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Halting Dehumanization in Medicine

Introduction:

The process of dehumanization in medicine is a cause of concern for everyone. The subject has been discussed from a psychological perspective by Haque and Waytz,[1] covering primarily the dehumanization related to doctor–patient relationship. However, the process of dehumanization extends beyond this and affects the whole health-care system. Dehumanization affects the physician himself who has become more of a doctor-machine. The constant expansion of medical information and the compulsion to remain in touch with evidence-based updates, takes the physician away from the patient. The analytic and objective outlook that is required separates the physician from his/her own source of inner joy. To address these concerns, the roots of health and disease as well as the process of dehumanization need to be understood from a deeper mind–body–spirit perspective.

Dimensions of Health and Disease:

Recent advances have established that the health of an individual depends not merely on body health but also on the health of the mind (local and personal) and the spirit (non-local and transpersonal). Medicine may be considered to have three coexisting and overlapping eras: Era I or body medicine, Era II or mind-body medicine and Era III or mind-body-spirit medicine.[2],[3] As per the “quantum view of medicine,” therapy in medicine is understood to consist of “quanta” or independent and simultaneously operating components of body medicine (structure-based), mind–body medicine (thought-based), and mind–body–spirit medicine (feeling-based).[4] The practice of medicine with the awareness of the “quanta” within a therapy (quantum-aware approach) is holistic.

Physician’s Health:

The physician, being the agent of therapy to the patient, is human and dependent on his/her own state of health. The physician, just as any other individual, needs to be healthy for being efficient and productive. Conventional medicine has apparently developed excess of body medicine with neglect of the mind–body and mind–body–spirit aspects of medicine. It is appropriate for a medical student, as a beginner, to consider primarily the bodily aspect of disease with the application of the faculty of objective thinking. While communication skills (pertaining to mind and spirit) are recognized to be an important part of medical training,[5] in actual practice, they tend to be neglected because there is little requirement for empathy and a persistent demand for the use of the analytic mind in conventional body medicine. In the absence of a functional framework that allows balanced use of all the three components, imbalance in the physician's own health results, leaving many physicians emotionally and spiritually deprived (physician “burnout”).[6]

Evidence-Based Body Medicine is Downstream:

The near-exclusive development of body medicine, without recognition of the other two components, has resulted in interpreting every disease in terms of structural derangement, while the origin of the disease could well be in the mental and spiritual dimensions. It is found that changes in the latter two dimensions result in structural changes at the genetic and consequently the molecular level in animal studies as well as in postmortem human brain.[7] A sedentary behavior (alteration in mental and spiritual dimensions) resulting in diabetes mellitus (effect in the body dimension) is another example. Tackling only the elevated blood sugar amounts to intervening at a lower level when the behavioral cause is upstream. The constant expansion of medical knowledge needs to be considered in this context of viewing the pathogenesis of every disease as a structural derangement. Understanding of a disease down to the genomic level does not alter the primary truth upstream. The expansion of such analytic and evidence-based medicine tends to keep the physician away from the core of the patient's problem.

Humans Perform Better with Intuitive rather than Logical Approach:

By evolution, the human brain is better in choosing from probabilities (intuitive) rather than working with certitude (logic). Learning from prior experience is more efficacious.[8],[9] Moreover, intuitive approach, which is creative and fundamental to hypothesis generation,[10] can reach the core of the patient's concern with ease, but has become neglected. When the physician's work is predominantly objective and evidence-based, it is out of tune with his/her inborn faculties of being creative and intuitive, thus cutting him/her off from a source of joy and contributing to increased stress.

Putting Empathetic Understanding before Evidence-Based Consideration:

The “quantum-aware” approach toward the patient, by allowing an empathetic connection, results in simultaneous objective and subjective understanding of the patient's problem covering all the three dimensions. For example, the ideal management of a case of diabetes mellitus would include not only advice on calorie restriction and use of hypoglycemic agents (body aspect), but also an understanding of the patient's behavioral circumstances (mental and spiritual aspects) that may require modifications. Such a multidimensional approach comes instinctively for the physician who is connected empathetically with the patient. By suggesting suitable lifestyle modifications, the physician does what is most appropriate for the patient. He/she does this more out of empathetic connection than from mere evidence-based consideration. The physician does “objectify the patient” to facilitate clinical problem solving, but awareness of the “mind–body–spirit” component avoids dehumanization of the patient and at the same time gives satisfaction to the physician as well as the patient.

