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Last May, it was my privilege to address fellows of the American College of Obstetricians and Gynecologists and guests at the annual ACOG convocation in Philadelphia. I proposed a Women's Health Bill of Rights. Most of these 10 "rights" related to equity and equality in access to, coverage of, and treatment in our health-care system. The tenth item on my list was quite different and reflects thoughts on a paradigm shift in health care.
Traditionally medicine has been considered a service profession, a science, and an art. In our allopathic tradition there has been little talk-let alone education-about the latter. Medicine as an art-is it something that we can learn, something that we might wish to teach, something tangible or ephemeral?
There is a rising tide of attention to the "optimal healing environment." In some ways, we are familiar with the concept. However, while we pay attention to such things as vectors of infection, sterile operating techniques, and postoperative rest, most of us are unaware of the "anti-healing" environments of our hospitals, our waiting rooms, our examination rooms. Why is this? Is it because we don't care? I believe that Western medicine's focus on disease, pain, and curing is in part responsible. We have become successful in treating patients, preventing or ameliorating pain, and curing many of the diseases that have plagued mankind. There is another dimension and the dyads of disease versus illness, pain versus suffering, and curing versus healing are at the core. The first half of the dyad represents the perspective of the physician; the second half of each dyad represents the perspective of our patients and their families. Illness, suffering, and healing are experiential and personal. They are not always objectively measurable. The melding of the mind-body experience, attention to physical places and spaces, understanding of the behavioral aspects of being a patient AND of being a physician are all parts of this whole.
These ideas concern the health-care provider as well as the patient. They are about quality of life and about caring. We all remember being students and approaching each patient with a burning desire to be effective. Do we still approach each patient with the same intention to heal? Is it important? The data may very well show that it is. Attention to this aspect of medical care may not only improve the quality of what we do, but it may shift our focus, alter our outcomes, and contribute to a sense of balance and well-being among professionals in a high-stress field. We have already made a start in this direction with use of integrative clinical teams, patient-centered care programs, and emphasis on communications skills. There is much more to do. The next time that we awaken a post-op patient at the crack of dawn so that we might inquire: "How are you doing this morning?" let us consider what our goals are. When we see a patient's problem treated in a cavalier or callous manner, let us focus on what impact that message has on her ability to heal. Let's look at what an optimal healing environment might mean for the health and well-being of not only our patients, but ourselves and our ability to do all that we can as partners with those for whom we care.
REFERENCE1. Toward Optimal Healing Environments in Health Care: Second American Samueli Symposium. Chez RA, Pelletier KR, Jonas WB, eds. Mary Ann Liebert, Inc. Publishers: Newport Beach, Calif; 2004.