If you tell somebody that you are going to do something and you don’t do it, is that lying? Is lying only when you look someone in the eye and tell them that “I did (or didn’t) do it” when you know the opposite is true? How about when we tell a friend that we will meet them someplace for lunch and then we don’t show up, did we lie to our friend? If we just show up late after saying we would be somewhere at a certain time, is that lying? Is it still lying if we are late but we have really good excuse? What if we have a really good reason for not doing what we said we would, does the reason make the lie not a lie? Are there degrees of lying or truth or “truthyness”? Does intent count? I mean if we intended to do something and then just simply forgot, or had a good excuse or “something came up”, does that make our commitment to another to be somewhere or to do something not a lie or is it just a more “acceptable” lie? If we make an appointment with an accountant, doctor, attorney, or hairdresser and we don’t show up or show up late, did we lie when we said we would be there at a certain time? What if the doctor is not there or late for your appointment, did he lie? When we say we will exercise, eat fresh fruits and vegetables daily, get to bed earlier, not smoke, not drink, or not watch as much TV and then we do these things anyhow, is this lying to ourselves? When our lies inconvenience, hurt, disrespect only ourselves, is that more acceptable than if we do this to others? How “good” is our word? When we say something, can we be counted on to do what we say we will do? Can we count on ourselves to tell ourselves the truth? Does not showing up, being late, and having a really good excuse, having good intentions, take the place of the truth, of being honest, of having integrity? Does “kings X”, “I had my fingers crossed”, “I really meant to be there”, excuse us from the fact that we lied?
In other words, is the truth a fluid thing …., or does our word, our promise, our commitment to do something, be somewhere, be on time, mean something, even in the small things? Can we say, truthfully, that we have “integrity” or that we are “honest”? Is “lying” too strong and how can it be anything else but lying?
Personally, I think lying is lying, period, no matter what our intentions or reasons. Whether it is too ourselves or to others, it is lying and from what I have seen I don’t think that any of us are truthful 100% of the time. Some of us may have good intentions 99% of the time, but we still lie. Acknowledging that we may lie, cleaning up what ever mess or hurt we may cause by lying and striving that much harder to have integrity in all of our relations gives us an access to having a healthier future. Having integrity gives us a say in our future because our words have the power of the truth when spoken and we can create our world with our word, because we said so.
Tuesday, August 3, 2010
Wednesday, November 25, 2009
I Don't Know
Over the thirty-six years of my practice I have observed some processes of growth in myself and in others. I have read of the accounts of such growth in many different books and articles and now I have observed and, hopefully, participated in the growth that comes over time. My observations pertain to the healing arts; however, I don’t think the process is unique to just the healing arts or health care. As a disclaimer, I do not pretend to be the first or even near the first to observe this phenomenon of change and growth; in fact I am probably way down a long list of everyone that has preceded me. I am not assuming either that I have reached some level of great wisdom. Be that as it may, I feel compelled to write this essay on my observations in the hopes that it may help someone else move forward in life a little faster.
The training of new physicians in the western world is a long and tortuous process. Physicians are taught anatomy, physiology, pathology, histology, biochemistry, diagnosis, treatments and remedies. Most are put through an intern or externship of months to several years. Allopathic physicians are, for the most part housed in institutional hospital settings that cater to the most advanced and acute cases of disease and injury. Dental, Chiropractic and Naturopathic students see patients in a crisis for the most part and for a short time. None of the new professionals are allowed to observe the overall progression of dis-ease or to come to some understanding of the total process of dis-ease. The training that is received is world class, excellent, well intended. The training, however, does not really address people as human beings and it does not, in most cases, allow the physician to develop his or her humanity into being a “healer”. (Healer being defined as someone who is able to facilitate and assist in the self-healing of another person) An example of what I would offer as a possibly more ideal model, in the intern phase, and even perhaps the basic science phase of training, is the older Eastern apprenticeship model of training whereby the intern, apprentice, would work with, under, a “master” until such time as the master felt the intern was ready to “care” for mankind. This process allowed for the full development of the physician over a period of twenty to thirty years. He was able to progress to a mature level of understanding of a human being and not just of their ailments. (I do not hold out much hope that this will occur, nor do I deny that there are inherent weaknesses and drawbacks to the apprentice model.)
