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Thoughts on Healing as a Doctor-Patient Collaboration

  [ 4 votes ]   [ Discuss This Article ]
By Neil Nathan, MD* • www.ProHealth.com • September 28, 2011


Neil Nathan, MD, is an open-minded physician who looks beyond “conventional” medical thinking to understand complex & unexplained illnesses. Dr. Nathan is best known to ProHealth readers for his recent trial of A Simplified Methylation Protocol for Treatment of ME/CFS and Fibromyalgia. But he casts a much broader net in his new book, On Hope and Healing for Those Who Have Fallen Through the Medical Cracks.*

_________________________________

Understanding Complexity in Human Beings
(A Holistic Doctor's Philosophy of Healing)


It is difficult for me to explain to others the process we use to help people regain their health. I think the reason for this is, in essence, that it is too simple and does not fit into the model used by medical practice today.

That model includes a very brief interview with the patient, followed by lots of high-tech testing and prescription writing. It seems pretty obvious that this model has no real chance of working or being effective, since it eliminates the possibility of allowing the patient to tell her story and express her feelings – there’s simply no time for it.

In my opinion, the essence of helping people boils down to intense listening, remaining ever attentive to their descriptions of their personal health.

While listening to patients should obviously be the most important part of our medical interaction, I throw in the word intense to emphasize that this is not merely sitting in the same room with patients, but reflects the hard work of really paying attention to them as they speak.

This means attending not only to their words, but also to the pauses between words, the words that are emphasized (hence more emotionally charged and meaningful), as well as their body language and facial expressions as they relate their stories (leaning forward in the chair, legs abruptly crossed, sudden deep breaths, sighing, eye contact or lack thereof).

In short, I must take in the totality of that human being and allow the totality of my being to get involved so that it registers information about what is really important to that individual, as he relates his stories. Somewhere in that entire presentation are the clues we need to be of help.

If the physician is busy working at her computer, keying in the patient’s information, or pressed for time, wondering how she can possibly fit into the morning schedule the required “output” of “productivity,” it is clear that meaningful listening cannot take place.

Somewhere in the past 15 to 20 years, we went from being physicians to becoming “providers,” and that seemingly simple linguistic change has had a profound impact on the practice of medicine.

The closest model that approximates a process of deep listening may be found in the field of osteopathic medicine. This may come as a surprise to some who aren’t aware of the osteopathic profession or how it differs from that of conventional medicine. There is, in fact, a deep philosophical underpinning to osteopathy, which is surprisingly absent from that of allopathic medicine.

[As explained in Chapter 17 on the role of touch in healing, allopathic, or ‘conventional’ medicine relies on interventions such as pharmaceuticals or surgery, while physicians with a specialty in osteopathy (D.O.’s) are also trained in observation and palpatory, hands-on examination of the body.]

There are four basic principles of osteopathy, as outlined by Rolin Becker, D.O., in his book, Life in Motion:

1. The body is a unit.

2. The body possesses self-regulatory mechanisms.

3. Structure and function are reciprocally interrelated.

4. Rational therapy is based upon an understanding of the body’s self regulatory mechanism and the body’s interrelationship of structure and function.

The steps taken to address healing the body are based on these principles:

Accept the Living Mechanism in you and the patient. (Life is always trying to express health.)

Surrender comes after acceptance. (Accept the fact that what the mechanism is telling you is true.)

Develop palpatory skills. (The body is smarter than you are, so learn to learn from it.)

A great deal of wisdom in buried in these succinct comments. What Dr. Becker is driving at is at the heart of our interaction with our patients: We need to change our thinking that our job is to fix what is wrong with the patient. Rather we must find a way to understand that there is a deep core of health in these patients already (after all, here they are in front of you, fully alive). This understanding needs to be accessed by both doctor and patient in order to harness the forces of healing

The key word here is accessed. This means listening, sensing, feeling, and paying attention, so that we can reach the patient’s own self-healing mechanisms and begin to move forward.

The beauty and brilliance of this concept is that it recognizes that patients essentially heal themselves; we don’t do the healing for them.

Missing the truth of this is what has gotten the field of medicine moving down the wrong path in its approach to evaluating and treating chronic illness. In the current philosophy of conventional medicine, both physicians and patients are under the misperception that the physician is doing the healing. So, the patient turns over the responsibility for healing to the physician, and the physician accepts it.

If both accept this unwritten contract, they are in trouble. The patients are abnegating their own responsibilities here, and the doctor is taking on responsibilities that are literally impossible to fulfill. This is a recipe for disaster.

Let’s take a simple example.

If a patient comes to me with pneumonia, and I give him a prescription of antibiotics, he assumes I’ve done my job. He thinks the antibiotic prescription will heal him. And if he gets better, he will assume that I and/or the antibiotic have cured him. But no antibiotic is capable of wiping out every bacterial cell in the body.

