Doctors and Patients

The Open Mind
Host: Richard D. Heffner
Guest: Ruth Yorkin Drazen
Title: Doctors and Patients
VTR: 4/10/03

I’m Richard Heffner, your host on The Open Mind, where one of my most favorite guests from over the years, Dr. Kathleen Foley, the renowned pain and palliative care expert at Memorial Sloan Kettering Cancer Center told me once, in no uncertain terms, of a woman I simply had to meet, an accomplished documentary film maker who has most recently created “Frankl’s Choice” a stunning film about the late Dr. Viktor Frankl, author of the world acclaimed Man’s Search For Meaning and I’ve now also had the pleasure of seeing others of her documentaries, On the Edge of Being, When Doctors Get Cancer and Cancer, A Personal Voyage and knew I simply had to invite her here to The Open Mind when Ruth Yorkin Drazen wrote me that, “My passion has been to influence change within the medical community as it relates to the care-givers and patients who confront life-threatening illness.”

So first then, let me ask my guest just what change or changes she has wanted to bring about in the medical community and to what extent she feels she has succeeded. That an unfair question?

Drazen: No, it’s a very fair question.

Heffner: What do you want to do?

Drazen: I really do want to see a new dialogue created within the medical community with those who have to use physicians. You know health care is the most personal experience any of us can know. I mean we entrust our lives to the physician. And I feel that I want to see the physician bond with the patient, particularly when its chronic disease and the patient needs someone to go on the long journey with him or her.

Heffner: But you say “bond” and my understanding always has been that it’s too tough a situation and it may not be wise for the physician to bond with the patient, emotionally too draining.

Drazen: I don’t agree with that because I believe that there is more to give, if you give. It’s doesn’t dry up. It’s like an ever-flowing well within the physician. That’s why the physician came into medicine in the first place, because he or she must think of the whole person, not just the individual’s disorder or disease.

Heffner: But you know when you, when you speak about that, I think of the doctors who cared for me, and they really did care for me, when I was … not a child … a younger man, and I know that they had the time to give me to do what you are requesting of them.

Drazen: MmmHmm.

Heffner: That isn’t possible now any longer, is it?

Drazen: Well I think it should be. I think we have to give up thinking of medicine and health care on a global basis.

Heffner: What do you mean?

Drazen: I think that insurance seems to be the force behind health care today rather than caring for the person. Many of us have to live with chronic disease. And we have to be able to have someone who shows us how to live with the disability and who better than the physician?

I understand the frustration of the physician because I had a child who died and I was very, very angry because there were no answers for this problem. And I think that that was the challenge that brought me into all of this in the first place. And I’ve waited a lifetime to come and see if I can’t influence a new kind of thought process, a different mindset.

Heffner: Well you say a “new kind of thought process”. But would it really be unfair to say that what you are looking for in terms of relation … the relationship between doctor and patient is something that existed many, many years ago.

Drazen: Yes, when we didn’t have all the “high tech” it existed.

Heffner: Will you give up the “high tech”?

Drazen: No, I think it has to be used in a rather different way. I think we have to give the physician the chance to make as clean a diagnosis and to be very realistic about the outcome. Because all of them know there are some things that no matter what we do, there are no answers. And I think that a patient can bear that news.

Heffner: No, but … you say you feel that what has … one of the things that has intervened between that older physician/patient …

Drazen: MmmHmm.

Heffner: … relationship and today is “high tech” medicine.

Drazen: Well that’s just one thing. I think that we have no time in our schedules today to realize that we’re whole persons and that we have to be viewed mind, body and spirit.

Heffner: Okay, what do you do when the doctor says he doesn’t have the time or she doesn’t have the time.

Drazen: Well, quite honestly I look for another …

Heffner: Change the doctor?

Drazen: … physician.

Heffner: [Laughter] I knew that had to be your answer.

Drazen: Yes. But I think there are ways that you can deal with it. I think it comes at the beginning, in the training of physicians. And they have to know why they’re coming into medicine in the first place.

Heffner: But doctors train doctors. So who leads, who takes the first step, who is wise enough to do that? I, I raise this question because I wonder if …

Drazen: Yes.

Heffner: … you are not in a sense, spitting against the wind?

Drazen: Oh, no. No. I don’t believe so at all. In fact I’m already seeing the process change through the most recent film that I made on Viktor Frankl.