What about the apprenticeship form of training makes it a more effective form of learning? It is my observation that there are three stages of maturity in an adult. The three are:
1. To Know About
2. To Know
3. To Know I Don’t Know
The first phase of maturity, “to know about”, is the first ten to fifteen years of practice or learning. The new physician knows about many things. He is well trained. She is competent and, in many cases, more aware of the latest technology. They may be more open to a new idea and not react in a “knee-jerk” manner to situations. The down side is that this person has no background or experience to understand what is happening. They have not seen or experienced the good and the bad outcomes of their ministrations. They have not dealt with enough people to understand or at least recognize the various idiosyncrasies of being human. Their knowledge, for the most part, is from “the book”. Their actions can be hesitant, indecisive, and without the quick reactions that come from having been in a situation before. They have nothing else to fall back on but the textbook. They, therefore, tend to be more dogmatic and defensive of their procedures and their decisions. They tend to hide behind their books and studies.
The second phase of maturity, “to know”, is the middle phase of growth, from ten to twenty or thirty years in practice. This physician has experience. She has seen many cases and people. He is able to see through and around many of the problems that people will bring. He is current with most new technologies. She is active and a strong advocate for various issues. This practitioner takes stands and leads charges for change. He has enough experience that his actions are almost automatic. Much good comes from this stage of growth. The down side, however, can be an inability to see errors in himself. Pride, arrogance, determination, all the things that make her a great leader also handicap him as a physician. His heart and head are not open, he has made up his mind and that is the way it is to be. A sense of immortality and righteousness seem to surround this individual. Short term purpose and goals dominate. Acquisitions, accomplishments, drive to succeed are obvious characteristics. However, boredom, indifference and loss of purpose, mid-life crisis, a “is this all there is?” attitude, are common afflictions in the later phase of this time of life are commonly noted in large part due to materialistic goals and objectives (acknowledged or not).
The third phase is that of “To know I don’t know”. This is the more mature provider of the art of “healing”, a “master” of his craft. Having seen much, experienced much and been humbled often, the mature practitioner is able to listen, hear, and notice what is happening with her patient. He can feel, empathize with, what the patient is experiencing. He has been around long enough to know that he doesn’t know and therefore he must be continually looking for answers, opportunities. She knows that for each answer she gets it will raise at least three more questions and that there are things that can’t be answered. He is willing to ask. These people are more humble because they know that nothing they have done could have been done alone. For every accomplishment that is hailed as original, he knows that it is based on the work of countless others that have led him to his conclusions and actions and that in his past there were those that paid for his mistakes that taught him what he knows now. Obviously, some of the dangers that are a part of this last phase are boredom, indifference, withdrawal, fatigue, surrender, extreme frustration and a sense, in this society, of uselessness, or, at the other extreme, arrogance, selfishness and ego.
The third stage is the stage of teaching and sharing. Some call it “sageing”. Having seen enough cases, dealt with enough people and situations this doctor can see beyond the immediate situation and help guide the patient or the young doctor on a course of recovery and improved health. The accumulation of financial security behind or at least taken care of, allows a sense of detachment and yet commitment to the larger picture of human existence. It allows the physician to teach with a “ruthless compassion” that knows the pain that her words may cause the student, but knows also that it is less than the pain of learning by failing with a patient. Or learn by dying prematurely. It is a phase of humility and yet a possible appearance of arrogance by those that think they know. It is a time of bigger visions.
It seems, then, that life begins with a blank slate knowing and having nothing and ends with acknowledgment that we know nothing, but that the knowing we know nothing is something…and then we die. Or we begin again.
