Jason Robert, of Arizona State University, made a presentation on Feb. 16 at the American Association for the Advancement of Science annual meeting. The focus is on mental health, but I think if you take a whole person understanding of health and illness you’ll agree that his points apply to all of health care.
“My claim is that gene maps and brain scans will likely not be able to offer universal, culture-free representations of the essence of mental illness. That is, mental illness is subject to biological and socio-cultural factors, such that isolating any of these as core elements will almost always miss the mark at the expense of patient care,”
He talks about how “personalised medicine” is being presented as a focus on DNA, with promises of new understandings of disease and new treatments which emerge from this genome-focus.
“None of these predictions have borne out, in part because they fail to grapple with the complexity of human beings — as brains, bodies, and, embedded in culture, steeped in history, and dynamically creating their own words,”
How well said! The attempts to reduce human beings to their elements, isolate those elements and treat them as if they were not a part of a whole, are doomed to failure because that’s just not how human beings function. It’s not real. What’s real is that the mind and the body are not two separate entities but are both manifestations of the one organism and that organism is embedded in physical, social and cultural environments – embedded – cannot exist in any kind of environment-free setting (if you could even imagine such a possibility!). And, his final, crucial point in that quote above – “dynamically creating their own words” – more than that, we can see that we actually create an entire sense of self from our own words….from our personal narratives.
He says
“We feel this newest generation of physicians have to be deeply well-trained in genetics and neuroscience, but not at the expense of a deep and meaningful training in interpersonal communication, interaction with actual people who really at the end of the day are your patients and your first priority,”
We really are in danger of losing this. The current trend is towards an increased dominance of statistics, management methods and pharmaceuticals. At the end of the day we are going to have to reclaim the central priority of the individual patients doctors see every day. I’ve just finished reading Jerome Groopman’s excellent “How Doctors Think” (which I will write a few posts about in the coming days) and he makes it so clear that without conscious engagement of the doctor with the individual patient, really nothing can go as well as it should. I’ve been teaching Fourth and Fifth Year Medical students this week and I was pretty shocked to hear from them that when they are being trained to “take a full history” ie to meet a patient for the first time and hear their story, they are only allocated 20 to 30 minutes to do so. When I was at Medical School, as beginners we were given an hour to that job. Once you moved from being a student to being a doctor the time pressures ratched up enormously and you had to hone your case taking skills down to just a few minutes in acute situations. However, at least you had a thorough grounding in a more comprehensive, patient-centred history recording. (Groopman says every generation of doctors thinks they were better trained than the current one. In terms of making a diagnosis from the history alone I’m afraid I am guilty of sharing that belief – is it true?)
In arguing the case for not oversimplifying our cultural understandings of people, he says
“We shouldn’t pretend that culture is any easier to understand than a person is; to understand that you can’t have caricature of culture in mind. What’s really critically important is understanding cultures dynamically, as complex, historic, social and political structures that dramatically influence people’s lives.”
I like that because I think there is a real tendency in all of us to stereotype people on a cultural basis without really understanding the culture at all. I also like how he points out that culture is a dynamic phenomenon, not a fixed one.
The conclusion of the piece is absolutely spot on –
While Robert acknowledges that it’s certainly the case that DNA and brain scans are going to be important, “if you ignore everything else, you might never have the capacity to actually influence the well-being of the patient.”
Well said!
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