Direct Experience with Patients Helps Develop Quantum Awareness:

Developing the holistic “quantum-aware” approach in clinical medicine requires the physician to have a sound, but not necessarily a constantly updated knowledge of conventional body medicine. More importantly, it requires a positive approach and empathy toward the patient, covering the mental and spiritual dimensions. As the development of quantum-awareness is proportional to direct experience with patients, working with patients is just as important for the clinician as acquiring theoretical updates on the bodily aspect of diseases. A few more minutes of the physician's time applied purposefully, would change the conventional objective approach into the holistic “quantum-aware” approach. Beyond the patient, adopting the “quantum-aware” approach as a standard practice among clinicians has significant implications for the entire health-care system.

Balanced Use of Resources:

Scientific advances in body medicine, though evidence-based, are infructuous unless they are meaningfully applied. “To cure sometimes, to relieve often, to comfort always” are words of medical wisdom. Situations such as inappropriate availability of high-tech medical equipment in the face of neglect of basic patient care, result from overemphasis on body medicine, which is virtually taken to be the sole aspect of medicine.[11] The attitude of “quantum-aware” approach leads to a balanced consideration of all the three components and a meaningful use of resources.

Recognizing the Value of Physician’s Experience:

In the field of medical education, the apparently logical need for remaining updated with advances in body medicine will be tempered by the importance of considering health and disease in all the three dimensions. The physician who has developed a balanced outlook to all the three components through years of practice, is an asset. To consider disqualifying a physician simply because he/she is not updated with the latest in body medicine, will not be tenable when its constantly expanding downstream nature is recognized.

Conclusion:

Predominant application of evidence-based body medicine with neglect of mind–body and mind–body–spirit aspects has led to a pervasive dehumanizing effect involving the patient, the physician, health-care delivery, and medical education. The “quantum-aware” approach, where there is balanced consideration of all the three components, allows the physician to be competent, intuitive, creative, and empathetic, being capable of reaching the core of the patient's concern. Health-care delivery and the process of medical education are modified accordingly. In short, while medicine is learned from the “head,” it needs to be applied from the “heart” to halt the process of dehumanization in medicine.

References:

1. Haque OS, Waytz A. Dehumanization in medicine: Causes, solutions, and functions. Perspect Psychol Sci 2012;7:176-86.

2. Seaward BL. Stress and human spirituality 2000: At the cross roads of physics and metaphysics. Appl Psychophysiol Biofeedback 2000;25:241-6.

3. Larry Dossey. A Conversation about the Future of Medicine. Available from: http://www.dosseydossey.com/larry/QnA.html. [Last accessed on 2019 Oct 04].

4. Vijayaraghavan P. Quantum view of medicine and its implications. Int J Acad Med 2017;3:334. Available from: http://www.ijam-web.org/text.asp?2017/3/2/334/222480. 

5. Choudhary A, Gupta V. Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J Appl Basic Med Res 2015;5:S41-4.

6. Drummond D. Physician burnout: Its origin, symptoms, and five main causes. Fam Pract Manag 2015;22:42-7.

7. How Stress can Change your DNA. SITN, Nov 2017. Harvard University. Available from: http://sitn.hms.harvard.edu/flash/2017/stress-induced-dna-modification-may-play-role-mentalillness/.

8. Laura Sanders. The Probabilistic Mind. Science News; October, 2011. Available from: https://lightdark.org/s/GirshickScienceNewsProbabilistic-mind.pdf. 

9. Gigerenzer G. Gut Feelings. The Intelligence of the Unconscious; 2007. Available from: https://www.mpib-berlin.mpg.de/en/research/adaptive-behavior-andcognition/publications/books/gut-feelings. 

10. Greenhalgh T. Intuition and evidence-uneasy bedfellows? Br J Gen Pract 2002;52:395-400.

11. High Tech Medicine Can Be Bad for Your Health. Allen Frances, HuffPost; October, 2015. Available from: https://www.huffpost.com/entry/high-tech-medicine-can-be_b_8331406? guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAG01TMJOda0IqC2O BgssNxQNuMpemwctUhMz- ASWDTu6- mkb9_kqbNvtCCCiGSI4obWTRPHhYy1Kpp95IqmKhYAv4S_HOlZ7zLJSsJBsrvU6S4zn6noSVpeF2I5ak 3fxWCF7iDpCJWkp TH3SM7CaehXnK_isSuOnQ 4A38bmcQCbi  

 

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