I don’t know.
The training of new physicians in the western world is a long and tortuous process. Physicians are taught anatomy, physiology, pathology, histology, biochemistry, diagnosis, treatments and remedies. Most are put through an intern or externship of months to several years. Allopathic physicians are, for the most part housed in institutional hospital settings that cater to the most advanced and acute cases of disease and injury. Dental, Chiropractic and Naturopathic students see patients in a crisis for the most part and for a short time. None of the new professionals are allowed to observe the overall progression of dis-ease or to come to some understanding of the total process of dis-ease. The training that is received is world class, excellent, well intended. The training, however, does not really address people as human beings and it does not, in most cases, allow the physician to develop his or her humanity into being a “healer”. (Healer being defined as someone who is able to facilitate and assist in the self-healing of another person) An example of what I would offer as a possibly more ideal model, in the intern phase, and even perhaps the basic science phase of training, is the older Eastern apprenticeship model of training whereby the intern, apprentice, would work with, under, a “master” until such time as the master felt the intern was ready to “care” for mankind. This process allowed for the full development of the physician over a period of twenty to thirty years. He was able to progress to a mature level of understanding of a human being and not just of their ailments. (I do not hold out much hope that this will occur, nor do I deny that there are inherent weaknesses and drawbacks to the apprentice model.)
What about the apprenticeship form of training makes it a more effective form of learning? It is my observation that there are three stages of maturity in an adult. The three are:
1. To Know About
2. To Know
3. To Know I Don’t Know
The first phase of maturity, “to know about”, is the first ten to fifteen years of practice or learning. The new physician knows about many things. He is well trained. She is competent and, in many cases, more aware of the latest technology. They may be more open to a new idea and not react in a “knee-jerk” manner to situations. The down side is that this person has no background or experience to understand what is happening. They have not seen or experienced the good and the bad outcomes of their ministrations. They have not dealt with enough people to understand or at least recognize the various idiosyncrasies of being human. Their knowledge, for the most part, is from “the book”. Their actions can be hesitant, indecisive, and without the quick reactions that come from having been in a situation before. They have nothing else to fall back on but the textbook. They, therefore, tend to be more dogmatic and defensive of their procedures and their decisions. They tend to hide behind their books and studies.
The second phase of maturity, “to know”, is the middle phase of growth, from ten to twenty or thirty years in practice. This physician has experience. She has seen many cases and people. He is able to see through and around many of the problems that people will bring. He is current with most new technologies. She is active and a strong advocate for various issues. This practitioner takes stands and leads charges for change. He has enough experience that his actions are almost automatic. Much good comes from this stage of growth. The down side, however, can be an inability to see errors in himself. Pride, arrogance, determination, all the things that make her a great leader also handicap him as a physician. His heart and head are not open, he has made up his mind and that is the way it is to be. A sense of immortality and righteousness seem to surround this individual. Short term purpose and goals dominate. Acquisitions, accomplishments, drive to succeed are obvious characteristics. However, boredom, indifference and loss of purpose, mid-life crisis, a “is this all there is?” attitude, are common afflictions in the later phase of this time of life are commonly noted in large part due to materialistic goals and objectives (acknowledged or not).
The third phase is that of “To know I don’t know”. This is the more mature provider of the art of “healing”, a “master” of his craft. Having seen much, experienced much and been humbled often, the mature practitioner is able to listen, hear, and notice what is happening with her patient. He can feel, empathize with, what the patient is experiencing. He has been around long enough to know that he doesn’t know and therefore he must be continually looking for answers, opportunities. She knows that for each answer she gets it will raise at least three more questions and that there are things that can’t be answered. He is willing to ask. These people are more humble because they know that nothing they have done could have been done alone. For every accomplishment that is hailed as original, he knows that it is based on the work of countless others that have led him to his conclusions and actions and that in his past there were those that paid for his mistakes that taught him what he knows now. Obviously, some of the dangers that are a part of this last phase are boredom, indifference, withdrawal, fatigue, surrender, extreme frustration and a sense, in this society, of uselessness, or, at the other extreme, arrogance, selfishness and ego.
