Tag Archives: HealthCARE

Building communities of care.

Empathy In Medical Training: Two Stories

atlantic-empathy-articleHow do you make a young doctor really understand what it’s like being 74?  Virtual reality.

This is the theme of We Are Alfred.  (See the full story and video here.)  Young doctors experience a simulation  of everyday events in the life of Alfred, a hypothetical older person with several sensory deficits. For instance, in the birthday party shown above, the participant experiences the effects of macular degeneration – and feels the disturbing emotional disconnections that come with it.

This project is a promising first step in developing empathy.   Doctors become more sensitive to what is actually happening, and are in a much better position to help.  Rather than jumping to conclusions about cognitive deficits or psychiatric disorders, they can begin to have real dialogue.

Still, much of medical education is designed to suppress empathy, so that doctors will be clinical and “objective.”  Leading medical schools are slowly changing this attitude and ensuring that young doctors understand the need to engage with people.  Our second story,  an article in The Atlantic , describes a project at the University of Oklahoma College of Medicine.  Before dissecting a cadaver, first-year med students  are invited to meet the surviving  family members.  The story concludes:

Lunch was served sometime during the story and empty plates were cleared before the family finished their biography. When the story caught up with the present—ending with the donor willing her body to OU College of Medicine—the students sat for a moment in silence. “It was humbling,” Thurman recalled, “to think she was our first teacher.”

Dr. Arno Kumagai and The Renewal Of The Humanities in Medicine

 

Medicine is the opportunity to bear witness to the mystery, tragedy, and wonder of being human. – Dr. Arno Kumagai

 

discussions-vs-dialoguesDr. Arno Kumagai was recently appointed Vice-Chair, Education, at the University of Toronto Faculty of medicine.  (Read the story here.)  As a champion for the humanities in medical education, his vision goes far beyond putting a friendly face on healthcare.  He is passionate and articulate about how dialogues in medicine are opportunities to deepen and transform the human experience for all concerned…doctors included!

Here are some excerpts from a talk he gave in the UK last year at the conference, Thinking with Metaphors in Medicine:

How we perceive and structure the world around us is dependent on the identities we carry with us… – P. Bourdieu

The “field:…a social space in which forces or influences interact (champ de pouvoir) as well as a space of struggle (champ de lutte) characterized by differences in power and privilege.                          P. Bourdieu

Group interactions may be seen as “fields” in which the habitus of each individual intersects and interacts with those of others within contexts of power and privilege.  P. Bourdieu

“Knowledge capital,” resources, opportunities, even ways of seeing, talking about and understanding, are under the control of those in power (the ‘Police’) – Jacques Rousseau

The goal of medical education is in large part, the professional development of the empathic self.  In essence, medical education is moral education.

Critical Consciousness – A recognition of individuals as conscious, reflective, social beings, an awareness of social contradictions and injustice, and a commitment to act to overcome injustice and oppression.  – P. Freire

[T]he essence of politics is to reveal what is possible through engagement with the ambiguous and uncertain.  – A. Bleakley

The foundation of Being is the relationship with the Other, and this relationship is ethical. – Emmanuel Levinas

The heart of dialogue is the recognition of the mystery of the Other and to act on this awareness.

Education as change: a process of transition or liminality.

Click the link to see the full presentation, which includes lots of pictures and some good humour!  Liminality – Dialogues at the threshold.  (If you don’t have Powerpoint on your computer, you can download the slides in Google Drive or similar apps.)

Silence and Healthcare

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Pico Iyer

Recently, I read the book, The Art of Stillness: Adventures in Going Nowhere by Pico Iyer.  Now, I am reading SIXTY – A Diary of my Sixty-First Year by Ian Brown.  Iyer and Brown are similar in many respects: they both are excellent writers, global citizens and keen observers.  Having said that, I would much prefer having Pico Iyer as a guest in my living room.

For Pico Iyer, physical and sensorial constraints actually provide  stimulus for deeper insight and – adventure!  Following the likes of Leonard Cohen, he turns simple, everyday moments into epiphanies. Ian Brown, on the other hand,  seems fixated on the symptoms of physical aging, and says little about the tender spiritual impressions that aging brings.  It seems there is nothing in sight but the end.

Much of modern healthcare and social services seems to be about caring for people – focusing on their needs, minimizing pain and waiting for the end.  But what we really want to do is care about people and create many magic moments together.  This is healing.

Note:  Thanks to my old friend Cynthia Dann-Beardsley for inspiring the last paragraph of this post.

