At what time and place in history would you choose to be seriously ill?
Docs get dissed a lot these days. Nothing makes headlines like a physician sawing off the wrong leg or dispensing medication later found to cause harm. Doctors are routinely criticized for not practicing preventive medicine, and it seems as if everyone has a story about a physician with the bedside manner of a Neanderthal. We docs also reportedly cause carnage to the hospitalized and elderly: one study in a leading medical journal estimated hospital-based adverse drug reactions as the sixth-leading cause of death in the United States.
Although polls show that North Americans are largely trusting of doctors, modern medicine is unpopular with many people, especially those who have had negative experiences. These people may turn to other healing systems, such as Ayurvedic or traditional Tibetan medicine, and many people have had rich and satisfying experiences with these choices. To reject all of Western medicine out of hand, however, is to deny ourselves potentially beneficial treatment options.
There is a middle way of viewing the issue. Researchers routinely dissect doctors’ practice patterns and have a fairly accurate idea about what physicians do well and not so well. We are excellent at fixing broken bodies injured through trauma, as well as saving lives during critical illnesses such as heart attacks, bleeding ulcers, serious bacterial infections and other acute life-threatening conditions. But modern medical practice has its downside. For instance, we dispense antibiotics like candy for benign conditions, which results in increased germ resistance, as well as unnecessary costs. Many of our more extreme treatments for cancer, such as chemotherapy or radical surgeries, come at the price of debilitating side effects without a guarantee of success.
Both the good and bad facets of modern medicine are in part products of our present cultural values and beliefs. Historically, major medical systems have always reflected social ideologies, from shamanism’s intercession with the spirit world to traditional Chinese medicine’s harmonious balancing of chi. We in the West generally value logic above feeling or intuition and tend to see technological advancement as largely positive. The genesis of modern medicine from this paradigm of reductionism and materialism predetermined our system’s strengths and weaknesses. By rigorously applying the scientific method, we have developed highly effective treatments and diagnostic tools such as antibiotics, fiber-optic surgeries and CAT scans. The flip side of our bias toward technology and hard science is that physicians tend to ignore other powerful factors that may contribute to the natural restoration of health, such as community support, spirituality, sleep and compassionate care.
Patients often note that they experience compassion inconsistently in the corporate-like environment of medical offices and hospitals. This is not surprising, given the current economic pressures on medical care and the minimal emphasis on compassion skills in medical school. As doctors we are mainly taught to bring our intellects to bear on the problem of solving the diagnosis—our hearts are often left out of the equation. Interestingly, many patients visiting family doctors don’t present a discernible diagnosis and are simply there as a result of psychological distress. These patients are probably best treated with education and compassion rather than diagnostic labeling and prescription. Although true compassion must be heartfelt, the behaviors of compassion can be taught. More progressive medical schools are now including activities like active listening and empathic reflection in their curricula.
Critics often accuse physicians of perpetuating disease-oriented medicine rather than proactive and prevention-focused approaches to health. On this charge, doctors can plead innocent in intent and partially guilty in deed. If you review the major guidelines written by doctors on common preventable medical conditions such as hypertension or diabetes, you will see that prevention is unequivocally and strongly endorsed. The research on practice patterns, however, confirms the disease-oriented bias that critics perceive. Some doctors only pay lip service to prevention. Why this gap between policy and procedure?
One reason may be that doctors get ground down by pill-focused patients who want quick fixes, and patients who can be superlative deniers about their personal health risks. Polling research shows that some physicians think initiating discussions about lifestyle interventions, with the exception of smoking cessation, is ineffective because of notoriously poor patient compliance. Medical research has generated mountains of invaluable data about exercise, diet and stress management. Patients need not be shy about asking about such topics, as most doctors will respond favorably when the patient initiates the topic and seems genuinely motivated.
In defense of the Western medical world, I would like to mention two rapidly growing fields that have arisen from the wellspring of medical science: behavioral medicine and psycho-neuroimmunology. These two disciplines can provide a response to critics of Western medicine’s excessive reliance on pharmaceuticals. Both disciplines have qualities that are uncannily compatible with dharma practice. Behavioral medicine offers effective treatments for a host of common conditions such as migraines, depression and insomnia; it uses meditation-related techniques such as breath control, awareness, relaxation, imagery and the use of “skillful thoughts” via cognitive behavioral therapy to attenuate symptoms and pain. Psycho-neuroimmunology research has suggested an association between enhanced health and soft health factors such as spiritual practice, positive spiritual beliefs, meditation and community support. The natural body-mind orientation of these two disciplines sidesteps the potentially unpleasant or even harmful effects that can plague medication use and surgery.
The first law of medicine is primum non nocere: first do no harm. There are times when we may have strayed from this dictum because of our proclivity for aggressive treatment. But hopefully medicine will continue to respond to its credible detractors with vigorous self-scrutiny and work to change for the better, as our intent has always been to provide the best care possible.
At some point in his or her life almost everyone receives some standard medical care. The decision to pursue the potential benefits of medical treatment in light of the risk of adverse effects should be based on truly informed choice. Even the success of behavioral medicine solutions—which I loudly proclaim as the dawning of a new era of medicine—demands that a person assess realistically both their commitment to change and their ability to maintain new habits. There are no right or wrong choices here, only issues of personal style and risk philosophy.
The great secret is that present-day Western civilization is probably the time and place that offers the greatest potential for health and longevity, given our knowledge of healthy lifestyle choices and our success in treating acute health problems. At what period in history or what place in the world would you rather be injured or seriously ill? A time or place where there is no anesthesia or antibiotics? When you next hear the wail of an ambulance siren or glimpse the blur of a medivac flight, envision the formidable resources being brought to bear on a suffering being right then. Never before have we had such power to save life.