The third stage is the stage of teaching and sharing. Some call it “sageing”. Having seen enough cases, dealt with enough people and situations this doctor can see beyond the immediate situation and help guide the patient or the young doctor on a course of recovery and improved health. The accumulation of financial security behind or at least taken care of, allows a sense of detachment and yet commitment to the larger picture of human existence. It allows the physician to teach with a “ruthless compassion” that knows the pain that her words may cause the student, but knows also that it is less than the pain of learning by failing with a patient. Or learn by dying prematurely. It is a phase of humility and yet a possible appearance of arrogance by those that think they know. It is a time of bigger visions.
It seems, then, that life begins with a blank slate knowing and having nothing and ends with acknowledgment that we know nothing, but that the knowing we know nothing is something…and then we die. Or we begin again.
I don’t know.
A Prayer
Dear God,
I know that You are always present
I know that it is my ignorance that blinds me to You
Lord, I pray that You lift the fog from my mind that I might know You
I pray that You lift the veil from my eyes that I might see You
I pray that You remove the blockage in my ears so that I might hear You
I pray that You open my heart so that I might experience Your love
Lord You are omniscient, omnipresent, all powerful and everlasting
Please open my eyes, my ears, my mind and my heart to You today and always
Please help me to know You in all that I do
Help me to be Your servant in all things
Lord, waken me to Your Presence.
Amen
On Saying Good-bye
Recently I attended a memorial service for a friend of mine. After the service it occurred to me that only three people, besides the family and minister, had stood and had spoken about my friend, his life, how he had impacted them or how they will miss him. Maybe it is because I am growing older and I have been to more memorials in the last few years than I would like that, thinking back, this bothered me. I know that my friend touched more people than three. There were well over a hundred people in attendance and he had been in practice for over 30 years. I also know that most surveys on the subject show that the fear of speaking in public is the number one fear most people have, even more so than that of dying. Given the fear that most people have of speaking perhaps it is understandable why there were not more people who were willing to stand and speak, but it still bothers me and so I am writing this letter as encouragement to speak up when someone you know passes on. I believe that we need to let the family know the depth and breadth of their loved ones life and that by our speaking we give others in the room the opening to speak up. Even if we just repeat what others have said, or just say “(s)he touched my life”, I believe it is important for us to speak up. (Better yet, why not tell the people in our life while they are alive how much they mean to us so that they may know the difference they have made) If we are at a memorial service that person has touched our life in some way. Maybe it is just an acquaintance, a co-worker, a client or a casual friend; they have touched us and changed us because of their time on this planet. Charlie “T” Jones says that “We are changed by the books we read and the people we meet”. I am encouraging us all to acknowledge the change, the difference, no matter how slight, that person made in our life.
There is a poem titled “The Dash”, by Linda Ellis, which refers to the sum total of our lives as the “dash” between the date of our birth and the date of our death. That isn’t much of an epitaph, a dash. Three people commenting on an almost 70 year life, doesn’t really say much about who my friend was, what he did, who he touched or how he touched people. It isn’t much about any life of any length. If we are there, at a memorial, we were touched, we were changed by that person and we need to speak up. If we can’t go, we can write a note, personalize a card or make a call. It does not need to be somber or spiritual, just personal, from us, from our heart.
I hope that there are no memorials in our near future, but I know there will be memorials. Please, let’s decide that we will tell the people in our life how much we appreciate them, that they do make a difference and if it has to be at a memorial, please let’s not be shy, let’s make the “dash” in that person’s life have meaning. I know that from now on I will.
As you have received this letter, please know that you have touched my life and that no matter what the circumstances were of our relationship, because of you my life is better and I appreciate you for giving me a fuller and better life.
