treat not just the symptom, but the person. As the patient was about to leave, “she stood and hugged me, and that was a sort of unusual thing. I knew immediately that something really interesting and profound had happened.”

 

The major theme of the book that was inspired by this experience, is the idea of the “chief concern”. This is an extension of a long-standing medical protocol, called the “chief complaint”, which is whatever is ailing the patient, and is generally the second thing a doctor will record after the patient’s name. “What we’re advocating, is [adding] the specific question “What concerns you about that?”, in order to “create a situation where the patient, and not the doctor, is the expert.”

Schleifer explained, that this kind of interdisciplinary work is not new, and that literature and medicine have always had a close connection, since the time of Aristotle, who was himself a doctor’s son. “One of the things that literature has consistently focused on is human suffering, as does Medicine”. Throughout their class, medical students read stories with protagonists of different socio-economic backgrounds, as well as detective stories, to better understand where their patient is coming from, and what their patient aren’t telling them. This kind of profile, or narrative, has proven to make diagnosis and treatment more efficient, says Vanatta, as well as improving the relationship between doctor and patient.

Check out the full interview on the Jefferson Exchange.

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