Friday, October 7, 2011

On treating human beings, not diseases

The mantra is for a doctor to view patients not as diseases but as human beings who happen to be suffering from something. I've heard this being trumpeted time and again in our Art of Medicine lectures—a subject only recently injected in the UP curriculum because of previous feedback that while UP graduates are competent and knowledgeable of the treatment protocols, no question about that, they severely lack bedside manners.

Interestingly, though, there is a major disconnect between what is preached in the classroom from what my friends and I sometimes see in the wards: patients are treated as less than human (the situation today isn't as bad as before, or so I was told). Doctors would address them, not by their given names, but by the diagnosis that had been stamped on their health records. In a sense, one cannot fault the heath care providers—they are overworked and underpaid. But this dehumanization, perhaps a process driven and encouraged by the current health system, further extends to how doctors would address the patients' concerns. Patients are reprimanded, often with harsh and hurtful words, when they do not comply with the medications.

My time in Family Medicine has taught me to look beyond the physical body that I see in the clinics—to imagine where such a patient is coming from, his context, his reasons, his concerns. A person, after all, is not only made up of eukaryotic cells. He is also made up of a soul and mind. And who he is is a function of many things: his genetics, his environment, his life experiences, and his family.

During my visit to Canossa Health Center, a big clinic run by Catholic sisters, I saw Family Medicine effectively at work. Here were patients who were almost being ideal: they knew their diseases well enough to explain it to others, they complied with their medications excellently, and they were proactive and optimistic about their condition. And why was the Center so good? The family, the basic unit of society, was involved in the management of disease.

I realized that the close family ties that bind Filipino families can be used to our advantage. We make use of the collective cultural power that comes by empowering the family. When we involve the family, we will do a whole lot more than when we choose to involve only the index patient concerned.

My rotation in the Family Medicine Clinic at the Philippine General Hospital's Out-Patient Department (OPD) was an eye-opener as well. I saw several patients presenting with different conditions, from osteoarthritis to hypertension to bacterial vaginosis to schizophrenia. While there was great fulfillment in making the correct assessments and in prescribing the correct plans, I had an even greater reward: earning the patient's trust.

By simply asking them how they felt, the patients poured their hearts out, sharing there stories of broken and failed marriages, financial difficulties, and anxieties. I praised God when I heard one 60-year old patient asked for my name, listed it down on the manila envelope containing his X-ray plate, and said thank you. Maybe I did something right, after all.

In the clinics, I learned the value of a good history and physical exam. I'm now beginning to see the advantage of being trained in PGH: with the myriad of patients that one can see, it is inevitable that one develops a trained clinical eye. Clearly I still commit a lot of mistakes, and I'm still a work in progress, as all of us are. But slowly the theories I had read in the books have started to make more sense.

I also enjoyed the Thursday Conferences in the Department. I had been to the conferences of the other clinical departments, but I had never heard a more humane discussion about the patients' conditions than here in Family Medicine. The patients, even when they weren't around, were treated with respect. Their dignity was kept intact. I wish it were like this everywhere.

Family Medicine isn't as popular as, say, neurosurgery. And for most medical students, the plan is simple: get into a residency program after graduation. Whether that will happen after a year of sabbatical or moonlighting, the idea is to become a specialist of something—and then a subspecialist, which entails added years of training. The tragedy is that we have forgotten the value of delivering primary health care, which is just as important, if not more. From how I see it, Family Medicine is unique in that, while being a specialty in itself (specializing in family dynamics and making wellness plans for each family member), it also functions in primary health care. People go to family doctors first before they are referred elsewhere, if their conditions require further management.

It was the writer of One Hundred and One Dalmatians, Dodie Smith, who said, "The family—that dear octopus from whose tentacles we never quite escape, nor, in our inmost hearts, ever quite wish to." And  she's right. In a sense we can never separate the person from his family. And treating him must entail involving this most basic and important institution.

Lunch photos were taken at our favorite joint, Midtown Diner, along P. Faura Street, where our favorite waitress, Ate Angel, works.


Anonymous Anonymous said...

Maybe you've seen the movie 'Wit', it also gave emphasis on treating patients as human beings and not diseases. (:

Thu Oct 20, 11:59:00 PM GMT+8  
Blogger Lance said...

As a matter of fact, I have. "Patch Adams" is also a film in this category.

Fri Oct 21, 01:05:00 PM GMT+8  

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