Fred
(PS. No, I am not dying, I do not have an incurable disease, nor am I going anywhere and my plan is to be around for quite awhile yet.)
There is a poem titled “The Dash”, by Linda Ellis, which refers to the sum total of our lives as the “dash” between the date of our birth and the date of our death. That isn’t much of an epitaph, a dash. Three people commenting on an almost 70 year life, doesn’t really say much about who my friend was, what he did, who he touched or how he touched people. It isn’t much about any life of any length. If we are there, at a memorial, we were touched, we were changed by that person and we need to speak up. If we can’t go, we can write a note, personalize a card or make a call. It does not need to be somber or spiritual, just personal, from us, from our heart.
I hope that there are no memorials in our near future, but I know there will be memorials. Please, let’s decide that we will tell the people in our life how much we appreciate them, that they do make a difference and if it has to be at a memorial, please let’s not be shy, let’s make the “dash” in that person’s life have meaning. I know that from now on I will.
As you have received this letter, please know that you have touched my life and that no matter what the circumstances were of our relationship, because of you my life is better and I appreciate you for giving me a fuller and better life.
Fred
(PS. No, I am not dying, I do not have an incurable disease, nor am I going anywhere and my plan is to be around for quite awhile yet.)
Options in Health
Most people live as if they are “fully alive”, functioning at 100% or as if they are on the verge of death, figuratively if not literally. We, also, acknowledge that there is a lot of ground, or shades of grey, between the two states of being. However, this acknowledgment does not alter the manner of living as if our health is “perfect” and separate from the rest of our existence. Government entities, individuals, business entities, our entire society treats health and health care as if they were a product that can be isolated, patented, packaged and sold to the highest bidder or is totally ignored as if it isn’t relevant to the issue at hand. We attempt to negotiate with, make compromises with, try to bend to our own political or economic agendas, or totally ignore, our health. We fail to recognize and deal with, face to face, that our health is our life.
Over the years it has become harder and harder to avoid the obvious fact that health care and health are not about the provider, disciplines of health, diseases or conditions, it is about the health of an individual (society, company or community). Although this seems like it should be obvious, if we look at how health care is provided and how health is depicted in the media, health is treated as a commodity that is comprised of diseases and symptoms or youthful individuals exercising, eating certain cereals and taking certain drugs and leaping around a mountain meadow with a Labrador Retriever. The message seems to be that if we give enough money to find the “CURE” that what we will be left with will be “health” and we won’t have to be responsible for our health. When discussing health with most people the first words out of their mouth usually relates to exercising more and eating better or taking some form of supplements, as if health is only eating good foods and exercising, neither of which are done by most of us. Our observation is that most practitioners and health professions, not necessarily intentionally, practice as if they are “the way and the light”, “the answer”, to better health. What we have come to recognize is, again the obvious, that health care providers are “a light along the way” and the entity being served has “the way and the light” inside of them. Using this metaphor a bit further, if we look at how people in our society obtain health information and assistance we would have to visualize the road to health as a super highway with flashy billboards and street lamps only at service stations on exit ramps. Each discipline at it’s own isolated station with only a dirt road connecting the different exits and with very little light being cast upon the super highway of the persons health. Bringing the stations next to the freeway with the ability to easily travel between each station and with a good communications network, would enable that person to move easily on the freeway through a full life with an integrated support system. In other words, fully integrate health care as a support team and remove the focus on doctors and treatments and back onto personal responsibility.
