Every time I see a patient for a first consultation I draw the following diagrams to explain what I’m trying to do and how it might fit with whatever other treatments they are receiving.
First I draw two simple shapes –
I say, “The circle on the left represents health and the disordered looking circle on the right represents ‘not health’. In acute diseases, it’s usually pretty easy to understand what’s caused the problem (represented by the red arrow). For example, along comes the flu virus and gives you flu, or along comes the number 6 bus and knocks you down and breaks your leg”. “The whole purpose of undergraduate training in medicine is to teach doctors how to recognise the disordered circles. It’s called ‘making a diagnosis’. This training focuses on the disease or the lesion. The doctor says ‘I know what this is. It’s the flu.’ or ‘You’ve got a broken leg’ or whatever. Whatever the problem, the body sets about its normal activity of trying to repair damage and restore health. This process is represented by the sweeping purple arrow –
“Interestingly, because doctors are trained to diagnose the problem in terms of the disease, all the treatments you are offered are intended to fight, suppress, or remove the disease. What the treatments are not designed to do is enhance the process represented by the purple arrow. Benjamin Frankin understood this. He said ‘God heals and the doctor takes the fee’. It seems strange to me that at medical school we only learn about pathology, about diseases and how to fight them, when, in reality, nobody, but nobody, gets better from any illness without the healing process working. It’s the body’s own capacity to self-repair, self-heal and self-restore which returns, or attempts to return you to health. Treatments directed against diseases might give the body a better chance to do that. In fact, with many diseases, the problem may be too serious for the body to manage to self-heal without the support of fighting the disease. Fighting the disease isn’t a bad thing. It’s just not enough. We need to see what we can do to support and promote your self-healing.”
I then add the following elements to the diagram –
What this shows is the addition of arrows, representing treatments, on the top right directed against the disease. The horizontal lines represent the kind of wall these treatments attempt to put between the disease and the outside world. Many, many treatments are called “anti-something” – anti-biotics, anti-inflammatories, anti-depressants, anti-hypertensives – that’s because most treatment is intended to act against the disease. I point out that, that may be important to do, but that what is missing are the treatments represented by the arrows added on top of the big purple arrow. These represent any treatments intended to support and stimulate the processes of self-repair and self-recovery. (I might then have a discussion with the patient about what factors influence these processes). The final element of this little diagram is the addition of the arrows around and within the circle which represents health. What I say about them is “In acute disease, as we already discussed, the cause is often obvious and single. In chronic diseases, however, the factors which have produced the problem are typically multiple. The aetiology, or origin, of chronic disease in a person is multifactorial. Some of these factors may be internal – genetic factors, hormonal and nutritional factors for example. Some of them will be external – impacts from the environment, viruses, bacteriae, physical trauma, emotional and psychological traumas and so on. Really anything which impacts on you as a person can impact on your health, and may be a factor involved in causing the illness.’
I find this introduction opens up a holistic, mind-body approach to any illness, empowers the patient, allows for their to be hope, and takes away any “either/or” thinking about dealing with illness from a biomedical perspective of fighting the disease or a biopsychosocial perspective of helping a person with an illness to recover better health.
What do you think? Tell me if this is clear and whether or not you think it is helpful. It’s easy for me to adjust the conversation with the patient at the time, but in a little post like this it might not be so clear?
Heroes Not Zombies 
Interesting article and great site.
Something to think over – as in the long run it may help improve your health.
Well I could certainly use it with my current flu symptoms.
Cheers.
@Suzanne Thankyou for those kind comments. I hope you find plenty here to stimulate you! Hey, who knows, a bit of positive mental stimulation might be just the thing your immune system needs! Get well soon!
Doc, I’m sorry – I’ve read this post twice, and I’m still not sure I understand completely what you’re getting at. I’m CERTAIN it’s a better presentation in person and I’m also certain that I’m a bit distracted – we came home this evening to a cryptic answering machine message from my father-in-law; we caught “emergency room” and “urgent tests” and that was about it. I called the local hospital and it seems Mr. Chili’s mother has been admitted with a blood clot in one of her cardiac arteries. She’s in emergency surgery right now, Mr. Chili’s with his dad in the waiting room, and I may be too busy vibing for my MIL to full grasp what you’re trying to say here.
I’ll try again in the morning.
@mrschili “distracted”!! I’ll bet you are. Hope Mr Chili’s mother’s operation goes well. Here’s just what I mean – the surgeons will do their work. Then its up to her self-repairing, self-healing system to do its work. That’s the two halves of the equation really. The doctors do their bit to address the disease (the coronary thrombosis) and then they wait for her to recover (the big purple arrow). My hope for Medicine is that it develops the ways to actively support that recovery, rather than just addressing the disease and passively waiting for the physical and psychological repair.