What Is the Purpose of Medicine?

A doctor's ability to deal with the mental, emotional, and spiritual concerns of his patients is often further restricted by the economics of medicine. Even if physicians have the desire and the skill to spend an hour in meaningful discussion with patients, the health care system in which they are working may make this impossible. In the era of the ten- minute managed care follow-up visit, anything but the most limited cursory assessment is often not possible. The financial, administrative, and time pressures on doctors in America have increased exponentially over the last decade, and current trends in managed health care suggest that things may only get worse.

It's important to mention, too, that a physician who explores emotional issues with patients and families may be opening a Pandora's box of unresolved guilt, anger, hostility, and confusion. Patients' demands and expectations can at times be wildly unrealistic, and disputes with doctors can degenerate into costly, time-consuming, and exhausting litigation. In oncology, where issues of life and death are commonly at stake, and where decisions regarding diagnosis and treatment options can carry huge costs and consequences, emotions often run high. In response, many physicians choose to deal only with technical issues that can be clearly defined, objectified, measured, and treated.

All this often leaves everyone feeling frustrated and dissatisfied. Many doctors simply shut down emotionally and do the best they can under the circumstances. Meanwhile, and in increasing numbers, patients seek out alternative, complementary, and often unproven forms of care.

What is the Solution?

I believe it's time to enlarge our vision of medicine for cancer patients--and for all patients. In this new vision, medicine has two distinct purposes. The relative purpose of medicine is to relieve symptoms and to cure disease. But there is also an ultimate purpose, which extends beyond the physical realm to include the mind, heart, and spirit of every patient, and indeed of humanity as a whole.

In this view, cancer patients are understood to be asking two things of their physicians. On the relative level, patients most definitely want their illnesses cured. But this is not the whole story. The ultimate reason why they want to be cured is in order to feel love and joy in their lives. Quite often patients are convinced their capacity for this has been violently stripped away by their diagnosis. Many cancer patients believe that they cannot experience the deepest levels of love and joy again until the doctor has gotten rid of the cancer. They have made a decision, consciously or unconsciously, that this physical criterion must be met before they can partake of the profound human emotions we all seek. They feel fundamentally separated from the emotions that make life worth living, and they feel that bridging the separation depends on the clinical work of the doctor.

In light of this, I believe the ultimate purpose of medicine must be to foster the emotional and spiritual fulfillment that is a shared aspiration of all human beings. Moreover, medicine must empower patients to find that fulfillment within themselves--regardless of their diagnosis, their current condition, or their clinical outcome.

Thus, I would describe the ultimate purpose of medicine as follows: to assist all beings to experience unbounded love and joy, and to know this is the essence of who we truly are. This purpose deserves attention fully equal to the relative purpose of curing disease.

Our potential to experience love and joy is in fact unbounded, and I believe that fulfilling that potential is the true objective of all human activity. But the fullest realization of that objective can never be found in external circumstances--not in a salary, an award, a relationship, or even in a clear CT scan. All external things will eventually change, and sooner or later will disappear. We must recognize, then, that the deepest levels of love, joy, and fulfillment we seek can only be found -- and can always be found - within ourselves.

Helping patients to discover this is the ultimate purpose of medicine. If this purpose were understood and embraced, so much pain, confusion, and misery could be alleviated, regardless of our success in fulfilling the relative purpose of treating disease. Certainly cancer care demands the most advanced technology, and providing that technology for patients is one of my highest priorities. But I also know that no advances in chemotherapy, radiation, surgery - or immunotherapy or gene therapy - can ever fulfill the larger needs and concerns of patients and their families. Even when medicine succeeds in its relative purpose, even when the tumor has been eradicated and the CT scans are clear, our task is not complete unless the ultimate purpose has been fulfilled as well. We must serve every patient's physical needs to the very best of our ability, but we must serve every patient's mind, heart, and spirit as well.

In striving to fulfill both the relative and the ultimate purposes of medicine, I have come to appreciate a fundamental insight that is often overlooked in daily life. In every moment we abide simultaneously in two domains of existence. The domain of doing encompasses all our worldly activities, efforts, identities, and endeavors. It includes everything we do to try to heal ourselves when we are sick, including taking chemotherapy, radiation, herbs, vitamins, massage, or acupuncture. But there is another domain of existence, the domain of being, that is equally real and important. The domain of being encompasses who we really are - beyond our thoughts, our individual identities, our successes, our failures, our sickness or our health. And the domain of being is where the ultimate purpose of medicine leads.

_{Copyright© 2000 by Jeremy Geffen}