Out of this gradual realization a group of practitioners and an on-line group of people with diverse backgrounds, to include; allopathic physicians, naturopathic physicians, a chiropractic college president, chiropractic physicians, a dentist, health consultants, business consultants, and interested lay people began a dialogue. The topic of the dialogue was “what is health?”, what is it comprised of, what drives it, how does it relate to the individual, to business entities, or government entities? How do we take this huge and complex subject and put it in a form that not only we, but also anyone can understand? How does health function inside the World Health Organizations definition of health as, “Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or injury”? The outcome of these dialogs was very similar to, if not identical to, the components of health as listed in Evans and Stoddart’s 1990 paper, in “Social Science Medicine”, “Producing Health, Consuming Health Care”. An example of these similar conclusions was, as stated by Stoddard and Evans, “The WHO broad definition of ‘health’ is, as noted above, so broad as to become the objective, not only of health policy, but of all human activity.” Or as we stated it, “our health is our life.”
An outcome of our two-year dialogue is the concept depicted in illustration one. This chart represents a flow chart of health and can be used in multiple settings. It can be used to depict an individual’s or a corporation’s relationship to health or as a representation of health. The chart represents, on the A to B axis (or “life line”), the two extremes as lived by most people, these are “Fully Alive” and “Dead”. Most people live as if they were in one or the other of these extremes as the state of their health. Of course, the distinction of the vast area separating the two extremes is brought forth in the stating of the extremes. Dividing the axis into quarters creates the areas of “Mostly Alive”, “Alive” and “Mostly Dead” and allows for each division to be assigned an arbitrary value as a percentage of “aliveness” with “Dead”, of course, being zero. From zero to 50% is the area of symptoms and disease and 25% to 75% is where most people exist. Actually most appear to live somewhere between 25% and 50% of their potential, as depicted by this chart, with all efforts seemingly directed towards getting to and maintaining 51%, or symptom free. Our system of health is directed at and intended to eliminate all symptoms and to prevent or eliminate all diseases. This is not an inappropriate effort especially if people or societies are living in the zero to 25% range of health or, perhaps, in a third world country. The dominant system of health care in this country, allopathic medicine, is at it’s very best when heroically preventing death. When, however, we attempt to modify and apply these same lifesaving, yet life-threatening procedures, in the non-eminently lethal situations, in the area from 25% and above, the risk-reward ratio begins to tilt away from benefit to risk of harm (i.e. 16500 deaths/year from NASID’s, 2000 deaths/week from prescription drugs, 1.5 million hospitalizations/year due to prescriptions drugs).
So what is the alternative to the traditional allopathic model of health delivery or of “preventing death”? Historically, the “opposing” or, as we would prefer “complementary”, alternative is “vitalism” or “Promoting health”! “Promoting health” in this manner implies supporting the innate healing ability of the body and working with the body not to the body. If we acknowledge and respect the efforts of reductionism and the mechanistic approach to health and look at what else can be done, or what is the “alternative”, it is apparent that “promoting health” and the vitalistic approach gives us an access to 100% health that is not available to the mechanistic procedures that are dependent upon symptoms and diseases for their application. In the alternative, vitalistic approach, the efforts are aimed at improving, or optimizing, function so that a “rear view mirror’, so to speak, is necessary to realize the degree of success, or, as patients who are in care of an alternative provider have stated, “I didn’t realize how bad I felt when I thought I felt good.” “Promoting health” versus “preventing death” gives us, also, the distinction between “quality of life” and “maintenance of existence”.
Using this model acknowledges the areas of strength and weakness of both approaches and more importantly allows the person, system, company, the opportunity to have a “say” in the approach THEY determine is appropriate at the given moment. It also allows that neither point of view is “right” or “wrong”, only “appropriate” or “inappropriate” as determined by the person or owners of the company.
The question then must be asked, “What are the factors that impact and determine the level of health that is expressed?” What are the spheres of our life that move the marker up and down the AB axis? Our dialogs led us to seven, obvious, major areas that are also subsets of each other.
1. Physical
2. Nutritional
3. Mental/emotional
4. Environmental
5. Occupational
6. Family/community
7. Spiritual (faith)
(8). Financial
The eighth, financial, is placed in parenthesis, as it is not truly a factor of human health, except as society, or we as individuals, allow it to be a factor. However, as people and companies make health decisions based on money it becomes a “real” factor of health.
