Sunday, September 30, 2012

The Gossamer of Failth

The gathering storm looms over medicine. The clouds are turgid with the darkness of human thought. The winds of change are strong as they rattle the shutters while the windows grunt and the whole house of health shudders.

The vortex nearby touches down and in its finite warp captures the patient and the doctor and lifts them in its frenzy to spit them out in far away places. The anger of division meanwhile boils and bubbles. The distance between here and there is farther then the eye can see. The purpose is alienation.

“Doctor, what do you think I should do?” cries the patient. She is shielded only by the warmth of her family and friends, but now seeks shelter in the comforts of another being’s ability. She confides in his knowledge, his care, his desire to seek the ultimate help and his concern for another human’s distress. While he looks at the ravages of nature’s wrath upon a human being and thinks this could be him and captures every essence of what can be done and should be done to come to bear in helping this patient. He volunteers himself, his comfort, his knowledge, his waking moments and most times his resting moments to come up with a plan to thwart the disease that lurks.

“This is what I think we should do.” Replies the doctor after much thought, capturing in that moment all the knowledge that has come to fore on his shoulders to help his fellow human, live through the storm.

“But the insurance is denying this treatment.” She cries, the tears of anger and frustration welling up and threatening to cascade. Her cry seems to inquire, when did another party step into this decision making process? When did the “I think…” of the physician turn into a conspiracy of personal desire. Each individual is an entity that lives by the rule of his/her own double helix. Each is different and each merits an individual mandate of individuation. One size does not fit all, or so as we know from the fields of genetics, neuro-psychobiology, psychotherapy and nurtured life. Whereas for one a simple “no” can be considered a blow to the solar plexus while to another it is a challenge to be undertaken. The field of psychiatry has taken blows from the insurance industry, the latter expecting to cure age-old ailments of the mind in three to seven easy steps. Imagine undoing the riddles of the mature forty or fifty-year-old brain that has been seeded with strong neural pathways from overuse and expect to break from them with words such as, “that is not the way for you to think.” The psychotherapist has to gain the trust of the patient before the latter allows him or herself to be shown a different path. That takes time. Similarly the established bridge between a physician and patient has to happen before the full benefit of therapy can be reaped by both; that of a healthy being rid of the illness.

“So you really think this is the right path. Even the internet says that this treatment has less then a 50-50 chance to work.” She looks down not meeting his eyes.

“You are unique in your own individuality. My plan is based on what I know about you and about this tumor biology.” He answers trying to peer into her eyes. For fear and distrust leads to lack of faith and there he knows no medicine will be powerful enough to wash away this ordeal. It is the limbic connection he seeks that must exist between the physician and his or her patient where true healing resides. The trust feeds into the faith, which bleeds into the self-regenerating spirit. Someone is helping me help myself.

“But I won’t be able to pay for it!” She cries.

“We’ll work it out. There are options available to us. I’ll make some calls.” The doctor says, comforting her. The connection between the two remains firm and she lets go of her reservations. From those words and his eyes, she feels that he will take her to where she wants to go. He feels equally indebted to carry out his promise.

The bond of trust has been established. The faith of words has challenged. And the humanness of living will serve as guides for both.

The gulf that is now widening between the physician and the patient is still bridgeable if the dividers would leave medicine alone, any further and the bridges will not be able to span the divide. The cost of care is alarming in of itself mostly because of the third blind party that shells out the money. It deprives some, of quality care under the guise of unnecessary while it fills pockets of the overseers. It creates a wider gulf in the practice of medicine. It creates an environment whereby the patient distrusts the physician’s motive and in so doing hurts himself or herself due to the disconnect. The dance between the patient and physician follows in lockstep to the beat of a given therapeutic course suggested. Should they lose the rhythm and start stepping on each other’s toes with abandon, all form, grace and function is lost.

The physician is like the deep-sea diver, diving as an instructor with a student. If the oxygen mask accidentally gets disconnected and the student panics, the instructor is there to calm him and restore the continuity, even through all the arm-thrashing and panic. Without that one on one trust all hope and more often life is lost to the ravages of the stormy seas.

Medical care is a joint stewardship between the patient and the physician. It is akin to a mountain climber who anchored through his anchoring lines and pitons can help a slipping climber by lending a hand. If the connection between the two is weak, there is no impetus to support others for fear of self. On the other hand if the anchor of the one giving help is weak then lending support brings both of them down to certain doom. 

In medicine it is not the degrees in front of the name, or the number of articles written, or read or journals subscribed to. It is not in the pinstriped suit or the color of the tie that real care resides. It is not in the P4P, "bundling payments," EMRs, "Demonstration Projects" or other crafty words used as symbolisms, it is in the empathic connection for another human being in need. The luminescence of interpersonal resonance between doctor and patient is bright when not filtered through the veil of impersonal advocacy and imposition of a barrier.

Insurance carriers from any agency, government or private, have little impetus except to restrict, minimize, shrink the outlay of capital so the private companies can make more for their shareholders. For the government, so it can garner more support from the voting public. There is no love lost in individual care by either one, except the need to curb, curtail and crucify.

Personal responsibility on either side of the medical divide is the answer to the most efficient and cheap medical care. The free in freedom is for self-responsibility and not what can be had for free.

The most sacred of all things in caring for an individual or being cared for by another, is trust. We still live by that Gossamer of faith.

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