Monday, September 28, 2015

Breaking Down Barriers to Achieve Humanistic Care

I write this while at 30,000 feet flying from the high tech environment of Silicon Valley and the Stanford Medicine X conference to the suburbs of Chicago for the Health Enhancement Research Organization (HERO) meeting. One could not get more contrast going from the beauty of the Stanford campus and their high tech auditoriums and lecture halls to the windowless conference rooms of a suburban hotel.  Yet the two meetings are similar.  Both are indicative of the positive changes occurring in healthcare these days. We are starting to break out of our concrete silos in order to address patient care from the patient's point of view. It seems radical and that alone is indicative of where we have gone wrong up until now.    

At Medicine X, many of the discussions were led by patients or included patients who have found their voices through the blogosphere and through organizations such as Accolade which help people become more empowered patients.  They are partners in their care – patients who spoke of their own struggles to be seen as autonomous individuals and not as diseases. At the session I moderated, Mary Reese, who suffered with chronic pain for 11 years spoke about her frustration of having physicians not believe her pain was real, dismiss her ideas and concerns, and fail to find any solutions. To her credit, she always maintained respect for those physicians and believed that they were acting to the best of their abilities. Not once did she blame anyone for her predicament. Instead she spoke of her struggles to be a good mother despite her difficulty just standing up and walking and the loss of the ability to do all the things she enjoyed doing. She then spoke of the human connection she was able to form with Karen, at Accolade who in turn helped her find her voice and helped her find the right medical resources to finally end the 11 year nightmare.

While the conference stresses technology, this year the technology was presented as a tool to best be kept in the background with patients like Mary in the foreground. The patients are using expert systems and new approaches which are all but invisible to them so that simplicity can reign.  Mary was able to access the skills of Accolade and the expert opinions of Grand Rounds, both of which are made possible by combining technology and humanism in a powerful way. She is now enjoying her life, free of the debilitating pain.  She brought tears to everyone' eyes as she expressed her love for her supportive husband and children who stood by her during that dark decade of pain.

This dichotomy between technology and humanism is being torn down as we appreciate the facilitating potential for technology within the humanistic paradigm.  Touching people as people who have unique needs and wants and not as a set of symptoms or a standardized disease is required to build trust and create effective care. The newer approaches highlighted at Medicine X recognize this need to break the shackles of old paradigms. 

In the same way, at HERO, the emphasis has traditionally been on prevention. Research to determine the best ways to effect improvement in diet, stress management, exercise, smoking cessation, and other lifestyle challenges to prevent disease has been the main focus. That focus has sometimes created suspicion that it could create a tendency to blame the patient for the disease.  I have sat in HERO meetings with groups that advocate for those with diabetes, heart disease, and arthritis during which those activists rightly pointed out the danger of stating that everything is preventable with the proper lifestyle approach.  That “everything is preventable” myth could easily lead to regulations, laws and benefit requirements that impose harsh penalties for being unsuccessful in addressing behavior change as part of treating a disease.

At this meeting however, I will take the podium with Dr Adam Perlman, Executive Director of Duke Integrative Medicine and Associate Vice President for Health and Wellness at Duke University Health System to discuss how prevention techniques can be used effectively within therapeutics for people with illness. We will challenge the model of every illness being preventable and instead offer a model which uses diet, stress reduction, exercise, and mindfulness both in the context of treating disease and for improvement of well-being for those without disease.  Instead of treating the risk factor or the specific illness, new models will emphasize helping the person fulfill their own needs.  We will present a new model in which the biomedical is combined with an integrative model and an assistance model so that the patient point of view, regardless of presence of illness, becomes paramount. The old silos between prevention, wellness, and therapeutics must go.  The concept of disease has to change as we realize that our journey of life is dynamic.  Disease may be too static, too limiting, and may not adequately recognize that the same disease may impact different people in different ways at different times. We need to make these changes using technology but never allow technology to get in the way of the person’s feelings, needs, beliefs and values.

The fact is, unique individuals who get up every day, love and care for their families, enjoy life and  get sick must be helped using every tool in the health, technology, medical and social arsenal. They must maintain their dignity and their autonomy and be partners in all efforts whether those efforts are preventive, therapeutic or supportive. They cannot be forced to find fragmented programs and services through Internet search or desperate attempts at networking.


We have a long way to go in breaking down the silos and reaching the core humanism that must drive healthcare. The road will be difficult as the voices of those who look for science, or prevention or technology to be the only answer may dominate at times. However meetings like Medicine X and HERO make me optimistic that we are moving in the right direction.