Hypothetically each of these areas intersect with the “life line” to create the percentage of health or quality of life being expressed. If we rotate the AB axis ninety degrees (illustration 2) we have the ability to apply values to each of the seven areas of health and begin to estimate what is “missing” and needs to be addressed for movement up the life line. Using this depiction and acknowledging the intersecting point that each area has in common helps to maintain focus on the interrelatedness of each area of life and, therefore, the need for communication between disciplines and the fact that it is about the “life line” of the individual, not the disciplines area of interest. It also helps to understand how each area of life or discipline specialty is a subset of all other areas of life depending upon the circumstances.
The question this representation raises is, “What are the values for each of the intersecting axis and how do we determine these values?” Obviously, some of the outcome measures used in the mechanistic model of measuring symptoms and function can be applied, however, new ways of measuring all areas in conjunction with each other must be identified to give the individual the opportunity to make informed decisions about his or her health. The metrics of “quality of life” need to be developed and to be as sophisticated as the outcomes measures for the “maintenance of life” or the dis-eases and symptoms of life.
Over the years it has become harder and harder to avoid the obvious fact that health care and health are not about the provider, disciplines of health, diseases or conditions, it is about the health of an individual (society, company or community). Although this seems like it should be obvious, if we look at how health care is provided and how health is depicted in the media, health is treated as a commodity that is comprised of diseases and symptoms or youthful individuals exercising, eating certain cereals and taking certain drugs and leaping around a mountain meadow with a Labrador Retriever. The message seems to be that if we give enough money to find the “CURE” that what we will be left with will be “health” and we won’t have to be responsible for our health. When discussing health with most people the first words out of their mouth usually relates to exercising more and eating better or taking some form of supplements, as if health is only eating good foods and exercising, neither of which are done by most of us. Our observation is that most practitioners and health professions, not necessarily intentionally, practice as if they are “the way and the light”, “the answer”, to better health. What we have come to recognize is, again the obvious, that health care providers are “a light along the way” and the entity being served has “the way and the light” inside of them. Using this metaphor a bit further, if we look at how people in our society obtain health information and assistance we would have to visualize the road to health as a super highway with flashy billboards and street lamps only at service stations on exit ramps. Each discipline at it’s own isolated station with only a dirt road connecting the different exits and with very little light being cast upon the super highway of the persons health. Bringing the stations next to the freeway with the ability to easily travel between each station and with a good communications network, would enable that person to move easily on the freeway through a full life with an integrated support system. In other words, fully integrate health care as a support team and remove the focus on doctors and treatments and back onto personal responsibility.
Out of this gradual realization a group of practitioners and an on-line group of people with diverse backgrounds, to include; allopathic physicians, naturopathic physicians, a chiropractic college president, chiropractic physicians, a dentist, health consultants, business consultants, and interested lay people began a dialogue. The topic of the dialogue was “what is health?”, what is it comprised of, what drives it, how does it relate to the individual, to business entities, or government entities? How do we take this huge and complex subject and put it in a form that not only we, but also anyone can understand? How does health function inside the World Health Organizations definition of health as, “Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or injury”? The outcome of these dialogs was very similar to, if not identical to, the components of health as listed in Evans and Stoddart’s 1990 paper, in “Social Science Medicine”, “Producing Health, Consuming Health Care”. An example of these similar conclusions was, as stated by Stoddard and Evans, “The WHO broad definition of ‘health’ is, as noted above, so broad as to become the objective, not only of health policy, but of all human activity.” Or as we stated it, “our health is our life.”
