Joe O'Donnell, MD

Compassionate Care: Building Support Culture for Patients and Students

Recognizing that medicine is both an art and a science, a growing trend in medical education advocates using the arts and humanities to educate compassionate physicians.

Joseph O’Donnell, M.D., professor of medicine and professor of psychiatry at Dartmouth’s Geisel School of Medicine, has been using the arts and humanities to help students compassionately care for others as well as themselves for more than 30 years.

Long interested in compassionate care, O’Donnell was influenced by the work of Robert Coles, a Pulitzer Prize-winning author and professor of medicine and humanities, who believes in the power of storytelling to illustrate our common humanity. Coles is confident that by reading and listening to stories by those who have experienced illness, doctors will develop empathy and compassion. He’s also convinced that mindfulness comes from considering works of art.

“Using the works of great authors to get people thinking about how they want to live their lives really resonated with me,” O’Donnell recalls. “Reading stories and reflecting on what we really do as physicians, encouraged me to consider what kind of person I wanted to be, what kind of life I wanted to live and what kind of impact I wanted to leave on the world.”

O’Donnell encourages students to wrestle with these existential questions since their answers provide insight into how they define themselves as both individuals and physicians.

An oncologist at the Geisel-affiliated Veteran’s Administration (VA) Medical Center in White River Junction, VT, O’Donnell focuses on palliative care and how understanding a patient’s story helps doctors relieve suffering during the course of illness and treatment.

“How we address suffering is really important to me,” O’Donnell says. “It’s beyond making good clinical decisions, it’s about compassionate whole patient care—the mind, body and spirit of the patient that we need to keep front and center.”

To O’Donnell, the absence of compassion makes medicine less satisfying for both the doctor and the patient, especially in a hospital environment.

Hospitalization can be dehumanizing and impersonal. Patients feel vulnerable, anonymous, frightened and uncertain about the future. Listening to their stories and trying to grasp the significance, reassures patients that they’re important and understood.

“When someone tells me they have a cough, I need to hear they may be saying they think they have lung cancer because they’ve been smoking for 35 years,” O’Donnell says.

Attentive to their stories, O’Donnell easily gathers the necessary details to diagnose his patients, and works with them to assuage fears about their illness and its treatment within the context of their life.

“I let them know that they can tell me what worries them,” he says. “If they’re worried about the cost of their medications, then we’ll work together to try to solve that problem.”

This willingness to be engaged with patients is something O’Donnell challenges students to embrace. He reminds them that whatever they do, they must look beyond the collection of symptoms and have empathy for their patients as human beings.

“The most potent drug in the doctor’s bag is the doctor himself,” O’Donnell says. “Putting your hand on someone is an unbelievable privilege that engenders trust, and being able to do that in a way that says ‘I care about you’ is significant,” he adds. “The way you listen to a heart is as important to a patient as what you hear.”

Idealistic when they enter medical school, many aspiring doctors are open to calmly listening to their patient’s stories—they’re intent on understanding what suffering is and how it relates to medical care. O’Donnell wants to preserve that idealism.

Medical school can be described as a test-strewn, competitive and lonely educational environment that inhibits idealism—facetiously described as the “precynical” and “cynical” years, rather than the preclinical and clinical years. As students become socialized into medicine they become less idealistic.

Geisel School of Medicine is different. It’s a place where relationships are forged, values fostered and differences are respected through shared stories and experiences. But it’s also a place where underlying assumptions about people’s differences and attitudes toward those differences are revealed.

“Right from the beginning we encourage students to get to know each other,” O’Donnell notes. “That’s the type of atmosphere we want to create—a collegial, collaborative community of learners who know each others stories and who support and respect each other.”

Being aware of what people are going through is equally important for the wellbeing of physicians, O’Donnell maintains. “Students are reluctant to admit they may be struggling with an issue or bothered by something they’ve encountered,” he adds.

O’Donnell understands that examining one’s own assumptions and struggles can be difficult, which is why he created the ‘art of observation’ in collaboration with Dartmouth art educator Vivian Ladd to help students understand individual idiosyncrasies. During a visit to Dartmouth’s Hood Museum of Art, students are asked to contemplate a work of art and then discuss their impressions with their peers. Appreciating a work of art engages the same intangible qualities—presence, mindfulness, critical curiosity, self-awareness and sensitivity—that are essential in a doctor when trying understand the meaning of a patient’s story.

It’s an unusual aspect of medical education to be sure, and some students are skeptical about the benefits, but it’s an experience few forget.

When O’Donnell meets former students during reunions he says those who accepted his challenge to know themselves as well as their patients, often tell him he was right about the stories, the “soft” social skills and cultural lessons—they have plenty of value.

William Carlos Williams, a 19th century physician and poet whose work O’Donnell admires, wrote: “Their story, yours and mine—it’s what we carry with us … we owe it to each other to respect our stories and learn from them.”

--Susan Green

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