Tenet 2: Health 3.0 is both personal and non-personal
In my last post I introduced the first tenet of Health 3.0: uniqueness. Let’s continue with the next tenet: the importance of both the personal and non-personal in Health 3.0. This may be the hardest tenet for me to explain, but here goes…
There’s a personal side of you, and a non-personal side of you. The two can be in conflict.
For the personal you, the personal is sacred. Bestowed with personal rights and responsibilities, you value your place in the world. You look to make your mark through the worthy pursuits of life, liberty, happiness, and loving relationships. You feel that a life well lived is filled with free will, creativity, productivity, and achievement. These are the principles of Western Enlightenment, and you’re Benjamin Franklin. That’s your idea of an enlightened life.
For the non-personal you, the non-personal is sacred. The manifest world is an illusion, and you’ve woken up to your true nature. You’re freed from the bonds of space, time, duality, and separation. And this freedom is how you can evolve the world toward greater compassion, goodness, and justice. These principles are taught by Eastern religions like Buddhism and Hinduism, and you’re Eckhart Tolle. Your idea of the enlightened life is to be one with everything.
How does this non-personal side of you see the personal you? As an enemy. Think Donald Trump. The personal you is an ego that needs to be destroyed. As the mantra goes, “it’s not about you” — meaning the personal you. That personal you lives in fear and keeps craving for more and more. It’s unwilling to sacrifice its selfish, individual desires for a larger cause. And it keeps you from the equanimity that you value.
How does the personal side of you see the non-personal you? Also as an enemy! Think Maharishi Mahesh Yogi. The non-personal you is too detached. It says things like, “there’s no such thing as good and evil, because everything is one” — and you can’t stand it. In its stance of everything being one, the system as a whole trumps the individual. And the individual becomes a cog in an impersonal machine. The non-personal you then oppresses the individual, all in the name of progress.
In America, our society has been built on the personal you — although people are increasingly on non-personal paths. I’m the American-born child of Asian Indian parents. I was raised by my parents that it wasn’t about me — it was about the family. But I also grew up in America, with its individualistic sensibilities. So the creative tension between the personal and the non-personal has always been in me.
But here’s the thing: You are actually unique. Again, meaning independent AND connected. The personal you and the non-personal you…are both in you. It’s not either/or, it’s both/and (which will be a recurring theme in our discussion).
And, that non-personal can manifest in this world only through the personal you. It has to take up a perspective to act. There’s no other way. Systems act through interconnected individuals. Otherwise there’s no action.
So being unique means being personal, but on a deeper level. You’re doing your thing. And you’re doing it not just for yourself, but in service to something beyond yourself.
Health care can be seen the same way. There’s a personal side of medicine, and a non-personal side of medicine. Personal medicine is (more or less) Health 1.0. Non-personal medicine is Health 2.0. And the two are in conflict right now.
The Personal and Non-Personal Sides of Healthcare
Personal medicine harkens back to the private bond between doctor and patient. There’s great dignity in that bond. Nothing comes between the two. In line with giants of medicine like William Osler, the patient is a person, not a disease. And the great clinician is one who pays attention to the patient’s personal story. Think Marcus Welby, M.D., making house calls. That’s the subjective point of view. From the objective point of view, personal medicine is personalized medicine — like specifically tailoring treatment to your genetic makeup, or capturing your personal biometric data through sensors connected to apps on your smartphone. Whether interior or exterior, personal medicine is all about patient-centered care.
Non-personal medicine is all about system-centered care. The patient-doctor relationship is integrated into the health care system as a whole. Patient outcomes are tracked over space and time, at the population level. And patient care is standardized based on best practices discovered through those population studies. Think medical homes, accountable care organizations, and big hospital systems in your town. That’s the objective side. On the subjective side, non-personal medicine sees a patient’s given symptoms as common reactions to an underlying problem. This frees the system to address the problem without getting bogged down in the minutiae of the particular symptoms.
How does non-personal medicine see personal medicine? It’s inefficient, unreliable, fragmented, and wasteful. And it has a narcissistic attachment to personal attention, as it victimizes the person with the label of illness. In a desperate attempt to be cured, the patient then shops around for healing in fragmented orthodox and/or alternative outfits. And the profit-driven practitioners of personal medicine are all too willing to please, as they unsustainably construct lavish facilities both to meet and manufacture demand. Remember how Michael Jackson died? That’s the shadowy extreme of personal medicine. Less extreme, but more pernicious, is Atul Gawande’s “The Cost Conundrum.” For champions of non-personal medicine, there’s something wrong when Dr. Gawande finds a big difference between the medicine of McAllen, Texas, and El Paso.
