What might health care look like if we base it on the values which emerge out of a prioritisation of difference?
Whilst a knowledge of pathology and the natural history of diseases aid a good diagnosis, a focus on disease is not a focus on a person, or on health. Even when running a specialist clinic, such as an Asthma Clinic, every single patient who attends is unique. Their asthma symptoms will be specific to them – the circumstances where their asthma is most troublesome will be specific to them – the strategies they have found bring greatest ease will be specific to them – and, crucially, their narrative will be unique. Where asthma appeared in their lives, and when, will be part of that narrative. What impact it has made and how they have responded to that impact will be part of that narrative. How the asthma will progress will also be part of that narrative. This latter part is unknowable, as the future is always an emergent phenomenon in a complex living organism. It cannot be accurately predicted. Last, but not least, each individual has a personal world view created by their genes, their nurturing, their life experience, their connections to others and so on – everything which influences values, beliefs and attitudes. Understanding that world view will help the patient to make sense of the asthma in their life, and understanding that world view is essential in helping them to choose therapeutic interventions as well as adaptive strategies. Whatever the general, the shared, or the common, all the findings, test results and so on, need to be re-integrated into the context of this unique human being’s life.
Because every patient is unique, the interventions which a particular patient finds beneficial will be specific to them. One-size-fits-all is a terrible approach to health care. Every single treatment protocol has an end point, and none of those end points can encompass benefit and a good outcome for each individual patient who goes through that protocol. So, what happens to the patients who make it all the way to the end of the protocol and are still suffering just as much? What does the doctor do with them? If we make only certain treatments available then there will always be patients who get no relief from their suffering. We need a diversity of treatment options, approaches and techniques available if we are to find the best, most effective treatment for every single patient.
Are protocols compatible with uniqueness and diversity? Can truly individualised health care be delivered by protocol? Can health care which actually relieves the suffering of every single patient be delivered by protocol? This might be extreme, but I’ve a feeling we should trash the protocols. Let’s get back to sound, clinical judgement which is flexible and focused ultimately on the needs of the individual who is in the consulting room here and now.
This goes with diversity. If there are a plurality of needs, and a plurality of solutions, with both being deeply affected by the world view of the individual, then we need to genuinely tolerate, in a non-judgemental way, those differences. There is no place in health care for rubbishing a patient’s experience and world view. Whose life is it anyway? Who is a professional to say that they know what the best life choices are for a patient? A professional should be caring, empathic, compassionate and supportive. Not judgemental, superior or authoritarian.
There is no such thing as a cure. Other than the cures which the body achieves. Human beings have the most incredible bodies. One way to think of a human body is to see it as a complex adaptive system. Complex adaptive systems have a number of characteristics but one of them is a self-healing capacity. The only healing which occurs in the natural repair, defence and growth of the living organism. It does this not least through integration – through the creation of mutually beneficial relationships between highly differentiated parts. All health care should be directed towards an increase in integration. Any treatment which impedes integration, impedes healing.
A lot of health care seems limited and disappointing to me. Sure, nobody wants to suffer, and a doctor’s duty is to relieve suffering. If we can do that by enabling a patient to get a handle on what’s happening, supporting them in the creation of a more meaningful narrative, whilst easing suffering and reducing difficult and limiting symptoms, then we are doing a good job. But is it enough? Is it enough to reduce the symptoms and stop there? Is it enough to support a patient through an acute illness but then stop when it comes to an end? Or if we really want HEALTH care, don’t we need to think beyond disease? Don’t we need to think about flourishing? About assisting an individual to grow, and, yes, to flourish – to feel well, to feel able to become whatever it is they have the potential to become?
If we begin to think about health in its fullest sense and in its greatest diversity, then we need to think beyond institutionalised health care systems. We need to think about what we can do to maximise the chances of people experiencing the best health they can – and that will take us into thinking about society, the environment, the economy, and indeed everything which is involved in creating the conditions for the health of human beings.