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Sacred Spaces

December 23, 2016
by Dave Levin, M.D.
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My former Cleveland Clinic colleague Mikkael Sekeres, M.D. is both an outstanding oncologist and an exceptional writer. He recently penned this piece in the New York Times. It’s a moving description of an encounter he had with a young oncology patient and his pregnant wife. It’s a terrific read that gives one a deeper appreciation of the clinical and personal meaning of this episode of care. Perhaps you have had similar experiences as a patient or, like me, as both a patient and in the role of caring health professional.

This part resonated especially deeply with me:

“My clinic rooms, clean and nondescript as they are, sometimes provide a safe house for laying bare the difficult thoughts, the wrenching decisions, that tug on my patients. I couldn’t guide this couple on what to do about the pregnancy, but they weren’t really asking me to.

They just wanted to be heard. By me, but more important, by each other.”

Creating, nurturing and valuing these “scared spaces” for healthcare is essential. No matter how much technology, technique and advanced treatment we have, at the very core healthcare is always about caring. It is about people connecting in deep and deeply personal ways. Patients need the time, space and trust to hear and be heard. Caregivers need the same. I can vividly recall times in my career when my patient and I found ourselves in such a sacred space. A moment came when one or both of us had the courage to ask or reveal something important. Such interactions can literally be life changing.

Healthcare IT (HIT) plays a role in sacred spaces too. HIT can enhance or detract from scared spaces. For example, is your doctor heads-down, facing a wall and pecking at his keyboard during most of your office visit? Or, was the exam room thoughtfully designed and inhabited by a well-trained provider with user-friendly software? That combination can enhance the patient and provider experience. Show a patient a graph of their blood pressure or the image from their last MRI and you just enhanced the encounter with HIT. Become lost and distracted by a poorly designed user interface or hide behind your keyboard (the modern equivalent of hiding behind the paper record) and you just did the opposite.

This ancient concept can apply to some of our most modern technical solutions, sometimes in surprising ways. For example, there is emerging evidence that some patients requiring behavioral health services prefer telemedicine and are more forthcoming than they are in face-to-face settings. It seems reasonable that mobile solutions in general will be well received by patients and providers—assuming they believe them to be secure and private.  Advances in fields like predictive analytics and genomics will bring great benefits but will also increase the need for sacred spaces that allow patients and providers to explore the implications of specific predictions about future health.

21st century medicine is a fascinating blend of cutting edge technologies and long-standing, immutable truths about human beings and how we interact. Everyone benefits when we remember to keep relationships front and center. Creating and maintaining sacred spaces in healthcare goes a long way in making sure we do.

Dr. Dave Levin has been a physician executive and entrepreneur for more than 30 years. He is a former Chief Medical Information Officer for the Cleveland Clinic and serves in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors. You can follow him @DaveLevinMD or email

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