Water cooler medicine
A few days ago, I wrote about the differences between Chinese and Western students and the way they perceive things. The Chinese students viewed images more holistically, and the American students viewed images as individual pieces. For a long time, so-called “eastern” medicine has been synonymous with “holistic healing.” This has included some practices of questionable benefit, but one of the overarching themes of eastern medicine has long to view the body as a whole, rather than a collection of pieces to be fixed individually. This also includes taking into account people’s lifestyles and habits, and perhaps making recommendations to alter them if necessary.
This holistic approach is something that western medicine has traditionally lacked, but now steps are being made in viewing a patient as a whole person rather than a bag of symptoms and body parts. This is even extending to how a patient is able to pay for their care — speculation on a patient’s background and what kind of lifestyle they are living can lead to a more complete picture of a person.
No longer is a well patient with a sick gallbladder of medical interest for her gallbladder alone. With doctors increasingly exhorted to care for the whole patient, not just the disease, that gallbladder is often examined in its full context, and all social information - what might be considered gossip in any other context - becomes relevant.
Is the gallbladder upset because its owner is eating too much fatty food? Are those deep fried onion ring binges caused by unhappiness in the home? Is there a possibility of domestic violence? Should a social worker and a lawyer be called as well as a surgeon? The scans show only the inflamed gallbladder, but medical caretakers are now encouraged to see beyond the scans.
Sharing information from every perspective has become the way of the future. In medical school, students are now encouraged to link disparate medical and social details into a cohesive story, a veritable novel about each patient. In hospitals, doctors, nurses, social workers, psychologists, therapists, dietitians and members of the clergy regularly meet to pool information about patients in “multidisciplinary rounds.”
This is actually the case for pharmacy students as well. During fifth year, the majority of class time is dedicated to case studies and outside research. Complete profiles on people are built and given, and students are encouraged to ask these sorts of questions of patients in person as well. The problem with this is that many patients don’t see what lifestyle habits and seemingly unconnected symptoms have to do with one another. When you ask questions, the patient may feel as though you are prying by asking questions that are none of your business. Doctors can more often get away with this than pharmacists can.
It can be frustrating sometimes when you ask a person about background information, even about something as simple as allergies. For instance, someone comes in complaining of a sore throat, and they ask what they can take to make their throat feel better. Well, often the cause of a sore throat is post-nasal drip due to an allergic reaction. So when you ask them if they’re blowing their nose and swallowing a lot, they often look at you funny as if they’d like to say “What does that have to do with anything?” because they’re expecting a recommendation of a throat drop or spray. Anyway, I’m rambling, but if you educate them about what’s going on, and what’s actually causing the irritation, they get happy because they know you’re going after the source of the problem rather than simply fighting the symptom.
This was a very simplified example — but the next time you visit a doctor’s office or pharmacy and someone asks you a question that you think is outside the boundaries of your situation, stop and think. The person isn’t being nosy; they’re trying to help you. They can better help you when they have a background picture of who you are and what’s going on. It is this sort of holistic medicine that offers the most promise in Western, allopathic medicine. I would expect to see quite a few changes in this regard in the next ten years. At least, I hope we will, because it will only benefit the public at large.
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