Dr. Jeff Kane: Whence illness?
A friend genially asked me, “Why isn’t your column about regular doctor stuff, like promoting check-ups and getting shingles shots? Instead, you’re always writing about attitude and beliefs. That’s not scientific. It’s touchy-feely, and besides, that’s not even your field. Are you a wannabe psychologist or philosopher, or what?”
Excuse me. I hadn’t realized how much I’d strayed from the mainstream. If I’d never read this column before, I’d probably ask the same question.
When you think about it, though, touchy-feely is precisely how we live. We inevitably touch the world in the ways we feel it. That is, we make sense of events via our beliefs, such as they are, and then respond accordingly. And some ways that we feel and touch result in medical problems.
When I practiced standard medicine, I continually wondered about the origin of patients’ symptoms. Half the time they seemed inexplicable, out of the blue. But just as often, their conditions seemed to flow from the way they lived. Unless you inhabit a bubble, you already know that certain lifestyles and habits generate illnesses: smoking and emphysema, alcoholism and cirrhosis, particular diets and type 2 diabetes, stress and hypertension, poverty and any illness you name.
Where do such correlations end? As I paid attention, less obvious ones became visible. For example, loneliness seemed a dependable pathogenic (disease-causing) factor, as did chronic anger, anxiety, and, for very many, tolerance of the intolerable. I began to feel like the standard physician mission amounted to bandaiding deep abscesses. That strategy is certainly not effective medicine, and in the long run self-defeating. I felt like an auto mechanic awaiting customers in my shop when I could be out helping them avoid a cracked engine block.
Like so many sensible notions, though, easier said than done. I gradually learned that healthcare will barely progress unless we address its most fundamental issues. What do we mean by illness? What is health, for that matter? How much do emotions like contentment and fear influence our behavior — and our physiology? What, after all, is the relationship between the body and the mind? Until we accept that the way we lead our lives bears health consequences–positive and negative — we’ll continue bandaiding abscesses.
I recently Zoom-attended a friend’s memorial. A psychiatrist, Dr. Loren Woodson was fascinated more by his patients than by their diagnoses and treatments. We’d both learned in our training to ask new patients some version of, “What brings you in?” or, “How can I help you?” Applying his interest, Loren developed a new one: “Tell me about yourself.”
Of course, if that style became popular, medical practice might require longer appointments than our current ten-minute drive-throughs. Don’t hold your breath awaiting that advance, though, since healthcare is all but fully industrialized. Most of today’s docs are corporate employees helping spin the wheels of commerce. I suspect they’d love to know their patients better, but when the chips are down they’d rather feed their families.
The only parties that can push for more effective healthcare are patients who say to their docs, “I want to tell you about myself.”
Jeff Kane is a physician and writer in Nevada City
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