What is your definition of healthcare? Is it doctors, nurses and other healthcare professionals working to keep you free of illness? Is it these same individuals working to keep your life as independent as possible? Is it being able to at least cognitively make a decision, good or bad? Is it simply living your life as you want?
Caring for individuals with an illness, injury or condition is what health professionals, like myself, actually do on a daily basis. However, there is much more to healthcare than the visible or physical job requirements. Moving between patient rooms, working extended hours to serve more people, devoting time to educating patients on their condition and continuing your own learning for the betterment of your patients, rather than just fulfilling licensure requirements, is much more of an intellectual and emotional process than most would think.
As I sit across from a 73 year old man in my office, whom we will call Mitch, I quickly realize that his expectations are very different from other patients. Why? Because Mitch is 73 and for lack of better words, de-conditioned. He is a 6 foot tall, white-haired man with terribly poor posture, a somewhat shuffled gait and a quirky sense of humor. His main complaint is that his low back feels achy when he wakes in the morning and that his neck feels tight when turning his head to back up his vehicle. At his age, Mitch is seeking care for chronic, dull low back pain and neck stiffness. He experienced a stroke last year which left him with only one fully functioning eye and has more recently began taking medication for dementia-like symptoms.
The physical ability to care for Mitch is not that difficult. I must be able to perform some basic soft tissue techniques, joint mobilizations, stretches and chiropractic adjustments. When I initially saw Mitch we agreed on performing corrective exercises on a regular basis, but after a few visits he quickly lost interest in taking responsibility for his own health. This is completely acceptable and rather common. Mitch is part of the generation of people who believe doctors should be able to fix their problems, whether via medication, surgery or manual therapy. And really, who can blame him? You go to a mechanic to get your car fixed, you have the AC technician fix your AC unit, and your doctor should be able to fix your body, right? Unfortunately, Mitch has degenerative conditions that I cannot cure. I can simply manage them, and he is definitely not the only one in this position. From a treatment standpoint, I can absolutely provide Mitch with reduced pain and increased range of motion. I cannot, however, provide these indefinitely. His symptoms, if not treated, will slowly creep back into a more noticeable and possibly painful existence.
Compare Mitch to another patient, whom we will call Cecilia, a 55 year old female with Right shoulder pain. As a fairly active adult with 2 grandchildren, a small business owner, avid gardener and landscaper, Cecilia uses her Right arm quite regularly as you can imagine. She is a petite, soft-spoken woman with a caring look; one of those people that would absolutely do anything for anyone in need and if she’s reading this, she knows this is about her. When I first evaluated Cecilia, it was apparent that she had a condition involving her rotator cuff that was of gradual onset, in medical jargon - there was no trauma. Because of other symptoms in addition to Right shoulder pain, I ordered an MRI that confirmed she had tears and evidence of inflammation in the tendons of the rotator cuff. After reviewing the specifics of these results and talking with others that experienced similar conditions, Cecilia decided she would like to avoid surgery as much as possible.
This is where my work began. I was now charged with the task of developing a logical treatment plan for this patient, with the hopes of returning her to her normal life activities pain-free. Her garden, her grandchildren, her home and her business all awaited her functional return. As clinicians, we obviously present some of the statistics on length of resolution, re-occurrence and complications. So as we started down the path of rehabilitation, it became apparent that resolution of her condition may require longer or more intense treatment than what is considered normal. The goal, obviously, was “return to competition” (borrowing terms from concussion protocols).
Now the intellectual and emotional aspect of healthcare comes into play. Consider both patients, Mitch and Cecilia. These are patients with differing backgrounds, experiences and expectations, not to mention a nearly 20 year span in age. Not only are my diagnostic and clinical skills necessary, but there is a human-ness to our interactions. I must be able to provide accurate diagnoses, treatment options and prognoses. Still, I am human. I must, at the very least, attempt to have empathy and understand a patient’s outlook.
Although I graduated with above average grades in chiropractic school, these objective grades prove nothing when it comes to patient care or the doctor-patient relationship. In the medical field, we pedestalize clinical knowledge and reasoning…and rightfully so, to a certain extent. These skills are what allow us to make sound judgments and offer advice to our patients. One of the most difficult concepts in healthcare is to involve the patient in the decision-making process surrounding their care. Obviously, there is a necessity for objectiveness in certain situations, hence a doctor providing care instead of your spouse - the emotional bonds can create a predicament. However, at the same time, empathy can be an extremely valuable asset in healthcare and I believe it is one that is frequently lacking.
There is a reason for this phenomenon in the U.S. and it is likely related to our broken healthcare system. We are all so far removed from the true nature of healthcare, the foundational aspect of a trained clinician providing care to a person in need rarely exists. Hence the “play on words” I used for the title of this post…The Patient Doctor. As a healthcare provider it is difficult to slow down and devote adequate time to each patient. This is due to many apparent, and some not-so-apparent factors. But it must begin to change. Clinicians need to change their own outlook to change the outlook of their patients. In doing so, we can advance the doctor-patient relationship for the better.
We ought to be more patient and empathetic, patients will notice. If you are a clinician reading this, try to be more patient. If you are a patient reading this, try to question your clinician and assist them in becoming more patient. Healthcare can and will change, let’s ensure it does so positively.
As always, I appreciate your feedback. Be Blessed!