The antibiotic allows the patient’s immune system to get a leg up, a good head start on the process. But the total eradication of the bacterial or viral invaders is completely dependent on the ability of that patient’s immune system to finish the job and mop up. It it can’t do that, the infection will continue to smolder and the patient will stay sick.

Healing, therefore, depends almost entirely on the patient’s own immune system and not on the antibiotic. I suspect that both patients and physicians have forgotten this, which leads to the odd interactions that now occur between them.

If the patient isn’t getting well after being given an antibiotic, the doctor feels responsible: “Maybe I used the wrong medication, or maybe I didn’t prescribe it for long enough, or maybe I’ve got the wrong diagnosis, or maybe….” To make things worse, the patients comes to believe that the doctor is responsible and returns to the office worried and upset.

But what’s really happened here is that we’ve missed the point. The doctor and patient need to work together to harness the patient’s healing powers and find some way to stimulate that immune system to work properly.

Perhaps the patient I mentioned earlier contracted pneumonia because he was stressed or exhausted from working long hours or dealing with a family emergency. Perhaps the structure of his rib cage and his ability ventilate properly were compromised by a seemingly insignificant fall, last week, when he caught himself awkwardly by his arms as he fell. Perhaps his immune system was weakened by his diet (for several weeks he had consume almost nothing but fast food eaten on the run). All of this may need to be addressed before true healing can take place.

But if both physician and patient believe that a different antibiotic should be prescribed (in the seven minutes allotted to this visit) and that this will fix the problem, there is the distinct possibility that both are likely to be mistaken and that healing will be delayed even more. The patient may then get even more ill and even more frustrated with the lack of progress from this medical interaction.

Returning to the principles of osteopathy expressed by Dr. Becker: From the beginning of our interaction, we should be searching for the sources of health that the patient brings to the table, and harness those to move forward.

What exactly does this mean?

Well, it could mean discussing the patient’s current stressors and ways to cope better, from the outset.

It could mean discussing the effects of smoking tobacco and drinking alcohol.

It could mean discussing diet and its effect on the immune system: Sugar and fast foods are known to weaken the immune system, so if you are treating your pneumonia and eat most of your meals at McDonald’s, this might well influence your ability to heal.

It could mean discussing the use of herbs and supplements that are known to improve immune functioning, such as vitamin C, Echinacea, goldenseal, or colloidal silver for an acute viral infection.

It could mean exploring the patient’s physical structure more carefully. Does this patient have any restrictions to movement of his or her rib cage or diaphragm (caused by an old fall, or tension perennially held in the chest) that could be treated manually, which would allow better ventilation of the lungs and speed healing (or prevent recurrence).

Searching for those sources of health could also mean looking at the patient’s thinking process and emotional response to pneumonia: “I always get sick every winter and it goes to my lungs and it takes months to go away” is a common expression.

This predisposes that individual to get sick because she believes she will get sick every winter, which opens the door to the very event she fears by direct effects of her beliefs and thoughts upon the immune system. The mind exerts a powerful effect on the body that is not always beneficial, unless it is recognized and harnessed properly.

You can see that doing this sort of analysis cannot easily be limited to a seven-minute visit. Clearly, it would not only take more time, but it also presents a completely different approach to how we provide medical care.

This model is more comprehensive, more logical and inclusive, and more likely to produce the desired results. It also changes the relationship or interaction between the doctor and the patient, so we are working together and we each have a responsibility for the outcome.

This is not a new paradigm. It has been around for centuries and was beautifully expressed in the osteopathic principles quoted above. Unfortunately it has been neglected, and we are all the worse for it. The more complicated and long-standing a patient’s suffering, the more difficult it is for us to understand it and to find some way to recognize, encourage, and stimulate the patient’s own healing abilities to come forth.

For some individuals, this information is so deeply buried that this process is going to take a lot of time. However, the clues will only emerge through careful listening and visits to the drawing board over and over again...

Without a clear diagnosis, it is awfully difficult to achieve healing, and it is only by listening, carefully and whole-heartedly, that we can obtain the clues we need to make that diagnosis.

- Neil Nathan, MD

[Note: Each chapter of Dr. Nathan's book includes case histories where the interplay of questions, test findings, and patient comments provided the "aha moments" that led to new insights and improvements. Subjects range from mold toxicity, hard-to-diagnose adrenal and thyroid problems, magnesium deficiency, gut dysbiosis, and food allergies to dental and other chronic infections.]

___

* This material is excerpted with kind permission from Dr. Nathan's five star-rated book, On Hope and Healing for Those Who Have Fallen Through the Medical Cracks. ©2010 Neil Nathan, MD, all rights reserved. It may be purchased on Amazon; or obtain an autographed copy through Dr. Nathan's office with Gordon Medical Associates near Mendocino, California (at www.gordonmedical.com).

Note: This article has not been evaluated by the FDA. It is general information and is not meant to prevent, diagnose, treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.




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