The "Care" Effect

I have spent a considerable amount of my nursing career studying, accumulating information, practicing and  experiencing healing philosophy and giving statistical based lectures about the power and efficacy of alternative and complimentary medicine.  Research and statistics backed me up.  One such statistic  was: $34 billion dollars is spent annually out of pocket on treatments and non conventional approaches.  As I espoused these statistics to interested health professionals (I thought they were interested-- otherwise why would they take the trouble to come and hear a talk on this?) I could see these facts, wash over their high-browed craniums like an air current over the body of a soaring plane.  Very seldom did I see little pocket of air form within them expand as the information was delivered. Which made me think, their interest wasn't so much in these soft medicine facts and treatments as much as the money that wasn't reaching their pockets.  Then I thought I wasn't presenting well, it was too much "other" information, which although was factually undeniable, was unfamiliar.  They couldn't relate, even though I took great pains to give them statistics and research which were immediately relateable (dollar and cents).  As medical professionals, we are told it's all about evidence-base.  But obviously not, as they weren't assimilating it.  Finally, I decided the stars were not aligned, corporate medicine wasn't ready to take the leap to move toward including these practices, despite the facts.

To be fair, this information on alternative and complimentary medicine has been heard, but in corporate medicine terms.  Integrative medicine centers, associated with major medical institutions, have been formed, in fact it's a big trend at the moment. These centers obviously need financing, and they often get this through donors with deep pockets.  Their continued growth and success is also obviously necessary, so revenue generation is required.  They figured out how to get insurance to pay for treatments (ie: MD provided acupuncture, MD provided health coaching, packaged lifestyle behavior modification classes as prescription). Ok. So, we're moving along, right?

The issue I take in the current approach of integrating conventional with alternative medicine is that it is construed from the old model of practicing medicine.  It's based on Descartes's original and ever present philosophy that we can be deduced down to separable parts and the ill parts can be managed as they need to be, not in relation to the entire person.  This isn't Whole thinking, an approach based on Oneness.  Complimentary, alternative, integrative medicine becomes a "specialty" and is worked into an outdated paradigm that hasn't been effective for almost forever, has always been hugely expensive and ultimately becomes a tepid healing (because it is not based on relationship).

In his article, Forget the Placebo Effect: It's the 'Care Effect' That Matters   Nathanael Johnson makes a case for a soft medicine approach, stating research that shows kindness and a deeper listening skill used by practitioners is actually extremely effective in promoting best outcomes.  What Descartes discounted was the power of trust and relationship in healing.  He was all about promoting curing and hard facts of using a fully scientific approach (in his time, excluding church/religion/spirituality as a useful influence).  And in 15-20% of illness, he's spot on.  If you have a broken leg, saying prayers over it probably won't fix it, a good surgeon would be useful.  However, the rate of healing of this broken leg may vary depending on soft medicine interventions.  Using the science knowledge of positive attitude, mobilizing the parasympathetic nervous system to off-set the sympathetic in the crisis of the trauma gets our blood cells working optimally, reduces "emergency" hormones coursing through the body (an obstacle to healing) and makes us generally feel a lot better than taking pills dealing with anxiety and even pain.  Hippocrates had a more whole healing perspective, an example of a well rounded physician.  Probably Descartes was alive at a time of great political upheaval and was able to establish the model we practice today. Today, we train a lot of doctors in this country and extremely few of them become physicians (whole healers).

In 80-85% of all illness (chronic in nature) a non-conventional approach is mandatory for there to be a healing.  Because medicine has become so militarized and corporate, we are embedded in systems and bureaucracy that aren't meant to budge easily.  There is little flexibility, not much innovation (outside of technology) in approaching what has become the business of health.  The hierarchy is ever present:  hard science is best, soft medicine is tolerated and not really seen as an ever important adjunct to the full and effective treatment of human beings. Respect for knowledge is assumed.  Respect for relationship is (generally) not important.  It is this that is at the base of all healing, it is this that must be cultivated in medicine today.  Of course knowledge and skill are vital.  But without an empathic presence, a fuller present intelligence, a greater skill at listening, knowledge and talent are marginal in the forum of healing.  These skills make our healers (doctors, nurses, therapists) whole in service to others and (great empathy and deep listening) is also in its nature, a reciprocal action, a healing of oneself.

"The 'care effect'—the idea that the opportunity for patients to feel heard and cared for can improve their health. Scientific or no, alternative practitioners tend to express empathy, to allow for unhurried silences, and to ask what meaning patients make of their pain. Kaptchuk's study was a breakthrough:  It showed that randomized, controlled trials could measure the effect of caring. But there was already abundant evidence from nursing science to suggest a healing power in the interaction between practitioner and patient."*

Can this "care effect" proliferate in the old paradigm?  The old paradigm being a corporate compliance-based entity with iron-clad legal implications at every turn?  Nurses, as indicated in the quote above have seen and implemented this "care effect" through the ages but in the old paradigm model, have continually seen it tie their hands as restrictions and standard measurements of care become narrower and more prevalent.  They are expected to ever increase their "caring" while also being required to take on more and more responsibilities (same for MDs as well).  It is unrealistic.  It is not looking at either the whole nurse/doctor or the whole patient and probably the whole system.  Caring becomes a commodity in an uncaring, sometimes hostile environment.  This is not an environment or system that can sustain true empathy nor deep listening.  This is not a paradigm that can provide truly integrative services. This paradigm is broken.

Caring and empathy is a deep part of our humanity.  When it begins to be measured in "accountability" terms like a bookkeeper's numbers, we begin to have a problem that soon turns to dysfunction.  Healing is an often mysterious, varied and flexible process that was never meant for Descartes's small pigeon-hole formula.  We have to take a risk that a new paradigm can sustain an excellence and affordability in healthcare.  We have to have a more empathetic and fluid paradigm to work from.  That paradigm is currently unknown, which is a scary prospect for the millions of people who depend upon a working healthcare model.  But otherwise, we are putting a square peg in a round hole and trying to make it fit.  The body itself might have lessons for us to glean in how to develop a new paradigm.  The fact that the Central Nervous System has these different and varied aspects (sympathetic and parasympathetic) that work together to help us to be whole, is possibly something akin to developing a paradigm that can do the same for our healthcare delivery.  Something to ponder.

*Forget the Placebo Effect: It's the 'Care Effect' That Matters | Wired ...