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By John D. Clague, Christian Science Committee on Publication for Oregon
Not long ago I had an email exchange with Dr. Pamela Wible, a physician in Eugene, about the recent documentary Escape Fire. The movie examines the problems with health care in the United States, and possible solutions.
Unhappy with the “conveyor belt” system of medicine that she had found herself in since medical school, “pushing pills into patients as they flew past me,” Dr. Wible got off the racetrack and stopped to consider what kind of health care system she wanted to work in.
The first step towards building her new medical practice was holding town hall meetings to see what patients wanted in a community health clinic. She describes her experience in building her practice around patient values for health in her recent book, Pet Goats and Pap Smears.
Because Escape Fire points out systemic issues that confronted Dr. Wible, I thought it would be instructive to discuss these with a physician in the trenches.
John: Several prominent physicians were interviewed in the film: Andrew Weil, Don Berwick, Dean Ornish, and Steven Nissen. They are pretty critical of our current health care system. Do you agree with their assessment?
Pamela: Yes. We have a disease billing system, not a health care system.
John: It was said in the movie that “conventional medicine suppresses symptoms which just keeps disease going. Do you agree with this view of conventional medicine?
Pamela: Yes, but conventional medicine is fabulous with trauma and tertiary care. We fail at chronic disease and certainly we lack the training to deal with the most prevalent health problem in America: Despair. Despair is at the root of self-destructive behaviors such as overeating, smoking, alcohol and drug abuse.
John: How do you measure health outcomes?
Pamela: By helping patients become self-actualized and fulfilled human beings. I don’t spend my time forcing them into algorithms that conflict with their values. I invite patients to define their own health goals. I align my care with their goals, not mine, and certainly not the system’s goals. We have an innate ability to heal ourselves.
John: It was also said that the interventions we depend on in our health care system depend on expensive technology (imaging etc.), and that includes pharmaceuticals. Do you agree with this?
Pamela: Yes. We have a high-tech, low-touch model. When I ask citizens in town halls to describe ideal health care, they describe the reverse. They prefer high-touch, low-tech care when possible. We breed dependency on a high-tech, complex system. The basic message to patients is that the answer to their problems is outside of themselves (in pills, doctors, machines). This is disempowering and dangerous. When I listen long enough, patients will reveal their real core issues. Unfortunately, we do not take the time to get to the root of their problems in ten-minute visits.
John: Seems to me that primary care physicians as the hub around which specialty care is provided would be the ideal model.
Pamela: YES!! YES!! YES!! We spend far too much time caring for the system, caring for profits, caring for insurance companies and third parties. Caring for patients and doctors is no longer the priority. 1) We need a simplified model. 2) We need ethical human beings at the helm. WITHOUT these elements, all models will fail. We need a spiritual awakening in health care. We are holistic human beings, not reductionist robots. Escape Fire, reveals the failure of our patriarchal, reductionist medical model. Though holistic therapies are suggested as the solution, the film primarily interviews male physicians and fails to showcase female physicians or innovative health care solutions developed by women in medicine.
The film was heavily focused on the “problems” we face in health care, yet did not offer a balanced perspective on solutions. We know the problems.
Dr. Wible makes quite a few important points about health care. I found her perspective on what female qualities can bring to health care interesting, especially since my own health care system was discovered by a woman, Mary Baker Eddy.
Even though Dr. Wible associates the qualities of nurturing, love, and compassion with women, I’m wondering if perhaps this is a way of highlighting these qualities. In her book she mentions men whom she respects, and who embrace a balance of male and female qualities.
It appears to me that problems in life arise when complementary elements such as male and female are divorced. Perhaps the whole nature of health care in this country could be readjusted and aligned by the recognition and reintegration of this balance. Caring, nurturing qualities are important to health care delivery, but not confined to one gender or the other.
In my reading of the Bible I’ve found it intriguing that the ‘great physician’, Christ Jesus, seemed to possess tough qualities, and yet expressed compassion and love in his healing ministry.
Pamela Wible is a doctor exploring these important issues and taking them seriously, introducing them into her practice with very positive results.
By John D. Clague, Christian Science Committee on Publication for Oregon
This piece was originally published on OregonLive last December not long after the shooting at Newtown, CT. Emotions surrounding the shooting are still raw. I thought it would be helpful to post my comments here, with a few changes to make it current.
