Rituals in Medicine

by Academy of Clinical Excellence on March 1, 2011


The late Jerome Frank, a Hopkins psychiatrist and esteemed scientific investigator of psychotherapy used the study of therapies that succeeded and failed to define several characteristics common to all successful therapies (Frank and Frank 1991). One of the characteristics he identified as most important to psychotherapy outcomes was the use of ritual. I believe Frank’s findings on the common elements of successful therapies have application to all of medicine, not just psychiatry.

Abraham Verghese, a professor at the Stanford University School of Medicine, author of the novel “Cutting for Stone,” wrote about the importance of ritual to the healing of patients in a recent opinion piece for the New York Times. In that article, he reflected: “In my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient.” Later he stated: “I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them….Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: ‘I will see you through this illness. I will be with you through thick and thin.’ It is paramount that doctors not forget the importance of this ritual.”

What other characteristics did Frank find common to all successful therapies? Do they also have a role to play in the healing of all patients? If so, can all doctors be trained in these skills, as they are in the physical examination?

Here’s a link to Verghese’s article in the New York Times

Margaret S. Chisolm, MD
Assistant Professor
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine

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