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Each Patient is a Work of Art
by Leo Galland, M.D.
| Disease theory has no logical relation to person—in disease theory it does not matter what person has the disease—therefore, the common complaint that patients are overlooked in the treatment of their diseases is another way to stating that in the intellectual basis of modern medicine patients and their diseases are not logically related.
—Eric Cassell, M.D. |
The treatment of “diseases” without regard to the persons they afflict has brought clinical medicine to a crisis of confidence as great as the one it faced a hundred years ago, before the release of the Flexner Report. I am expressing dismay at the inadequacy of current clinical practice. Others have attacked its excesses. The inappropriate use of drugs, for example, accounts for well over half of the episodes of cardiac arrest that occur in the hospitals of our university medical centers. A Harvard research team studying iatrogenic (doctor-caused) injuries concluded that 180,000 Americans are killed in hospitals by their doctors every year, because of therapeutic mistakes. In most cases, clinical errors occur because the doctor has overlooked the individual characteristics of the patient being treated. Specialization, which was so dear to Flexner, is now decried as too costly. The federal government has cut educational funding for specialists and mandated more training of general physicians. Yet there is little understanding of the real skills required of generalists. Current administrative rules pressure them to act as double agents. Ostensibly responsive to the needs of their patients, primary physicians are ultimately controlled by the demands of managed care corporations and are penalized if they fail to control their patients’ use of services.
The present crisis provides an excellent opportunity for reconstructing healthcare. Disease theory has outlived its usefulness. Any regulated healthcare system that relies on rigid protocols for the treatment of disease will trample the individual needs of sick people. The only way out of the crisis is for the individual—not the disease entity— to become the focus of care. Physicians must be trained to understand the kaleidoscope model of health. We have learned enough about the mediators, triggers and antecedents of sickness that patient-centered diagnosis can be fully integrated into the process of clinical evaluation. Generalist physicians must become experts at reinforcing the Pillars of Healing. They must be trained in creating a healing relationship with their patients and in analyzing each person’s díaita, counseling individual changes. They must be able to instruct patients in establishing a healthful environment and understand the intricate chemistry of detoxification so that their treatments support the body’s processes of repair, rather than hinder them. This must become the standard of care, for individual practitioners, for managed organizations and for regulatory agencies. These endeavors will not fully replace crisis management, surgery or the use of drugs. They will decrease the need for expensive and invasive treatments, decrease the frequency and severity of complications when such treatments are employed and improve the overall effectiveness of care.
The crises afflicting mainstream medicine have stimulated interest in alternative medical therapies. About a third of the U.S. population consult alternative health practitioners. Americans spend more money out-of-pocket on unconventional healthcare than on conventional care. People seek out alternative therapies because conventional, disease-oriented medicine does not meet their needs. Conventional medicine is too often impersonal, ineffective or dangerous. Recognizing that alternative therapies increase patient satisfaction and decrease cost, managed care organizations are starting to incorporate them among the services they offer.
Several medical schools have added courses in alternative medicine to the curriculum and divisions of integrative medicine are coming to life in major medical centers. Research projects have been initiated that utilize scientific methods to evaluate alternative healing techniques. These efforts alone will not have much impact on the practice of medicine. The strength of alternative medicine lies not in its varied techniques, which often fail to withstand scientific scrutiny, but in its fundamental approach to the patient. As a whole, alternative medical therapies rest on the traditional concept that illness results from imbalance or disharmony. Supporting the body’s capacity for healing by restoring “balance” is their ultimate therapeutic goal. This traditional perspective must be restored to the practice of medicine and must guide the application of medical science to the care of patients.
The power to initiate change lies within you. It begins with your taking an active role in maintaining and promoting your own health. Whatever your age or your state of health, there are five steps you can take immediately to begin the process of health enhancement. These steps have been woven into the stories and explanations that appear throughout my book Four Pillars of Healing. They are:
- Eat consciously. Say “no” to snack foods, which for most North Americans supply one-third of daily calories. Ignore the latest dietary fads. Nutrient density is the key to healthy eating. Read food labels and avoid those foods that list sugar or oil as ingredients. Eat vegetables and fruits at every meal, especially those rich in disease-fighting antioxidants, flavonoids, carotenoids, saponins and fiber. Spice your meals liberally with garlic, onion, ginger, turmeric, oregano, sage, thyme and rosemary. Buy fresh local produce in season, wash and peel or scrub clean with a soft brush just before cooking or eating. Wash your hands thoroughly before and after handling food. Cook all meat, fish or poultry well and thoroughly clean all utensils that contact uncooked food. Filter and/or boil drinking water. Most people will benefit from supplementing their healthy diets with flaxseed oil, vitamins C and E, magnesium, trace minerals and friendly bacteria, like Lactobacillus acidophilus and Lactobacillus plantarum. Unless you are iron-deficient, avoid supplements that contain iron.
- Get enough physical exercise. Commit yourself to 30 minutes a day of moderate- or high-intensity activity. Make exercise a family affair or do it with a friend.
- Explore meditation. A period of quiet contemplation, prayer or deep relaxation once a day improves immune function and has remarkable recuperative power.
- Create a safe home. Once your home is clear, turn your attention to the safety of your work environment and your children’s school.
- Avoid drugs that disrupt your body’s ability to heal itself. Street drugs and tobacco have no redeeming qualities. Drugs that lower stomach acid increase your risk of intestinal infection. Alcohol and aspirin appear to have a two-tier effect on health. Very low doses may be beneficial; higher doses are potentially harmful, damaging the lining of stomach and intestine, increasing the entry of intestinal toxins into the liver. Antibiotics are the most important drugs ever developed, but their overuse has tragic consequences; it destroys the body’s friendly flora and contributes to the emergence of antibiotic-resistant pathogens.
Implementing these five steps will do more than improve your health and well-being. It will equip you to change the nature of the medical care you receive. Healthcare can only change for the better if you, the patient, are an active participant in setting priorities for your own care. Taking charge of your own behavior empowers you to assume a collaborative relationship with your doctor. Inform your doctor of the steps you are taking to improve your health. Present your goals and expectations. Request the information that you need. If you are sick, explain the ways in which your illness has changed your life; express your feelings about the illness and expect that your doctor will listen, acknowledge you and treat you with respect. If your requests are not met with respect, change doctors and register your dissatisfaction with the managed care organization that employs or contracts with the doctor.
The foremost demand of patients is for healthcare that addresses their personal needs. That demand often remains unfulfilled, for the precise reason described by Dr. Cassell. The concepts that underlie modern medicine are concepts of disease, not of person. Patient-centered diagnosis allows the person who is sick to be at the center of healthcare. It sees through the obsolete notion that disease entities can exist in and of themselves. It unites science and humanism, allowing the power of science to consistently support the artistry of personal healthcare. It allows us to see, with the tools of science, that each patient is a work of art.
Adapted from The Four Pillars of Healing, by Leo Galland, M.D. Published by Random House, Inc., 1997.
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