integration

One day, a long time ago, I was still pretty new at my practice in my former paying job in health care.  One of my patients was a middle-aged gentleman who had undergone radical surgery for prostate cancer.  He had been told that the surgery had gone well, and that the surgeon thought he had excised the tumour completely. 

With tubes and lines coming out of nearly every orifice, the man was bearing up well with the post-op recovery and optimistic about the prognosis.  However, he was shaken in his confidence when I informed him that he had been booked for a bone scan that day. 

"Why?" he wanted to know.

I tried to explain in simple terms.

He wasn't satisfied with my answer.  "I thought the surgeon said he got it all."

Over and over and over again through the course of the day, he would ask me again, and I would try to explain why bone scans are generally done in these circumstances.  My answers didn't satisfy him at all.

He was a gentleman used to giving orders and getting answers in his professional life, with a decent education and a tendency to organize his life so that it made sense to him.  I could understand his frustration.

To my delight on one trip past his room, I spied his surgeon making his rounds.  I popped in as unobtrusively as I could and listened to their conversation.

No mention of the bone scan.

Not having heard their full conversation, but suspecting that the patient wasn't going to ask the question he had been pestering me with all day, I asked:

"Did you ask Dr. X about the bone scan?  Here's your opportunity."

"Oh yes,"  the patient said, but he looked as if he would rather murder me!
"Why am I having a bone scan if you said you got the tumour, doctor?"

The surgeon standing at the foot of the patient's bed rocked back on his heels, his hands clasped behind his back.  He had looked out the window during most of his conversation with the patient and that didn't change.

"Because I said so,"  he said flatly.

I looked at him, aghast.  Then I looked at the patient.

"O.K.," was all the patient said.

The doctor turned on his heel and left the room.

Even so early in my practice, I had seen this many times before. However, I could not help being a little surprised.

"Are you satisfied with that answer?"  I asked the patient.

"Well, no,"  he admitted.  "But I don't want to make him mad."

I must add that this kind of autocratic behavior from doctors is quickly becoming a rarity.  Many patients still have the attitude that doctors are gods, but many more expect clear explanations and rationales for the diagnostic tests and course of treatment.  And some even want to participate in the decision-making process.  And doctors are changing with their patients.

Although many people still buy into it, entering the  system so reliant on the liberal administration of drugs or surgical intervention, that such a client may leave a doctor's office disappointed indeed if she does not leave clutching a prescription or a referral to an expert or surgeon, many individuals emerge from encounters with orthodox medicine feeling justifiably disappointed and angry.

This system is one of industrial strength bureaucracy, impenetrably impersonal, an assembly line of health care delivery.  Tests and treatments are often delivered in an un-integrated manner, leaving the client feeling she is trying to navigate a maze at best, or worse, feeling excluded from the process of their own care, bewildered and dissatisfied.

According to the National Center for Complementary and Alternative  Medicine in the United States, approximately 38% of Americans use some form of CAM.  Although these people come from all sorts of backgrounds,  more women use some form of CAM and more people from higher educational and higher income backgrounds.

According to the authors of The Okinawa Program, doctors working in orthodox medicine  (and I would add nurses and other professions) are frustrated too.  Insurance companies and government health plans are pretty specific in the kinds of tests doctors can order, the types of treatments that will be covered and even in the amount of time a doctor can spend with a patient.  Their training in alternative and complimentary treatments is very limited, if it exists at all.  Often, doctors leave medical school with the attitude that CAM is a field of quacks and charlatans, with patients who are silly or gullible to subscribe to superstition and old-wives tales.  More often, they are quite uncertain about what alternative therapies are actually about.

But this too is changing.

The dissatisfaction with a model that has treated people as objects has grown to such an extent that many of the conventional medical schools are including some courses on alternative or complementary medicine in the curriculum, starting the process of integration.

It is amusing to notice the extent to which whatever system of belief enjoyes being accepted as the orthodoxy will persecute another system of belief that appears to challenge it and will label it as heresy.

Any questioning and experimentation of an inquisitive intellect, often propelled by need, will breed new or "exotic" theories and therapies.  These are almost always, without exception, resisted by the orthodox of any place or time as quackery.

To complicate things even more, there is the well-researched placebo effect, which has been shown to be so strong that belief and trust in a therapy or therapist, often elicits real cures, even when the methods are based on wrong assumptions and beliefs and the methods are completely unrelated and insignificant to the cure.

So, deception is the element that must be included in the definition of a quack, where an individual or an organization pretend to have medical knowledge, using intervention intended to deceive a gullible client, often for material or some other secondary gain to the practioner(s).

A practioner, orthodox or otherwise, who genuinely believes in her methods and is able to create belief in her client is not a quack, even if her beliefs and practices turn out to be unsound.

But the greatest driving force of change here is that people are demanding it.  Where they used to be satisfied with the old health care system with its top-down hierarchies of power, history is being made by the newly empowered consumers of health-care, turning the former paradigm on its head.

With more education and money than ever before, today's client has access via the internet to information of almost any kind, including information about their health problems and the treatments available.

This worries a lot of people in orthodox health care.  It worries consumers as well.  How to find diagnoses and treatments that are sound?  What to do about consumers who might be taken in by quacks?  Who is the best authority on one's health?  What about all the mis-information out there?  (I promise I will deal with that problem in a future post.)

But an honest health-care professional will admit that no system of therapy has a monopoly on knowledge and even more certainly no system has a monopoly on failures.  And most bewildering of all are the people who get well despite the worst prognostications of one system, often when those people have left to seek another! 

It is discouraging to note that clear and dramatic cures of advanced illness following therapies of any kind, of any system, are very uncommon and rarely documented, except in anecdotal form.   It's as if  we don't know how to study the situations where these people get well.  In orthodox medicine where we keep statistics on such things as morbidity and mortality, we don't keep such good statistics on cures, especially cures that "aren't supposed to happen." 

But integration is probably the eventual outcome of the historic dichotomy that has existed between the orthodox system of medicine and what we today call alternative and complementary systems of thought around wellness and healing.

Of course, there are some who will throw out the orthodox baby with the bath water, who will not get their babies innoculated, who won't go near a doctor for any reason.  And then there are those who still regard objective science as the answer for everything, even though long ago, science itself has undergone a transformation in which it finds itself contemplating the extent to which the observer materially changes what is observed, where theories are exploding our former Euclidian understanding, resulting in a fractal universe, so to speak.

Scientific theories of chaos and complexity, quantum theory, the holonomic universe, systems theory, morphogenic fields, dissipative structures, etc., can leave one feeling like the supposed mirror of "pure science", of universal objective reality, has become disorganized and distorted to such an extent that it floats in atomic and subatomic splinters before our very eyes.

Anyone, all truth-seekers, can see that there is an influence of a huge, all-inclusive web of factors on everything in this world, every object, feeling, emotion, action.  We realize we are no longer just a complicated mechanism, a mechanical object, an unemotionally self-aware rational ego separate from the interconnected webs of life and the universe.  We realize that it is most certainly pathological and destructive of life to continue as we have, denying that life depends on interlocking circuits of contingency and interdepence and influence.

In terms of health care, we are starting to reconnect the body and emotion, the unconscious, the imagination and intuition.  We are getting a glimmer of the immanent intelligence of nature, and we are mourning too late the disappearence of indigenous and archaic cultural perspectives (see for example Wade Davis: The Wayfinders, Why Ancient Wisdom Matters in the Modern World.)

The question remains, where is orthodox medicine?  Hopefully it is ready to relinquish the unhelpful and open to a soulful embrace of magic!  The public is already well on its way!