It’s never easy to see tragedies that undo lives and families and communities. In my 30 years of law enforcement I encountered plenty of this sort of thing. Our hearts go out to the community of Newtown, Connecticut, and to all parents and teachers across the country. It’s been over three months since the shooting and we are still challenged to find a way to address the unexplainable. Without some view of the nature of life that transcends all the shortcomings of the human experience I’m certain that I would be adrift in despair.
I have found, though, that in holding onto and affirming what, for me, are fundamental truths, I can find peace.
This is what I feel:
I don’t know why this happened in a cosmic sense, and it’s futile to try and figure it out. My heart says that God did not cause this tragedy, nor turn His back on us.
To me, God is the essence of goodness. And God is complete love. As such, I feel that God loves each one of us as His own creation, including all involved at Sandy Hook School. That love is still with those dear children and staff, embracing them and holding them close. They are with God. More importantly for those trying to cope with the aftermath, divine Love is closer than ever to comfort and strengthen families and communities.
I believe we must be more persevering in our search for solutions to prevent future violence, whether it involves one person or thousands of people. For me, it means praying to know that a loving and good God will guide our desires and actions towards finding solutions.
I, and others, might find ourselves letting go of some cherished beliefs and ideologies in this search for solutions, no matter how uncomfortable that makes us initially feel. Motivated by love for our children and our communities, embracing each other with more patience and attentiveness, we must find a way to work together toward that end.
I believe that being willing to pray for real solutions will bring them to us. We can still feel the “peace that passes all understanding” during this season and beyond by insisting that we will not become cynical and afraid, and knowing that God has not turned away. And when we do that we will find a way to hold these crimes in check.
By John D. Clague, Christian Science Committee on Publication for Oregon
Simplifying our life seems to be getting more complicated. But never fear, there is an app for everything nowadays. Managing each aspect of the most intimate everyday details is being digitized through applications running on ever faster and smarter devices in astounding numbers.
Almost everyone I know owns one of those ubiquitous smartphones or tablets. They seem to be able to do everything a computer can, and then some.
The technological wonder of these devices is surely one reason for their popularity. They can perform more commands per second than the computers in Apollo 8 by an order of magnitude in the thousands. They are cheaper and have far more memory. And you can easily carry them in your pocket.
And then the proliferation of software written specifically for mobile devices has a lot to do with their popularity.
Individual applications, or “apps”, exist for every conceivable function and service. And there are thousands of them. Apple has approved for download more than one million apps. Consumers have downloaded apps from their store more than 25 billion times. The Android download numbers are impressive too.
Managing health has not escaped this trend.
According to Research2Guidance, a global market research firm, nearly 247 million mobile phone users worldwide are expected to download a health app by the end of 2012. There are as many apps to manage health functions as there are health issues: losing weight, monitoring blood pressure or diabetes, exercising and so on.
There is even a proliferation of apps to assist physicians in making quick and accurate diagnoses and prescribing indicated treatments.
Are all these apps on our mobile devices the ultimate in making us healthier?
One person who might not think so is Dr. Marc Siegel, MD. Through a personal crisis he discovered a phenomenon he calls the inner pulse. It’s an awareness, or “sense”, about what’s happening with one’s body. He says it’s :
“… the fulcrum of a person’s life force, the place where the physical and the spiritual combine. It is the link between your body’s life force and your soul, tangible proof of your connection to a larger reality and of that reality’s strong presence in your body.”
“The inner pulse is more than just instinct and intuition.”… “Clearly, being aware of the inner pulse can change your life dramatically in a positive way.” (pg. 15)
Perhaps, though, the inner pulse, as Siegel describes it, goes beyond being aware of what’s lurking in our body. The inner pulse may not just tell us what condition the body is in, but may be able to affect health in a dramatically positive way, if we know how to access it.
Olympic skier Janine Shepherd tells the story of her remarkable return from a biking accident that left her paralyzed, yet she went on to a whole new life as a pilot. Told that she would never walk again, she asked, “Why me?” But at her lowest point she began to realize that it wasn’t just about her life. It was about life itself. She began to see that she was not her broken body. In the uncertainty of her circumstances, she found that she was free to explore life’s infinite possibilities. She felt she was responding to a spirit that was bigger than she was.
One day she looked up and saw an airplane flying overhead and said, “That’s it! If I can’t walk, I’ll fly.” She started by taking a flying lesson and went on to learn to walk again, to fly a plane and then to become a flight instructor.
