Faculty Profile: Harvey Max Chochinov

Oh! The humanities! Harvey Max Chochinov finds unique ways to include literature and the arts in health care teaching and research.

The distinguished professor of psychiatry recounts an anecdote from Michael Bliss’s biography of William Osler, Canadian forefather of modern medicine. In the story, a colleague knocks at the great professor’s door only to be greeted by choking and gagging sounds from within the room. He enters upon the scene of Osler threading a tube down his own throat.

“Is everything all right? What are you doing?” he asks, stricken. Responds Osler, offering his colleague another tube so he can join in: “We place these down many patients, and I thought I ought to know what it feels like.”

The colleague politely declined, Chochinov says, smiling. The point is that “Osler had these amazing insights about medicine — he understood that there were many things you could touch and feel that had to do with anatomy and physiology.

“But he also knew that there is this whole human aspect of care that really is about feeling, and unless you appreciate that, you aren’t going to be able to connect with or understand what your patients are going through.” In short, he says, “Osler understood the importance of humanity and of the humanities for the world view of the healer.”

Chochinov is the recipient of many awards and accolades. In addition to making “dignity therapy” an internationally recognized approach within his speciality of palliative care — incorporating disciplines from across the medical spectrum — he also has a number of other disciplinary aces up his sleeve. In fact, he solidly qualifies as artsy, with strongly developed interests and skills in music, history and literature.

His latest book, Dignity Therapy: Final Words for Final Days, just won the 2012 Prose Award for Clinical Medicine (the American Publisher’s Awards for Professional and Scholarly Excellence).

It explains the approach developed by Chochinov and his research team over a period of about 20 years. While there have been other aspects to come out of the palliative care research (such as the issue of “personhood,” a key component of “dignity-conserving care”), he says, dignity therapy is one that’s gained international attention.

Chochinov says he has spent much of the past decade on issues related to dignity.

“What we discovered is that even for people with advanced illness, there are a multitude of things that can influence a patient’s sense of dignity — everything from how well pain is controlled to whether or not they feel that people, including health care workers, still recognize them for who they are, for their worth, and confer honour and respect. In essence, attentiveness to dignity at end of life yields the very best that palliative care can deliver.”

While Chochinov is modest about the diverse talents that have led him to where he is now, he notes that it seems as though his past experiences and skills have prepared him well for what he is doing today.

“I’ve been fortunate, in that they have all come together in a particular and unique way to inform what I do,” he says.

Chochinov: “Everyone in health care needs need to understand that we are implicated in the success or failure of our interactions with patients.”

“The interest in literature informs my writing. I believe that how one says things matters. Certainly, as a clinician and someone in palliative care, I know that words, and how we choose to express ourselves with patients, can shape the entire tone of care.”

“With both history and literature, we gain so much wisdom about the human condition, which, in essence, is what I’m trying to understand in an empirical way, in palliative care research. Whether I’m assigning a short story by Chekhov or something by Tolstoy, these are wonderful teaching tools because they come from people with profound insights about being human, being vulnerable and being mortal,” he says.

According to Chochinov, all of medicine could benefit from the humanities. In fact, he’s working on a new book, which he hopes will be for everyone in health care “from the receptionist who works at a medical clinic to the person who makes the first incision.

“It seems to me that everyone in health care needs to learn something about communication skills; in particular, we need to understand that we are implicated in the success or failure of our interactions with patients,” he says.

Chochinov would like future psychiatrists to see palliative care as a tremendous career opportunity — psychiatrists have been slow in entering the field. “It can be tremendously gratifying,” he adds.

Palliative care, he says, has been growing both nationally and internationally. “The piece that our group has tried to add to that whole dynamic of growth is attention to psychosocial issues, understanding that, in addition to the medical expertise involving symptom management, that holistic palliative care requires attention to the physical, as well as psychological, spiritual and existential, issues that patients and families confront near end of life.

“The wonderful thing about the work one does in palliative care is that usually one knows very quickly whether or not you’ve made a difference. And how many jobs can you say that about?”

See more on Harvey Max Chochinov here.

Q+A

WHO INSPIRES YOU TODAY AND WHY?
I admire people who have the courage of their convictions; people who are able to put the needs of others ahead of their own; those who live their lives with passion and strive to make a difference in this world in whatever way they can. I have been fortunate to have found such people in friends, family and colleagues; my children inspire me.

BEST PLACE YOU’VE VISITED; SOMEWHERE YOU LOOK FORWARD TO VISITING:
In my work, I’ve been privileged to speak and travel around the world. My memories and most vivid impressions are of people; and I’ve met wonderful people in China, Japan, Taiwan, Singapore; Australia, New Zealand; Western Europe, Israel, Brazil, Argentina, and the list goes on. I’ve been invited to give some talks in Prague and Budapest this coming May. Not having done as much travel in Eastern Europe, that is a trip I am very much looking forward to.

A RECENT BOOK YOU’VE ENJOYED:
I loved Doris Kearns Goodwin’s A Team of Rivals: The Political Genius of Abraham Lincoln [the movie is based on this book]. Not only is the story telling gripping, but the lessons about leadership, vision and power are insightful and contemporary.

ON MUSIC:
Music was a big part of my childhood. I studied classical violin and along the way, also learned to play guitar. When I was nine or ten years old, I remember being taken to hear Itzhak Perlman play the Tchaikovsky Violin Concerto; it was a mesmerizing and transformative experience. It introduced me to what has remained my favorite violin concerto, and affirmed that, lacking Perlman’s talent, I was not destined to be a professional musician.

ACTIVITIES OUTSIDE OF WORK:
Anything having to do with the arts; film, theatre, music. I love reading, particularly books that provide new insights about the human condition. And of course, spending time with family and friends.

Faculty Profile is a regularly appearing column that features faculty of the university in the context of their research. This article first appeared in the March 21, 2103 edition of The Bulletin.

Mariianne Mays Wiebe