Heffner: How did you see that?

Drazen: I think that Viktor Frankl has changed my life and that was the force … the reason that I wanted to make the film, really. And after I made the film I was extremely fortunate in that the American Board of Internal Medicine wanted to use it to see if it could have some effect on making doctors more sensitive. So they decided to do a study and I was witness at one of the large medical centers when the film was shown to the senior academics. And there were probably 15 people in the room. And I saw how involved they became and how they were able to say “I’m very unhappy. I don’t have the time to live.” And it isn’t always the hospital and it isn’t always the insurance company. It’s that the doctor has sacrificed on a level that he’s just burned out. And he hasn’t acknowledged it.

Heffner: He’s made his choice …

Drazen: And his isn’t a good choice. So he has to learn to feed himself before he can feed the patient. And you know what I mean in terms of “feed”.

Heffner: I do, indeed, but I wonder again whether you’ve really answered the question as to whether you aren’t fighting against the unfightable.

Drazen: No. If … you know, they say if you’ve helped one person, you’ve helped the whole world. You know that saying? I believe that it’s true and I can see the change in some of the physicians already, who’ve been exposed to the film. For example, at Harvard they have now figured out a system whereby a medical student is going to see the film twice a year. For four years. And this medical student will see the film when he or she comes into the class. And at the conclusion of the year. And what they will do is that they will write essays on their experience with the film as they go through the medical program, you will see, I would hope, some changes in their understanding.

Heffner: What will they see that will lead to this change?

Drazen: They will recognize that we all have the capacity … we have the awareness to find meaning in our lives. And we can only help one another when we’re open to doing that. Some of us find it through art. I think that’s one of the powerful ways to find it. I think that some find it through their spirituality, through their faith. Viktor Frankl has unconditional faith. He shows us how to transcend suffering. And I hope that physicians will help patients transcend suffering by caring for them.

To me this is the most precious thing you can have. My husband died of cancer and I remember when the physicians that he was very fond of would come into the room and he was really on the, on the “way out” as you say. And I remember there was one physician in particular, he would … my husband would take both of his hands and he would kiss the top of his hands. And my husband wanted him, he wanted to feel him, he wanted to know that he appreciated his, his giving to him.

Dr. Foley took care of my husband. And I know how she cared. It was tough on her and she paid a price for that. But I hope that in some way our friendship is Jerry’s gift to her.

Heffner: The, the essence of “Frankl’s Choice” … do you feel that it can be transmitted to the rest of us who are … I was going to say “the victims”, but then I realize you would say “no, we’re not victims” …

Drazen: No. No one’s a victim.

Heffner: We make our choices. He made his and we make our own.

Drazen: Yes.

Heffner: And you do find that the physicians who frequently use the circumstances of their lives, the insurance company, the Medicare demands, etc., etc., etc., that they are moved by this.

Drazen: Oh, I believe so. I think that they will be inspired to go further, to look into what he’s talking about. For example, in the film … and you saw it …

Heffner: MmmYmm.

Drazen: … so you remember. He talks about his entering Auschwitz and how they took this manuscript away from him. Now he wrote this book before he was there. And he had already developed this philosophy and I think that The Doctor and The Soul is the greatest book that he wrote, even though everybody talks about Man’s Search For Meaning. Because we’re all on a search. Every day we search. It’s a very complicated thing to be responsible for one’s thoughts, one’s life and to, to rejoice … look what we’ve got today … every day is a gift.

Heffner: Tell me where you see this. You certainly don’t mean just in the questionnaires that have been filled out after …

Drazen: Oh, no.

Heffner: … physicians in training have seen and physicians have seen the, the film.

Drazen: MmmHmm.

Heffner: You see this elsewhere.

Drazen: Yes, I do.

Heffner: And even as the rest of us declaim the mechanization, the increasing privatization of our lives.

Drazen: Well we go into a different space when we think about his ideas. I know I … when I awaken in the morning, I ask myself, am I really going to be responsible today or am I going to kid myself?

