Knowledge is king!

I was in Moscow last week and was very fortunate to have some time with an established doctor and her daughter, Irina, who is editing a medical journal.

They described what medicine was like for Irina's grandfather, a surgeon in the 1920s. They spoke about medicine in Russia today. They said, “In the past we had skills but no knowledge but now we have knowledge but no skills.”

Older doctors from all over the world will remember a time when resources were scarce and the opportunities of therapy were much less and the doctor depended on his intuition, skill and knowledge of the patient and their families to make decisions. This is what we call the art of medicine and many feel that the teaching of the art of medicine has been replaced by a medicalised, politicised medical system.

In Romania three years ago when we were talking about the progress of medical systems, an older Professor stood up and remembered some of the good parts of Romanian society and medical care prior to 1930. “We weren't always like this you know,” he said “in those days people had values and these values were good and led to a greater care for patients and a greater community. We have lost these things now.”

A British newspaper reports, “Patient treated like a slab of meat.”

So what went wrong in the process of so much amazing medical advancement in saving lives and preventing chronic disease? What happened to the good values of patient care, the personal skills of the doctor, the ability to listen to the patient?

With the rise of medical knowledge has come a vast bombardment of medical technology to support diagnosis and treatment of sick patients. These are thrilling advances, scientifically satisfying, adding to medical knowledge so that we make much more informed decisions in the treatment of many diseases. As our medical knowledge has increased, we are looking at smaller and smaller parts of the body to understand the amazing processes that God set up in the first instance. Technology is developing nano pumps to work as tiny engines within blood vessels to accelerate blood flow. Molecular biology is contributing to new and active drug therapies for cancer which target the intracellular processes very precisely. We try to work within evidence-based practice where decisions are supported by suitable research.

The problem comes when doctors and other healthcare workers forget that the patient is a person and assume that patients would always want to take the scientific answer to their problems. Hence medicalisation assumes that medicine knows what is best for all individuals who require treatment or are in need of health care. It assumes that the physical healing of the body is all that is required - and matters are made even worse by attempts to standardise medical treatments across the country or continent by the use of medical guidelines.

All too quickly these guidelines appear to be compulsory and the doctor's ability to make a decision is lost in the linear decision following a logarithm for treatment.

So where is the patient in all this? What attempt is made to explain the science and technology to the patient to help them make a decision for themselves? What is there to stop the relentless rollercoaster of investigation when somebody presents for acute care at an emergency department? What doctor is brave enough to go against guidelines? Doesn't the doctor always know best?

“The medical model does not look at individuals holistically in that all aspects of a person are interconnected. A physician will look at all the signs and symptoms and the results of investigations to arrive at a diagnosis to treat the system that is diseased or affected. The problem arises when the disease itself is caused by something not physical, but psychological, social or spiritual in origin. For example an elderly lady refuses to eat or drink because she has been taken into residential care and her home sold to pay for her healthcare costs. A nutritional assessment will reveal malnutrition and her urea and electrolytes will indicate dehydration. The doctor may treat both these factors. However the fundamental issue of her loss of meaning and purpose in life may be neglected if only the medical model is used.” (Making Sense of Spirituality in Nursing and Health Care Practice1)

My son has a T-shirt the front of which says, “Knowledge is king!”

This worship of medical knowledge is certainly king in medicine these days. However, the art of medicine, the art of understanding people, the art of being sensitive to the patient's emotion, the art of using intuition and previous experience to make compassionate decisions according to the patient's needs, also needs to be encouraged in medical education.

Medical knowledge can, I believe, be taught alongside a high level of clinical skills both relational and physical. Students and doctors can be taught to listen actively to their patients and understand their personal beliefs and values and how that affects their health care.

But let's also work on good professional values and attitudes and add that into the equation.

The last ingredient is compassion and comes I believe, from knowing that the person in front of you -your patient - is a person made in the image of God and hence is precious and unique. Compassion comes I believe, from listening and understanding that person’s problems and realising that it could be you.

Rabbi Jonathan Sachs said, “Science takes things apart to see how they work and religion or spirituality connects things together and gives them meaning.”

Dr Ros Simpson

PRIME Senior Tutor

References:

1Ref McSherry,W (2006) Making Sense of Spirituality in nursing and health care practice. 2nd ed p30 JK Publishers London.