It strikes me that the practice of Medicine (I’m specifically referring to the world of Medicine for humans here), begins and ends with a relationship between human beings.
I’ll just focus on the doctor-patient relationship here, because that’s how I spent my working life. But I suspect that much of what is relevant to this relationship is also true for other health care workers, and perhaps even in other areas of human life.
When I say the practice of Medicine begins and ends with a relationship between human beings, I mean that the whole, unique person who is the patient has to be understood, cared about and attended to, by the whole unique person who is the doctor. Both individuals are important. I think this is partly why there are no doctors who are the best doctors for everyone, and I think it explains how in a group General Practice, each of the doctors in the partnership will have a specific loyal cohort of patients who always seek a consultation with that one particular doctor.
I also think this means that the whole person must always be considered. Anything less is reduced, and anything reduced is less than human.
In this context, I recently read “A General Theory of Love”, by Drs Thomas Lewis, Fari Amini and Richard Lannon. [ISBN 978-0-375-70922-7]. This book describes the model of the triune brain, which you might have come across elsewhere. (My introduction to that model was Dan Seigel, and later, Rick Hanson). It’s the observation that we have three brain regions – the brain stem, which is responsible for survival, and is found even in reptiles (henceforth to be known as the “reptilian brain”), the limbic system, which is responsible for memory processing and emotions (called the “mammalian brain”, because all mammals have this part), and the neocortex, which is massively developed in humans and seems to give us the capacities for abstract thought, conscious decision making and rational analysis.
In “A General Theory of Love”, Thomas Lewis and his colleagues focus on the limbic system – they describe in detail how this part of the brain helps us to “feel” other people’s feelings. It’s the kind of phenomenon that others call “heart feelings”. Without this part we’d have the reptilian survival strategies or the cold, analytic distancing of the neocortex. Let me be really clear here – this is a simplification and human beings are a lot more complicated than that. But this is a useful simplification which clarifies certain truths about what it is to be a human being.
In this post, I want to just bring to your attention some of the points the authors make when taking this perspective on the practice of Medicine, because I think health care is in a dire and degenerating situation in the world.
The last century saw a two-part transformation in the practice of medicine. First, an illness beset the relationship between doctor and patient, then radical restructuring attached the residual integrity of that attenuated tie.
I think the illness and the radical restructuring they refer to developed from a general reductive de-humanising of health care. Iain McGilchrist has shown how a “left hemisphere approach” has come to dominate society and I find that explanation helpful. Lewis says
American medicine has come to rely on intellect as the agency of cure. The neocortical brain has enjoyed a meteoric ascendancy within medicine even as the limbic star has fallen into disfavour.
Whilst this focus is a little different, the basic point is actually the same. By coming to rely on data, figures, statistics and techniques, we have reduced the human-ness of medicine. We’ve increasingly denigrated the patient’s narrative, the individual’s subjective experience, and the place of heart felt caring.
The limbic brain has a crucial role to play in attachment, and Lewis describes attachment theory along with the physical and social consequences of disordered attachment incredibly clearly. And here’s one of the most important points in this book – the physical reality and hence importance of relationships, emotions and attachment –
Medicine has lost sight of this truth: attachment is physiology
The radical restructuring they refer to is seen throughout Western Medicine – its the rise of bureaucracy. We see it in the proliferation of protocols and guidelines, of the prioritisation of measurement – what others have referred to as “Taylorism 2.0” (the modern equivalent of Taylor’s “scientific management”) – at the expense of what cannot be measured – the lived experiences of the patients and the health care workers.
Good physicians have always known that the relationship heals. Indeed good doctors existed before any modern therapeutic instruments did…
For many years, the medical community hasn’t believed that anything substantive travels between doctor and patient unless it goes down a tube or through a syringe.
They neatly sum up their thesis with
medicine was once mammalian and is now reptilian
Corporations and organisations have taken the high ground imposing their limits, their rules and regulations on those who try to care.
A corporation has customers, not patients; it has fiscal relationships not limbic ones.
The use of terms “customers”, “clients” and “consumers” in the area of health care has always disturbed me. Now I think I understand more clearly why!
I concur with this conclusion –
Before it is safe to go back to the doctor, a mammal will have to be in charge. And before that can happen, our physicians will have to recapture their belief in the substantive nature of emotional life and the determination to fight for it.
I’m not sure I’ve heard any politician, manager or profession leader say this so clearly – the problems facing health care are not ones of efficiency, targets and “better” guidelines. The problem is we need to make health care more human.
We need Medicine based on love, care and attention….where the heart is the keystone.
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