 

Addiction As A Failure Of Imagination

heroin_spoonIn recent years, virtually all mainstream advocacy groups, social agencies and philanthropic organizations concerned about mental health and addiction have rallied around a single, common message: Addiction is a disease.  Addicts are powerless to recover on their own, and they must acknowledge this before healing can begin.

Neuroscientist Marc Lewis recently published the book, “The Biology of Desire: Why Addiction is Not a Disease.  He argues that it’s time to change our minds on the roots of substance abuse.  He insists that the illness model for addiction is wrong, and dangerously so.  (See the book review by Laura Miller posted on Salon.com.)

Lewis echoes one of the key concepts inspiring this blog: Health is not simply the absence of illness. Healthy communities depend on the contributions of spiritually active, creative people. Together, we can create conditions in which all can thrive.  External intervention, by human or divine agencies, may indeed help to remove the symptoms, and even to create the possibility of a fresh start. However, we must also empower people to take actions themselves. To help them do this, we need to provide a sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.

Fix The Brain, Fix The Person?

Fix the brain, fix the person?

In the early 1980s, I began working in the computer industry with a group of technical writers.  Our job was to make sense of highly complex and confusing systems, and explain them in practical business terms to the “users.”  We fought like hell to get rid of this insulting term. “Users” were businesspeople with a job to do, and the system was supposed to be serving THEIR need – not the other way around.

We are in a similar situation today. Large segments of our population are in liminal transition – people find themselves unable to cope with the basic necessities of life, and are in need of various levels of support.  (The shocking statistics relating to dementia are only one example of this trend.)  As many health practitioners know, what really matters is a deep and abiding faith in the prevailing personhood of each human being. Technology and medicine are critical supports, but they are indeed just that – supports.

I was prompted to write this post after reading an article in Hospital NewsAging and brain health innovation investment a game changer for seniors’ health care sector.  The article describes how:

the Seniors Quality Leap Initiative (SQLI) will provide…unique expertise to enable the evaluation, dissemination and adoption of new care practices while designing and beta-testing emerging technologies that support seniors well-being in real world care settings. Some of the inaugural innovations that will be pursued by the new Centre include an on-line cognitive assessment, consumer-directed cognitive neuro-rehabilitation strategies, facial recognition software, remote wellness monitoring, health coaching software solutions, mobile medication monitoring and tele-dementia care.

Although “new care practices” are mentioned, they are not described. What effect will these practices have on personhood?  Are we, once again, putting the proverbial technological contrivance before the sentient being?

Restoring Fair and Stable Employment Practices

pepso

In partnership with United Way Toronto, PEPSO recently published The Precarity Penalty: Employment Precarity’s Impact on Individuals, Families and Communities and What to do about It.  People are finding it harder and harder to make ends meet, even when working several jobs.  The researchers make the case that conventional employment statistics only tell part of the story.  Even when the economy “strengthens,” large segments of the workforce continue to struggle.

A team of researchers at York University have recently published a paper that explores employment precarity in a specific sector: Liminality in Ontario’s long-term care facilities: Private companions’ care work in the space ‘betwixt and between.  Government regulations and labour standards cover much of the work done in the Long Term Care sector, but there is a growing demand for paid “companions” – people hired by families to care for loved ones at risk of neglect.  In many cases, these arrangements work very well.  However, the researchers make the case that the employment situation of many (if not most) of the companions is precarious, and that the current system is simply not sustainable.

Reading these reports, I learned that “liminality” is no longer something we observe only at the edges of our society.  More and more people with professional training and a strong work ethic are being pushed down and exploited.  So the question arises:  How do we demonstrate to employers – institutional and private – the benefits of returning to fair and stable employment practices?

Putting CARE Back Into Healthcare

Woman Having Counselling Session

Woman Having Counselling Session

Globe journalist André Picard recently gave the convocation speech to the graduating class of medical doctors at the University of Manitoba. (Text  Video) He congratulates them for their achievement, and then challenges them to consider what really matters.

We hear a lot these days about personalized medicine, about drugs and treatments that can be tailored to specific genomic and epigenetic markers. But you know what people really long for: personal medicine, not personalized medicine.

I had difficulty choosing a suitable quote for this post – there is so much rich and relevant material in his short speech.  It would be wonderful if more people in the healthcare profession would listen and take heed.

Adriana Barton contributes a related article, Reclaiming medicine’s spiritual roots: Treating people, not just diseases (Text).  She describes how spiritual practitioners are being integrated into healthcare teams as trained, respected colleagues.

spiritual care…is based on the idea that everyone has the need for hope, meaning and purpose in life, and that connecting to one’s spirit, the essence of the self, can be a powerful motivator in healing.

More and more stories like these are appearing in the mainstream media, and this is encouraging!