In previous blogs like I need hope too: Redefining goals based on care recipients wishes in value-based care, I discussed the need for hope and how it drives decision making both from the perspective of the patient and their physicians. Since the teaching of physicians focuses on training to diagnose and treating aiming to cure, our hope lies within avoiding a situation that is ultimately impossible. Frequently we tie our “hope bucket” to an outcome that is unattainable; instead, we must shift our definition of success from one of curing to one of healing. Though they might appear to be the equivalent, they are quite different. Healing encompasses emotional and spiritual components and touches our patients at a much deeper level beyond physical, whereas curing is purely physiological.
“Focused” hope centers on curing, whereas “intrinsic” hope involves a more realistic and resilient emotional foundation. Historically, healing implies a deeper, more subjective transformation, regardless of whether or not a cure occurs. The foundation of healing involves the evolution of intrinsic hope which is hope regardless of an outcome. If we want to influence hope in our patients, as physicians, it is imperative to pivot from being curers to healers. The way we do this is to aid in our patient’s journey through hope. One can have focused hope, but eventually, it is essential to transition to intrinsic hope especially if an illness is progressing or when a negative outcome is probable. Sharing a poor prognosis requires us to also adjust how we define success. Once we understand the situation, it’s imperative to assist those we serve to transition from focused to intrinsic hope.
The value of Intrinsic hope is it begins to replace unrealistic expectations with a more profound and resilient emotional foundation. This new way of thinking shifts the focus to the quality of life and elevation of personal meaning. Consequently, this might be as simple as helping our patients focus on having fun, seeking out old friends, or connecting with a higher power. For example, if a treatment has failed, the goal shifts to a trip to visit old friends, thus the intrinsic hope of reconnections and the pleasure that will bring.
As Physicians, mindfulness and remaining in the moment is also key. As healers, we must gain insight into emotional issues in addition to the physiological situation of those we treat. Though we might need to guide the conversation between the focus of a cure and reality, we must do so in a way that discloses the underlying concerns. One such method is to “ask-tell-ask” where one asks an open ended question, then gives information, and continues the conversation in an exploratory manner.
Re-framing also must occur. Human nature tends to prevent us from moving from the flight or fight component of our being. Therefore, it’s necessary to work with others on the journey by continuously reframing the situation without removing hope, but instead replacing focused hope with intrinsic hope. Emotional defenses warrant a determined yet compassionate approach.
Ultimately, as clinicians, we must decide if we wish to block out the emotional impact of this portion of our calling for self-protection or instead utilize this communal relationship we create to elevate the joy of what we do by focusing on the positive impact we are having. This latter approach allows us to be successful within a contextual model that is much deeper than just providing a cure. Let us continue to evolve our definitions of success, hope, and healing to better care for those we are blessed to serve while simultaneously growing personally in the joy of our vocation.