Friday, 10 April 2015

A Doctor/Patient Model Could Have Been

It has always been my contention that though doctors increasingly wax on about "personal responsibility" they simply don't want the reality that entails. One of those titles sums up, "It's difficult being a doctor in the age of the empowered patient."

Why if you wish patients to take more responsibility for themselves? That phrase "empowered patient" is somewhat redundant. Why should patient equal dis-empowered? Why should a patient be any less than the equal of any doctor they bring their body to? Who else but a patient has the potential to have a uniquely comprehensive insider view of the experience of being themselves? And how can this even be a thing when there are open assertions about sometimes, extreme lack of patient initiative?

Like all humans, medics wish to have their cake and eat it to. They want the abject docility, they've come to base their power on, without the burden that increasingly imposes on them, in an era of chronic health problems. As a profession overall, they've grown accustomed to used to the kind of passivity that serveed the contagion/magic bullet mode of disease.

Their power has to a large extent come from patient dis-empowerment, to put it bluntly.That exchange requires reformation.

They could have had this already, if they'd truly desired to. Fat people took it up themselves to follow their general prescription, to diet, diet and diet again-no matter what, and press repeat. Until our nervous systems burned out from that-because that's what happens if you keep at it long enough. Or simply wised up that these findings were consistent and repeatable. In other words, they were scientific, despite mainly going unacknowledged at best, or denied at worst by those charging themselves with that.

If instead the truth had been full recognized, our extensive co-operation and goodwill could have promoted a respectful mutual dialogue and illuminating interaction. A truly progressive exchange. As we were so committed to the experiment, it could have changed in nature being informed by our experience. That usually happens with research, progress.

Those of us that wanted to could have signed on-unofficially-for the shifts in focus that would have had to have been the product of greater intelligence collated from practice. Practice that illuminated physiological function e.g. the first thing that happens when you merely intend to start a restricting energy is hyperphagia-hunger and appetite activity goes right up.

This can be a trigger for hyperphagia nervosa [heightened appetite not knowingly related to hypothalamic compromise]. This could have been warned against, to this day, most people don't realise having restriction hanging over you long-term can have this effect. It would have acted as a break on the always be trying to lose weight culture. It would have meant switching off between attempts and that could have stopped some hunger/disordered/eating disorders from developing.

Not only reducing the number and extent of hyperphagia/cs, reducing the psychological harm that can occur when the nervous system gets repeatedly then becomes chronically overtaxed. That's simply one aspect. True acknowledgement of facts and reality, monitoring through genuine and meaningful study would have reduced stress immeasurably, giving people a sense of their own power, even if it didn't bring the desired results.

Not all of this is for medics obviously, but this would have informed communication between doctor and lay people-if not patient. All would have been ample evidence of the extent of people's efforts, that could then not be denied. It could also reassure doctors, reducing their weird sense of being victimized by their patients' weight.

When you find out that a person struggling to deny their body for years, finally somehow corners their body into reduction and finds their body loses weight from everywhere but their mountainous belly/their big arms, legs etc.,-me!!

You'll find it hard to shout, "Non-complaint" into a void made from ignorance. Indeed, there would be no void, instead a pool of facts and figures. There would be potential for progress and hope of more.

This filtering of on-going experience into an on-going real life experiment with human metabolic function would have altered the expectation of patient engagement without little duress, for either.

But of course, the medical profession as a whole didn't want that. Many still don't. Though I can grasp that, I'm still struggling with the depth of their desire to martyr themselves at the alter of fat people's supposedly refusnik will. I cannot fathom what they hoped or hope to achieve from penning us into a place where we cannot move forward, only press repeat ad infinitum often going backwards. Nor do I get how they are able to behave as if this hasn't happened.

Though I guess that's a feature of the denial of reality. 

They'll take some challenge from their social peers though as long as it's tightly within the conventional frame of boning up on acceptable available research;
Often our patients were well-informed scientists, teachers or university lecturers. They did extensive research on the unusual ailment or the latest groundbreaking medication. As a trainee GP with little experience, it was often daunting to manage these intense patient-led encounters. Whether prescribing a statin for high cholesterol or referring for investigations, everything involved negotiation with the patient. It was immaterial that there were 10-15 minutes allocated to each encounter: the consultation finished when a plan was reached.
This for me doesn't really come close to what might have been. That's about social position, not the future of medicine. We could have been part of moving the research process forward of directing it to more fruitful and useful grounds.

What a bloody waste.

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