Finding a place for hope and care in medicine

JORDAN MOSHE

“It is clear that the element of hope is sorely lacking in medical study and practice,” says Dr Jerome Groopman. Groopman and his wife, Dr Pamela Hartzband, are visiting South Africa as guests of the Reach for a Dream Foundation to teach physicians and lay people the central role played by hope in medicine.

The two medical practitioners will be addressing doctors on hope – whether it can change the course of an illness or help patients to recover, and how it works at a biological level.

Educated at Columbia University in New York, Groopman is the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School, the Chief of Experimental Medicine at Beth Yisrael Deaconess Medical Centre in Boston and the author of five books.

Throughout his years in medicine, Groopman has not seen any increase in the amount of hope administered to patients by their doctors. “Even when I was taught, hope was not a part of my learning. My training was among the best, and even at that level, this concept did not exist.

“When I was on one of my ward visits, I realised that the one thing that patients from all backgrounds and with any condition are looking for is a measure of hope,” explains Groopman.

According to him, hope, just like emotion, stems from a biological place. It is as much a part of the body’s chemical make-up as any of its other parts.

He explains that true hope needs to be distinguished from false hope and from optimism. “Whereas optimism says that everything will work out for the best, hope does not assume things will passively unfold,” he says. “Adults know that consistently positive outcomes are not guaranteed, and as Jews, we know that this is certainly not the case most of the time.”

Groopman learnt the role played by hope at first hand. Having been a patient himself, he experienced a failed back surgery, an event which caused him severe pain and disability for a number of months. His condition, along with encouragement from his wife, drove him to find a meaningful way to come to grips with his situation.

He explains: “Hope entails an active effort, a clear awareness of obstacles and detours, and a forward-oriented vision. True hope involves finding a possible path forward through uncertain terrain.

“This is a process that involves the patients making conscious decisions, taking control of their situation and being active participants in their experiences.

“This includes their doctors, who are there to help them understand their paths and problems, and assist them in identifying the best way to proceed.”

The people who best understand the place of hope are children. “Children who face life-threatening conditions are better at grasping the role of hope in facing adversity,” says the chairman of the Reach for a Dream Foundation, Mervyn Serebro. “They have the ability to confront almost anything and have the unique ability to find joy in almost any little thing. The concept of a critically ill child is contrary to the rhythm of the universe, and the role played by well-founded hope is crucial to helping them and their families face the challenges at the worst time in their lives.”

Serebro explained that the purpose of the visit by Groopman and Hartzband is not only to encourage doctors to implement hope into their practices, but also to appeal to them to direct children whose lives are threatened by disease to the foundation.

“The sad reality is that most medical practitioners cannot see past their own arrogance and will not encourage their patients to reach out to us,” says Serebro. “They believe themselves to be fully equipped to assist their patients, but in fact, their ability to support them with much-needed hope is sorely lacking.”

Groopman and Hartzband echo this sentiment. “Medical practice is all about medical process today,” says Groopman. “Doctors do not believe that it is a doctor’s job to deal in hope. They feel either that hope is a luxury or they are not equipped to give it to people.

“But a doctor is a pivotal point for the family of a patient and for the medical team assisting him or her. He or she is ideally positioned to ensure that a patient’s treatment is invested with hope at every stage of the journey. The integration of hope into medical practice ensures that the care administered is comprehensive and complete.”

Groopman emphasised that his approach is not necessarily novel, but is drawn from the founding tenets of Judaism. “Judaism is centred around the element of hope,” he explains. “Theodor Herzl said: ‘If you will it, it is no dream’, and the Israeli anthem is named Hatikvah – the hope. These examples illustrate the fact that hope lies at the very foundation of our faith and is a crucial part of our lives.”

Despite the centrality of the concept, hope is not something looked on favourably by many people.

When Groopman and Hartzband first published information about their approach in a medical journal, they were bombarded with complaints from doctors, who felt that they were naïve and overly critical.

“While there is increased acceptance of the role of hope,” says Hartzband, “the struggle to advance its progress is difficult. Medical students in America are often taught principles which are based on economic theories, those which stress the need to process as much as possible in as little time as possible.

“The medical field has seized on the car manufacturing model and placed it at the centre of study and practice. This ‘Toyota’ practice teaches students that the ideal visit duration is 12.5 minutes, and that this time is sufficient for consultation and prescription.”

She goes on to explain: “The language of medicine has changed. People speak about ‘provider’ and ‘consumer’ nowadays. When you’re ill, are you a shopper? Is your doctor an internet service provider? The humanity of the caregiver and patient relationship is no longer at the centre, and people are suffering as a result.”

Reach for a Dream and the US-based medical couple agree that the system needs to change. “All doctors concur that medical safety is the first consideration,” says Groopman. “But beyond this, it’s not good enough to give a hospital or a practice a gold star for meeting the technical standards set out.

“There needs to be an improved understanding of the human element, and medical merit cannot be based on the number of patients a doctor can process in a single shift. The concepts of pace, demand and people must be altered.”

Speaking about the need for hope in the work of Reach for a Dream, Groopman stresses how essential it is for current practice to change. “Judaism has the spiritual advantage of individual connection. We appreciate the sanctity of any life and understand the need to care for every individual as they require. The motivation for, and sensibility of, the approach of hope is rooted in Torah values and their wisdom.

“So is the concept of humility. If doctors can learn that they are not always right, that they can improve their approaches and work differently, then there’s hope for the future.”

Groopman concludes: “If we put the person at the top, true healing is possible. It’s not about the disease, nor the drug, nor the scan. It’s about the person, body and soul. When we make a misheberach for the recovery of a person, we ask that he be healed in body and soul.

“What is the connection? Is the body not the body and that’s what matters where disease is concerned? No. While a doctor may be unable to heal the body, the spirit can always be healed. Many people can’t be healed, but their nefesh can be nurtured and relieved.

“Doctors are capable of doing much more than they realise. The more the nefesh can be healed, the greater the ability of the patient to dream, the greater the possibility of true healing.”