And what do I mean by “being responsible?” Certainly not just paying my bills and doing the errands, etc. But really do I think I’m deserving of a feeding, a nourishing part of my life? Is there some piece of poetry, is there some piece of music that I can stop and listen and read and have 15 minutes to heal. You see I think we have to heal every day, because we’re all bruised. This is what life is about. And we have to give to one another, that’s the gift that the physician has, that we don’t have. But we can begin to reach out to one another …

Heffner: You’re not really talking about physicians then? You’re not really talking about medically trained people, you’re talking about anyone and everyone who can understand Frankl’s message and can extend …

Drazen: Yes. That’s right.

Heffner: … himself or herself.

Drazen: That’s right. If you can help someone cross the street who is blind. If you can look into somebody’s face and know that they have real psychic pain and you don’t have to say anything, you can just touch them. This is very precious. We all need to be loved. This is really the heart of the matter.

Heffner: That’s the heart of Frankl’s …

Drazen: Message.

Heffner: … message.

Drazen: To work and to love.

Heffner: The, the physicians you approach … do they ever say, “why me?” Why do you direct yourself toward physicians? Why aren’t you, as a … in your almost theological mode, almost religious mode, but very personal mode … approaching all the others … not just the nurses and the dentists … I’m not talking about the medical model … I’m talking about the simple message which you obviously want to deliver and Frankl did deliver to everyone. Why the doctors?

Drazen: Well the doctor is probably the one individual in the community who has a very special gift. He has a very unique responsibility …

Heffner: His knowledge?

Drazen: Yes. And his training. And he must serve us in a very significant way. People primarily are secular today. They don’t go to … reach out to a priest or a minister or a rabbi as they did centuries ago. And I think that the doctor in some way serves and fills all of those places for us. He’s a confidant among other things, because sometimes you can have the most beautiful family and wonderful family and you can’t share what you’re really feeling, your anger, your disappointment, your pain, your fear … above all else. Because they’re afraid also. We’re all afraid. I think the most important thing that the patient has to know is that the physician is both afraid and is also highly frustrated. When he can’t deliver when you want him to deliver.

Heffner: Ruth … we used to think and it was a drawback that doctors were gods …

Drazen: Right.

Heffner: Doctors have tried to teach us that they are not gods.

Drazen: That’s right.

Heffner: I’m not saying they don’t believe they are, but … they have tried to teach us that they are not. You, it seems to me, are putting them back on that pedestal. You give them an obligation. You give them a, a bunch of “shoulds” that are unlike those that you impose upon any other group of people in our society.

Drazen: Well, I don’t think the physician is very different than, than you and I maybe. I think that he is interested in the same things and he wants to live his life …

Heffner: MmmHmm.

Drazen: … but I also think that he can’t be very effective if he doesn’t come in touch with the person he’s taking care of. I mean I’m more than just a problem to him. And I think that he’s loaded with disappointment, frustration and guilt when he plays a game with me because he knows it better than I know it, when he’s kidding me.

Heffner: But you know … it seems to me if you were to make the admissions judgment or judgments of all the medical schools in this country, you would require of the applicants to medical school something that is not required of them now. A capacity to feel and to understand …

Drazen: That is correct.

Heffner: An orientation that maybe given more to ministers and rabbis and priests than to physicians.

Drazen: MmmHmm.

Heffner: Don’t we have to approach this in a somewhat different way and, and find different categories or kinds of physicians because what you are looking for and searching for is not given, it seems to me to most people and to most applicants for medical school. You’re saying you have a mission, I endow you with … and you take that oath …

Drazen: That is correct. That is correct.

Heffner: You have a mission.

Drazen: MmmHmm. That’s why you’re on this earth. You’ve chosen to do this. And you have a responsibility to them.

Heffner: But maybe we’re talking then about different levels and gradations of medical help.

Drazen: Yes. That’s correct. I think there is a difference. I believe that when the physician … the candidate is interviewed, I think that we have to be able to hope that the interviewer is wise enough to get some sense of the person so that the candidate can be guided and the person who must be interviewed countless times, because many people would be great in the lab, but they won’t be great in clinical medicine. And, you can have a person who’s really not that smart … you can … he knows all the facts and he can take care of you. But he really is a great clinician because he’s a great person inside. And that’s what you want to evoke. And that’s the responsibility of every medical school.

Heffner: What did you find out when you studied doctors with cancer? Doctors as patients.

