This was actually a 6-week course which explored the different ways in which we could overcome the technological and scientific constraints to make medicine more humane. I thought I’d share some of the key learning points from this course, particularly parts of the course which I found especially thought provoking. Some areas that were discussed within the course and that I found most interesting were: children with long term illnesses, the psychological impact of the arts within medicine and the process of dying.
One of the common problems with the biomedical approach to treating an illness is that often the illness or disease becomes the object of investigation. The patient’s body becomes a site for specific protocols and specialised tests to be run on in an attempt to treat or cure the disease. This isn’t the best approach as the patient’s experience of being ill and their feelings in dealing with a disease is often not part of the treatment. I read a really interesting quote which follows in saying that the good doctor is the one who treats the patient and not just the disease. So for example, when treating a cancer patient the doctor shouldn’t just focus his attention on the tumour, instead he should treat the patient as a whole. It’s important to listen to what the patient had to say about their own life experiences in relation to their disease. You mustn’t isolate the physical symptoms, but also consider the social circumstances, mental state and background of that patient – this was described in the course as the illness narrative.
I know that recently a more holistic approach to caring is being implemented, where doctors consider the psychological impacts of the disease and the feelings of the patient behind their illness. However, after thinking about some of the ideas investigated in this course, I’ve started to ponder on whether the same can be said for the treatment of young children. The voices of children are sometimes marginalised amongst the views of what’s best for the child from parents and the doctors, but it is equally as important to listen to their perspectives too. Perhaps it’s quite easy to dismiss the views of children with the thought that they do not understand their disease or what is happening to them. This thought could be even more common due to the fact that quite often parents try not to be too transparent with very young children about the nature of their condition, in fear of unnecessarily distressing them.
However the idea that children do not understand their disease and do not have an opinion on them couldn’t be further from reality. An interesting case mentioned in the course was the case of children who have been institutionalised due to very severe cases of TB. There was a young child of five years mentioned who was playing with clay and created a little model. After that she indicated and said that TB was eating her stomach and her mouth. This was a very accurate description coming from such a young child as she had gastrointestinal tuberculosis and pulmonary tuberculosis. I was quite surprised to hear this as I wouldn’t have expected such a young child to be able to actually understand what’s was happening to her without having being told. I think this just goes to emphasise how important it is to incorporate children’s emotions when they are living with a disease. The case was even more intriguing as in the past body mapping techniques were to engage people to express and visually document their own experiences of an illness. The idea was to draw an outline of one’s own body and then mark on that where one feels a diseased organ, the location of bruises or a health concern. This is ultimately what the child was doing.
In Medicine, decisions are based on evidence. Many studies conducted around integration of arts and medicine have demonstrated improvements in health outcomes, quality of life and improved hospital experience. I read about a study of 200 patients showing that music therapy decreased levels of anxiety, pain and depression and improved mood. This particular hospital created a visual art programme which was able to positively impact patients’ and families’ overall hospital experience.
A holistic approach is perhaps the most vital aspect when dealing with people who are nearing the end of their lives as it allows them to die with dignity. A doctor who keeps sending a cancer patient back for continuous chemotherapy sessions without ever considering the patient’s feelings or emotion is not fulfilling their role properly. It’s not always about curing the patient, because at the end of the day death is inevitable and unavoidable. Therefore, those who are approaching the end of life deserve the security of skillful attention to their physical comfort, emotional well-being and sense of personal dignity. Their families also deserve respect, communication and support. It isn’t about just thinking of the cancer as a separate entity, but the wider effects this diagnosis could have, even on other people beyond the patient themselves.
The initial purpose of the NHS was to treat acute illness, trauma and infection in short episodes of care is no longer relevant. Advances in modern medicine, obesity-related health problems, mental health problems and an ageing population have created a different landscape of care. It is also now more common to have two or more conditions than to have a single one. A health system that continues to address these problems as single entities is not going to be effective.
I really liked this short extract as it nicely highlighted how important it is that all aspects of healthcare, whether it be mental, social, or clinical are integrated and used together to help a patient.
Life of a Medic 