Heroes Not Zombies

Doctors are trained to diagnose. In effect this means understanding a patient’s illness, interpreting their suffering, making sense of it. However, in practice, undergraduate medical training makes disease, not illness, the focus. Eric Cassell nicely distnguishes between “disease” and “illness” in his “The Healer’s Art” (ISBN-10: 0262530627). Illness, he says, is the patient’s whole experience of suffering, whilst disease is the pathology.

In fact, the developments in Medicine over the last few hundred years have mainly been driven by technologies which allow us to look deeper and deeper, considering smaller and smaller elements of a human being. At first, we started to look at the organs inside a body to see where disease lay, then with the invention of the microscope, we looked into the organs to see the cells, and so on, right up to the present day where we look at the DNA. This has helped us to greatly improve our understanding of how the human body functions and what is happening when a part of the body becomes disordered. However, a person is more than a material body made up of DNA, cells and organs. Every person is different but what makes them unique is not just their DNA but their connections. We all exist as organisms embedded in multiple environments. This concept of embeddedness is an important one in biology. If I want to understand a patient who presents with a particular illness I need to explore who they are in the contexts of their families, their relationships, their physical and cultural environments.

I’ve thought about this a lot and I’ve made this little device to help me to more consciously practice holistically. This is a simple strip of photos I’ve taken. You can think of it as a kind of slide rule. When a patient presents to the doctor they tell their story. They say, this is what I am experiencing, this is where it started and this is what I’m concerned about. (OK, they might say a lot more than that, but most people will tell a story that includes those elements). As the doctor tries to understand what is happening, tries to make sense of the patient’s story, in order to make a diagnosis, he or she will shift the focus of consideration.

Start with the person in the middle of the strip (that’s me, reading) – the person. As you move your focus to the left you can look deeper and deeper in. Where does the problem lie? What is not functioning? Where is the disease? Is it at the level of a system? Say, the nervous system? Or at the level of an organ? Do I need to do an XRay or a scan? What is happening at cellular level? Do I need to biopsy something? And what about at a molecular level? What lab tests would elucidate what’s going on here?

Pretty much that’s how most consultations with doctors go – listening to the story, examining the body, running some tests. This can all be extremely helpful but let’s now go back to the person who might have the disease. How do we understand their illness? How do we understand the contexts of their illness? Move the focus to the right. What about this person’s relationships, and family? Have their been any major changes or issues there recently which may have had an impact? How do we understand this person’s illness in the particular society to which they belong? And finally, what about thinking more globally? Understanding this person and their illness in the larger world.

Why is this important?

Well, everything to the left of the person in this “spectrometer” is a consideration of the disease they have, but in order to become healthy, to recover, to cope or to heal, we have to support that individual’s unique systems and strategies of defence and repair. We can only do that by understanding who this person is who has this disease. So, only to consider what lies within the person is not enough, we also need to consider who this person is and how they experience life.