Drazen: I learned a lot. I learned how important it is to, to feel them, to care about them, and to recognize that they’re no different than we are. They are as wounded when they face that disappointment and that there’s nothing you can do. They hope against hope as we do that something of a miracle will take place. And I learned that …I learned to love them, to be truthful with you … as people. I never found that I interviewed anyone that I didn’t really know and share my life with before I filmed them.

Heffner: Are doctors lousy patients?

Drazen: Some of them must be, yes, I think so. Because they’re scared to death. They know the answers. Particularly those in oncology.

Heffner: Why do you say “particularly” because there’s such a certainty you can be that certain?

Drazen: Oh, well, I think that they know. I don’t think there’s any question about it. One of them in my film … died just a few days ago … and I called him many, many times through this last … through the end stage of the disease. And I tried to, to give him a boost every day because he had a row to hoe that was tough. And he knew all the answers. But the most important thing that I felt about him was that he had entrusted me, he was the first person I had ever filmed.

Heffner: The young doctor … young when you filmed him …

Drazen: Yes. Peter Morgan.

Heffner: Peter Morgan, that was such a touching film.

Drazen: What a beautiful man. What a beautiful man.

Heffner: I had the feeling that what we saw on the screen was that that man was made by his illness. Do you think otherwise?

Drazen: Well, I think some of us come in wounded. And I think you’re right. I think that Peter was wounded right from the beginning. We’re all wounded in various ways. I … my original training was that of a musician, I was a pianist. And I know that I’ve always felt that I was wounded and I reached out to try to heal myself every day.

Heffner: Is that and the death of your child and the death of your husband, are those the things that directed you, as a filmmaker toward the matter of doctors and their training and their approach to their patients?

Drazen: Yes I guess in a real sense because I learned when my child was ill that there were very few physicians who really could tolerate the problem of the parent … especially when …

Heffner: What do you mean?

Drazen: … everything was so negative. Well they could do nothing and so … what was the point in having a discussion with me?

Heffner: You must be sympathetic though toward them.

Drazen: Yes, I am because I understand their psychic pain and, and the fact that they really can do nothing. But when my husband died I was convinced that there was a place to try and bring about, within the community of medicine a dialogue, a dialogue where physicians would learn and want to talk to us. That we can bring them something. We’re a gift to them, if they look hard enough. Every person is unique.

Heffner: Do you know a doctor, a physician who is not harried, who is not busy, who is not running, running, running?

Drazen: I believe I do. I think that he has and carries a very, very heavy schedule. One comes to mind quite quickly. And yet you’re not aware of it when he’s caring for you. That is the real art. You see medicine isn’t really only a science, it’s an art.

Heffner: And are artists born? Scientists certainly aren’t. They’re made.

Drazen: Well I think that some level … I agree with you, I think that artists are born, it’s within you right from the beginning, that you have this driving need to express an idea. And right now I’m working on a film with … to make a film on Gustav Mahler and heaven knows you really encounter all of the ramifications of the psyche, together with the great music that he’s left us with.

Heffner: How do we explain the movement from physicians with cancer and Frankl and to music. I know that you began as a musician.

Drazen: Yes. Well I think that making the film on Mahler will give the physician another insight, another level. First of all he will find someone who really speaks his language. He will get a new space for himself emotionally. And I want to offer it to him.

Heffner: You really want everything you do to be directed toward the, I hate to use the word, because I don’t think it’s adequate …the education or the socialization of doctors.

Drazen: Of doctors and society. I want us to be able to make the best of our lives, to be the best that they can be. And that … this is very complicated … it really requires a very real focus of your mind and your soul constantly on … not what I have to do … but am I in touch with what I am doing?

Heffner: When will we see the, the new film?

Drazen: Oh, I think it has to take me probably until 2004 and hopefully I’ll live to do it. [Laughter]

Heffner: I think you’re going to live forever. The question is …

Drazen: Oh, I hope my films might live for a long time, even after I’m gone.

Heffner: Ruth, the films you’ve done thus far will live forever and I’m grateful to you a) for showing them to me and be) for coming to discuss them with them.

Drazen: Well, I …

Heffner: Thank you so much for joining me on The Open Mind.

Drazen: I thank you for the privilege of talking with you.

Heffner: Thanks, Ruth. And thanks, too, to you in the audience. I hope you join us again next time, and if you would like a transcript of today’s program, please send $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.