And how does personal medicine see non-personal medicine? It’s dehumanizing — for both the patient and the clinician. A socialized, bureaucratic health delivery system serves up generic care to the patient who is now a mere client, through a doctor who is now a mere distributor. Clinical guidelines become mandates. Patients are given what guidelines dictate, not what they want. And the human touch of doctors becomes an afterthought. Alienated from an out-of-touch system, patients increasingly seek the human connection of alternative medicine. And alienated doctors increasingly seek an exit strategy. The UK’s troubles with its National Health Service is what personal medicine types believe is the endgame for Obamacare.
This is one big element of the battle between Health 1.0 and Health 2.0. The conflict between personal and non-personal medicine.
Health 3.0 transcends and includes personal and non-personal medicine. Like personal medicine, Health 3.0 honors the dignity, value, and vitality of the individual patient in caring for him or her. And like non-personal medicine, it situates that care in the health care system as a whole. Without dehumanizing the patient and caregiver. And without the craving attachment to keep churning the health care wheel. It’s personal medicine, on a deeper level.
The Emergence of Health 3.0
Health 3.0 re-integrates the shadows of personal medicine. A 3.0 practitioner listens to her patient’s history of symptoms. But she knows that those symptoms are often just non-personal markers of the patient’s very unique history. Underneath, for example, her patient’s dyspepsia may be something very different from another’s. Is it the bacterial infection H. pylori? Or is it, as Yale gastroenterologist and teacher Howard Spiro wrote about a patient experience, because “her husband beat her, she had had 4 failed pregnancies, her only daughter with spina bifida was confined to a wheelchair, and she was on welfare and could not work.”
In Health 3.0, healing moves beyond covering up specific symptoms and into addressing disease at its core. The 3.0 practitioner helps her patient feel less victimized by her illness. It’s not just about the symptoms. And it’s not even just about the circumstances behind the symptoms, as harsh as they may be. If the patient’s awareness can be opened up to a larger reality, she may realize that there is more to life than her particular suffering. This freedom can loosen the knots that tie her up with dyspepsia. She can then direct more energy toward nourishing herself with healthy food, lifestyle, and relationships. And less energy toward trying to medicate her symptoms away.
As she deepens her own awareness of her true nature, the Health 3.0 practitioner is transformed as well. She’s freed from the scarcity mentality that might be driving her to crank the health care wheel for dollars. She’s increasingly uninterested in practicing fragmented, self-interested medicine. She’s less apt to prescribe drugs or surgery reflexively and begins to open herself up to holistic approaches in medicine. She’s more concerned about how her actions affect the health care system as a whole. And she embraces the previously dreaded electronic health record as a tool to integrate and systematize her practice.
At the same time, Health 3.0 also re-integrates the shadows of non-personal medicine. When the 3.0 practitioner listens deeply to the unique history of his patient, the patient feels deeply heard. This gives the patient the confidence that his illness won’t be just pigeonholed into a set of guidelines from the system. And meaning in illness returns. It’s not just a silly metaphor read into illness. Finding meaning in illness actually allows the patient to bear the burden of disease and heal.
The healing goes both ways. The Health 3.0 practitioner doesn’t feel at all that he has to deny systems-level rationality just to listen to his patient’s personal story. It’s actually the opposite. In Health 3.0 the practitioner feels called to connect with his patient’s story and to help illuminate the meaning in his illness. This connection heals the practitioner’s alienation from medicine, restoring his sense of purpose. He and his patient are no longer commodities in an assembly line of health care; he feels comfortable enough in this sacred space to expose vulnerability as a fellow human being. He can drop the non-personal badge he used to deploy as a shield against the vast gray area in medicine. He feels free to practice medicine less defensively.
Listening, with intent to connect, is what generates empathy. Empathy is the therapeutic placebo between the practitioner and the patient. Empathy withers in the non-personal. It’s actively cultivated in the personal. And in the deeper-level personal medicine of Health 3.0, what does the cultivation of empathy bring back online?
Intuition. We’ve devalued it in Health 2.0 because it’s too woo-woo. But in Health 3.0 we practice a personal intuition that’s informed by, not divorced from, the non-personal side of medicine. And beyond it.
On the non-personal and personal sides of medicine, empathy, and intuition, Dr. Spiro had this to say:
With protocols from evidence-based medicine, robotic surgery, and genetically based therapies, current medical students ask what will be left for them to do as practitioners. I tell them that so far no computer has taken the place of a person who comforts the sick. The nurse practitioner who listens to the patient can comfort far more readily than any laptop doc. Clinicians more than ever must learn to act as mediators between the machines and our patients. To understand them, wider humanistic learning, more intuition, will be helpful.
The trouble is that physicians have lost confidence in themselves. They no longer consider it professional to help patients by their words, by their person, or by their presence, or they are embarrassed to try. Yet here is where a caring physician comforts so much more than a computer.
Restoring the patient-doctor dialogue is one goal of programs in the humanities: to pull the attention of physicians and nurses — all the caring professions — back to people, back to our patients — and to ourselves.
The more we practice personal medicine on deeper level, the more the health care system itself is healed.
That’s how it might look in theory. In my next post, I’ll show how it looks in practice.