We are more than our individual parts

Psychoanalyst Darian Leader says doctors need to treat more than the physical symptoms. "Doctors don’t listen to us. That’s one of the reasons for the growth in complementary medicines. No matter what their medical benefits, they treat patients as individuals and not just the sum of their parts. What concerns me is that by not listening to patients, doctors and other health professionals are not only making patients feel excluded, they are missing out on information about their history that could reveal the true root of their medical problem."

One bestselling textbook for medical students pays lip service to the doctor-patient relationship, telling doctors to indicate to the patient that they recognise their experiences. Then it explains why: “Otherwise the patient may tend to believe that the clinician has not got things right, which increases the risk of the patient not adhering to the recommendations that follow.” In other words, it makes it more likely that the doctor will be obeyed.

It wasn’t always like this. Just before the Second World War doctors were lamenting how the study of disease had begun to overshadow the study of the patient. They recognised that illness was not an isolated physical problem but something that concerned the whole person and his or her relationships with others. Then, but not now.

Now patients are shunted from consultant to consultant, each one unable to follow a patient for long, removing any possibility of learning about their ways of coping, reacting and dealing with their lives. The patient is alienated in a chain of medical procedures, and any chance of studying the relationship between illness and the person as a whole has been lost.

Until the mid1950s, it was not uncommon for a psychotherapist or psychiatrist to receive referrals from a dentist. Yet today this would be a newsworthy event. What happened? In a series of papers in learned dentistry books and journals in the 1940s, psychological factors were recognised as bringing about changes in the saliva and gums that encourage bacterial activity.

Medical students, for example, have higher rates of dental decay after exam time than at other less tense moments. Nighttime gnashing of teeth has been linked to a psychological state in hundreds of studies.

Yet, today, teeth problems simply mean a trip to the dentist. Case closed. Does the patient lose out here? I heard about a dentist who diagnosed constant clamping of the jaw at night in a patient who was an artist, a painter. The dentist advised on dental procedures but didn’t ask any questions of the patient. So he was unaware that the symptoms had started when the painter knew that a canvas she was particularly attached to was going to be sold. Once she realised that it was her wish not to part with the painting that produced her jaw clamping, the nocturnal symptoms disappeared.

It’s a similar tale with eyes. Psychiatrists once received many referrals from ophthalmologists, yet today this would be seen as bizarre. In 1960, a paper in Psychosomatic Medicine estimated that between 40 and 100 per cent of recorded eye disorders were influenced by psychological factors. Intraocular pressure, for example, can be associated with states of anxiety, and may influence conditions such as glaucoma. But today, drug treatments are applied almost automatically.
The move away from listening to patients to looking at bare physical facts is reflected in the way that we now regard the only authoritative research as being about numbers, not people.

Source - Times

5 comments:

  1. How HAVE we come so far from seeing people as whole beings? I find this article extremely telling. Maybe nnot complementary as such, but surely exactly what anyone involved in trying to help people is all about?
    See my website - www.amatsu-therapy.net
    xx

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  2. Anonymous11:47 am

    Well we need a bit of both. The big picture and the little bitty details.

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  3. Do you think the big picture is made up of little bits? Or are we totally wrong and the big picture is it? The little bits are nothing without the whole?
    xx

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  4. Anonymous9:56 am

    It depends if you end up needing a little bitty transplant.

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  5. But I guess that if we were better at preventative, we wouldn't need transplants - little or big.
    xx

    ReplyDelete