By Ron Epstein, MD
When I have been seriously worried about a health issue, or anything else that is out of my immediate control, companionship is often what matters most. The word companionship comes from the Latin roots com (“with”) + panis (“bread”), meaning “someone with whom you share bread.” Companionship is bidirectional and does not imply hierarchy. It is walking in stride together, without consciously trying to match each other’s step and pace. Companions share sustenance, material and spiritual. It is a being-with, without judgement or agenda, a virtue in and of itself. It helps us not to worry alone.
As I was beginning medical school, a mentor shared with me a copy of “Doctor and Patient,” written in 1969 by the Spanish physician-philosopher Pedro Lain-Entralgo. It was a landmark for me. In this short book, Lain-Entralgo described what is now called “person-centered care,” arguing that attention to the patient’s subjective lived experience and their human relationships is essential to all forms of healing. Drawing from Greek philosophy and other sources, he envisioned the healing relationship as “medical philia (friendship)”, a well-boundaried tenderness and commitment that goes beyond a purely transactional and utilitarian “patient-centered” relationship. The first premise is shared humanity, and that is what enables and energizes a relationship of shared vulnerability intrinsic to healthcare.
As family physician for 35 years, I came to know patients as whole, complex human beings, and they have come to know me. We walk in step and stride, even though the relationship is asymmetric in many ways. Speaking with other clinicians, my experience is not unique. The physician-author Jack Coulehan once described his medical practice as “tenderness and steadiness,” tenderness to connect with another human, and steadiness to not be consumed by the other’s suffering and distress. In the words of Roshi Joan Halifax, “strong back, soft front.”
While there has been much written about equanimity and compassion in medicine, I haven’t seen much about companionship. Companionship is important not only in patient care, but in our relationships with one another as colleagues. Even before Covid, physicians and other health professionals have felt increasingly isolated and lonely. More and more, I feel that companionship is part of the answer to the epidemic of burnout and clinician distress. In our workshops, we create space in which companionship can grow, and from the beginning of our work, we have been gratified that participants overwhelmingly identify the sense of connection with other participants as a powerful element of their experience, promoting a greater sense of well-being and flourishing in their work.
Further Reading
- Beckman H, Wendland M, Mooney C, Krasner MS, Quill TE, Suchman AL, Epstein RM. The impact of a program in mindful communication on primary care physicians. Acad Med. 2012;87(6):1-5.
- Coulehan JL. Tenderness and steadiness: emotions in medical practice. Lit Med. 1995;14(2):222-236.
- Lain Entralgo P. Doctor and patient. McGraw-Hill Book Company; 1969.