Janine’s experience shows that there is an unmeasurable spirit that can bring out strength and ability far beyond what an app would be able to measure in the body. I call that God, and don’t ever want to underestimate the power it can have to restore a measure of health when human hope is gone.
The Bible says:
“There is a spirit in man, and the inspiration of the almighty gives them understanding… Whither shall I go from thy spirit? or whither shall I flee from thy presence? If I ascend up into heaven, thou art there: if I make my bed in hell, behold, thou art there. If I take the wings of the morning, and dwell in the uttermost parts of the sea; Even there shall thy hand lead me, and thy right hand shall hold me. (Job 32, Ps. 139)
Janine may know nothing about these Bible passages, but her life certainly embodies the energies of what I call a spiritual sense. I believe this spirit is available for everyone to tap into and receive an impulse like Janine did. Perhaps Dr. Siegel’s “inner pulse” is another way of naming this resource.
I haven’t yet found an app to make that link, but when I do, I will definitely let you know.
by John D. Clague, Christian Science Committee on Publication for Oregon
I’ve noticed an increase in the number of people on street corners asking for money the last several years. I have to admit that sometimes cynicism nags at me in response to the plea scribbled on a piece of cardboard in their hand.
“Anything will help. God bless”
Other times I just feel bad for the person holding the sign. On rare occasions I actually give them some money. I can’t explain why some people struck a chord with me and some didn’t.
Why would I pass judgment on the individuals standing there– deciding some are worthy and some are not? And what makes one worthy of my noticing them with compassion? Does it matter if they’re married or have kids or not? If they are an alcoholic? If they have mental illness? Or if they are truly a victim of economic circumstances leaving them down and out?
Consistency is important to me. I’m working towards a steady attitude of unconditional compassion for all mankind.
Jesus’ parable of the good Samaritan (Luke 10:25-37) has an important message for me. It presents a moral imperative to show compassion for those whom we might consider unworthy.
That a Samaritan (considered by ancient Jews to be an impure group) would stop to help a Jew who was in trouble, was unthinkable by social norms of the day. Perhaps one point Jesus was making in the story is that the Jew was worthy of the Samaritan’s compassion, not because he deserved it, but because he needed it.
Nothing in this parable suggests that another must deserve my compassion, or that I should get anything in return for my benevolence.
Then why do it? Does feeling and acting compassionately have any reward, even a sense of satisfaction for having felt and done something for someone else? In the traditional Christian moral paradigm, compassion and giving might be considered a prerequisite for going to heaven.
But what about the here and now?
I know that when I feel compassion for others, and act selflessly on it, I feel a sense of peace and inner happiness. But research is finding that’s not all.
At the University of Michigan, professor of medicine Bertram Pitt MD, has found that forgiveness and regular acts of kindness do contribute to people’s overall happiness.
Studies on altruism, however, suggest that happiness is not the only benefit. A study of 2,700 residents of Tecumseh, Michigan, found that men who volunteered in their community were two and a half times less likely to die than non-volunteering men.
Tia Rich, Ph.D., Director of Stanford CARES (Compassion, Awareness, and Relationship Skills to Ease Stress), spoke with BeWell about the relationship between compassion and health. She says that: “… Compassion … can be expressed between strangers or even enemies…” such as was illustrated with the Good Samaritan.
She goes on: “In 2008, compassion’s role was the focus of researchers at the University of Wisconsin, Madison who reported the results of functional magnetic resonance imaging (fMRI) studies conducted on Tibetan Buddhist monks with more than 10,000 hours of compassion mediation experience. The research suggested that the experienced monks had greater awareness and attention to emotional stimuli and had a greater compassionate response to those stimuli. These findings suggest that compassion’s effect…may be a mechanism by which the stress response is reduced and health is promoted.”
K. C. Blair, Founder and Director of Good Samaritans International, says: “I never thought as a scientist I would find myself saying this, but our research data has led to our conclusion that compassion creates healing and maintains health.”
A freelance writer, breast cancer survivor, and frequent contributor to CNN, Amanda Anita, writes in her blog “How to deal with mean people”:
“Indeed, a slew of studies confirm that kinder people tend to live longer and lead healthier lives; volunteers have fewer aches and pains; and compassionate people are more likely to be healthier and successful.”
Whether or not you feel an obligation to love your neighbor as yourself, as I do, compassion for others can make life better for them. And it can also improve your own longevity and health. But, as anyone knows who tries to practice compassion, it isn’t about logic and head games, but about expanding the heart. Many of those who make compassion their way of life understand this.
