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Ruminations on Arthur Frank's Generous Medicine.

Article Excerpt
Frank: "At the core ... there remains what I have called fundamental medicine: the intimate encounter between someone ill who brings her or his suffering and someone else who offers hope of relief." (p. 1)

That possibility of being seen and heard by the doctor in a way that would earn the label "intimate encounter" draws us as patients to do the verbal and physical disrobing that we do. Extraordinary every time is the trust that such disrobing requires and displays. Extraordinary too is the steadiness of the hope for that reward. Yet the doctor is not so steadily filled with longing for an intimate encounter. The talk doctors talk much of the time indicates an intention to avoid intimacy rather than engage in it. Their buttressing notion is that such avoidance is protective of their ability to be objective, to think clearly, to act rationally, and to keep moving. "I can't afford to be getting involved," they say. "All the suffering around me--it would ruin me if I really took that in. Not to mention the fact that I don't have the time." Still, there they stand in a scene with another who is without clothes, all vulnerability and fright and need. Can that person create an intimate encounter if the other refuses the offer? Can the intimacy exist and affect the doctor without his consent, without her knowledge? At a recent conference in Family Medicine, a colleague and I presented a seminar on narrative medicine. We gave the participants the following instructions: "Write about a patient whose suffering has moved you. You will have 15 minutes to write." A young physician raised her hand. "I really can't think of any patient to write about. I've been working in a nursing home for a while. My patients are barely conscious. I don't even know them. And anyway, you know, I don't get that involved with patients." My colleague responded, "That's ok. Just write whatever comes to mind." She and the rest of the group began writing. Within minutes, we heard someone crying. We looked around and found that the someone was the young unmoveable physician. With tears still coming, she read to us what she had written about her experience of leaning in close for the physical exam and touching the still-rosy cheeks of one of the comatose old people in her care. "Her skin was smooth as a baby's."

Frank: "By generosity, I designate a quality less economic than existential. Generosity involves giving, but my concern is with the giving of self in the willingness to recognize the other as fully human--as one with whom...

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