Heroes Not Zombies

As far as possible I’m keen on finding ways to help people without using drugs or technologies. I know that both drugs and technologies (I’m including surgical treatments in there) have their place (mostly in acute, not chronic, situations in my opinion), but I really think that the people involved in health care are undervalued. So I was interested to see this piece about leg ulcer treatments.

A five-year study led from the University of Leeds has shown that ultrasound therapy does nothing to speed up the healing process of leg ulceration — contrary to what had been expected. Traditional methods of nursing care, which are cheaper and easier to deliver, work just as well, the authors conclude…..”The key to care with this group of patients is to stimulate blood flow back up the legs to the heart. The best way to do that is with compression bandages and support stockings — not ‘magic wands’ — coupled with advice on diet and exercise. Believe it or not, having a really hearty chuckle can help too. This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body.”

So, good nursing care and laughter are effective treatments…..not just in a “feeling better” way (which is often strangely disdained by materialists), but in actually getting chronic leg ulcers to heal up. Interesting, huh?

I stumbled across this piece in the NY Times. It starts like this

Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

At this point I stopped and checked two things – firstly, had I been redirected to “The Onion” without realising, and, secondly, was the article written on April 1st? Turns out the answer was “no” to both of these potential explanations. I read on.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional. Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,” he said, “and not to get sidetracked trying to be a semi-therapist.”

This can’t be true. Tell me it isn’t true! Has there been a major shift in psychiatry in the US to deliberately NOT listen to patients, but to focus only on drugs? Apparently. Dr Levin misses the old style but finds he’s pretty good at the new one….

“I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.” “I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”

At least in the article they interview one psychiatrist who has opted out of this shift and she hits the nail on the head

“Medication is important,” she said, “but it’s the relationship that gets people better.”

You know, I think this is the key issue here. When did we reduce “relationship” to “talk therapy”? As if a relationship between a patient and a doctor can be reduced a treatment intervention, and that drugs, of course, can be prescribed more quickly and “efficiently” than a relationship so drugs win!

If this really is true, I think it’s profoundly sad. In my opinion it’s a greater valuing of human relationships and a greater emphasis on people – patients and practitioners – that’s needed in medicine today.

Less drugs, more relating! That’s what I say!