When Richard Davidson, a neuroscientist from the University of Wisconsin, began studying the effects of compassion meditation in 1992, he traveled to a Tibetan Buddhist monastery and attached electrodes to the head of an expert meditation practitioner. He was surprised when the other monks began laughing.“I thought it was because he looked so funny with the electrodes attached to him,” Davidson recalled. But it turned out the monks were amused that he was trying to study the effects of compassion by attaching the electrodes to the practitioner’s head, rather than his heart.
By John D. Clague, Christian Science Committee on Publication for Oregon
I’ve imagined that doctors are good at taking care of themselves, and that they’re a healthy lot. After all, they’re smart people. Their discipline and training are more rigorous than most professions. They are dedicated to helping people get well and stay well, and I assumed that included them.
It appears that I’m not alone in this point of view. Merry N. Miller writes in Medscape News about what we think doctors should be.
Physicians are expected to be healers, available to others whenever a crisis occurs or a medical need arises. They are expected to have unfailing expertise and competence, to be compassionate and concerned, and to provide universally successful care in a cost-effective manner.
Many doctors do fulfill this image, and most doctors have a healthy diet, don’t smoke, and they exercise. But in spite of, or perhaps because of what we expect physicians to be, those in the healing arts suffer high rates of mental distress. And paying so much attention to the bottom line can sometimes turn health care into a stress-filled industry for the care giver.
Dr. Pamela Wible in Eugene was part of that rat race in the early years of her career. Here’s how she describes it in her new book Pet Goats and Pap Smears:
“I felt like a factory worker pushing pills into patients as they flew past me on a conveyor belt. I tried other jobs, but they were all the same—assembly-line medicine. Doctoring was dumbed down to a numbers game with cookbook care if they had no insurance or if they took too long to express themselves.
After ten years on the treadmill, I was tired of being rude to people and neglecting myself—all in the name of health care.”
Spending so much time trying to help others can come at the expense of a doctor’s own health needs. The consequences of this contradiction are sometimes tragic.
The father of one of my best friends in college was a specialist physician. His family lived in a nice neighborhood and from what I could tell, they were happy. At one point I learned that his father went through “the cure” for alcoholism. Tragically, he later took his own life.
At the time I thought this was unusual. Unfortunately, I was wrong. Research shows that physicians have high rates of failed marriages, severe depression, substance abuse, and suicide — one of the highest rates of all professions.
The few who have taken a close look at this problem posit that, while alcohol and drug abuse is sometimes a problem, harsh self-criticism and a perfectionist personality can make some doctors neglect to get help for themselves when it’s needed.
But, do doctors have to be healthy to properly care for their patients?
As Wible so aptly puts it:
“If doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged.”
Wible’s story doesn’t end in tragedy, though. There was a mental shift that occurred.
It was her sense of compassion for patients that allowed her to break out of her own despair and the rut that can be destructive to the wellbeing of our caregivers.
What she did was revolutionary. She set up town hall meetings for would-be patients to give them a chance to tell her what their ideal community clinic would look like. From their 100 pages of input, she built a community clinic embracing many of the ideas she heard.
She built her practice around a compassionate, caring relationship with her patients that started with the town hall meetings and listening to their needs.
Research is now finding that “relationships” are at the core of a more complex dynamic that has a significant impact on health. These are called “therapeutic relationships” and they directly affect patient response to physician prescriptions.
Some of Wible’s favorite prescriptions, described in her book, are: “take a vacation to the coast; go on a seven-day silent retreat in the woods; stop worrying; go on a media fast for a week; fall in love with yourself; speak your truth; see an energy healer”… and so on.
She’s helping patients get healthy by addressing their thought. It appears that her practice of spending time with patients, listening to them deeply, and caring about them allows her to get at their real health issues.
Getting back to her core values for patients, listening to them deeply and compassionately, and not just being a pharmaceutical dispensary nor quickly processing patients through her clinic, she is now happy and fulfilled in her medical practice.
Could it be that by meeting deeper patient needs, Wible has found a way to fulfill the ancient biblical admonition, “Physician, heal thyself?” (Luke 4:23)
By putting the patient at the center of compassionate health care, might it help other practitioners to be more healthy, too?
As author Monica Dougherty puts it: “Compassion is really about loving yourself first and then others. Loving means wanting the best for everyone.”