An outcome of our two-year dialogue is the concept depicted in illustration one. This chart represents a flow chart of health and can be used in multiple settings. It can be used to depict an individual’s or a corporation’s relationship to health or as a representation of health. The chart represents, on the A to B axis (or “life line”), the two extremes as lived by most people, these are “Fully Alive” and “Dead”. Most people live as if they were in one or the other of these extremes as the state of their health. Of course, the distinction of the vast area separating the two extremes is brought forth in the stating of the extremes. Dividing the axis into quarters creates the areas of “Mostly Alive”, “Alive” and “Mostly Dead” and allows for each division to be assigned an arbitrary value as a percentage of “aliveness” with “Dead”, of course, being zero. From zero to 50% is the area of symptoms and disease and 25% to 75% is where most people exist. Actually most appear to live somewhere between 25% and 50% of their potential, as depicted by this chart, with all efforts seemingly directed towards getting to and maintaining 51%, or symptom free. Our system of health is directed at and intended to eliminate all symptoms and to prevent or eliminate all diseases. This is not an inappropriate effort especially if people or societies are living in the zero to 25% range of health or, perhaps, in a third world country. The dominant system of health care in this country, allopathic medicine, is at it’s very best when heroically preventing death. When, however, we attempt to modify and apply these same lifesaving, yet life-threatening procedures, in the non-eminently lethal situations, in the area from 25% and above, the risk-reward ratio begins to tilt away from benefit to risk of harm (i.e. 16500 deaths/year from NASID’s, 2000 deaths/week from prescription drugs, 1.5 million hospitalizations/year due to prescriptions drugs).
So what is the alternative to the traditional allopathic model of health delivery or of “preventing death”? Historically, the “opposing” or, as we would prefer “complementary”, alternative is “vitalism” or “Promoting health”! “Promoting health” in this manner implies supporting the innate healing ability of the body and working with the body not to the body. If we acknowledge and respect the efforts of reductionism and the mechanistic approach to health and look at what else can be done, or what is the “alternative”, it is apparent that “promoting health” and the vitalistic approach gives us an access to 100% health that is not available to the mechanistic procedures that are dependent upon symptoms and diseases for their application. In the alternative, vitalistic approach, the efforts are aimed at improving, or optimizing, function so that a “rear view mirror’, so to speak, is necessary to realize the degree of success, or, as patients who are in care of an alternative provider have stated, “I didn’t realize how bad I felt when I thought I felt good.” “Promoting health” versus “preventing death” gives us, also, the distinction between “quality of life” and “maintenance of existence”.
Using this model acknowledges the areas of strength and weakness of both approaches and more importantly allows the person, system, company, the opportunity to have a “say” in the approach THEY determine is appropriate at the given moment. It also allows that neither point of view is “right” or “wrong”, only “appropriate” or “inappropriate” as determined by the person or owners of the company.
The question then must be asked, “What are the factors that impact and determine the level of health that is expressed?” What are the spheres of our life that move the marker up and down the AB axis? Our dialogs led us to seven, obvious, major areas that are also subsets of each other.
1. Physical
2. Nutritional
3. Mental/emotional
4. Environmental
5. Occupational
6. Family/community
7. Spiritual (faith)
(8). Financial
The eighth, financial, is placed in parenthesis, as it is not truly a factor of human health, except as society, or we as individuals, allow it to be a factor. However, as people and companies make health decisions based on money it becomes a “real” factor of health.
Hypothetically each of these areas intersect with the “life line” to create the percentage of health or quality of life being expressed. If we rotate the AB axis ninety degrees (illustration 2) we have the ability to apply values to each of the seven areas of health and begin to estimate what is “missing” and needs to be addressed for movement up the life line. Using this depiction and acknowledging the intersecting point that each area has in common helps to maintain focus on the interrelatedness of each area of life and, therefore, the need for communication between disciplines and the fact that it is about the “life line” of the individual, not the disciplines area of interest. It also helps to understand how each area of life or discipline specialty is a subset of all other areas of life depending upon the circumstances.
The question this representation raises is, “What are the values for each of the intersecting axis and how do we determine these values?” Obviously, some of the outcome measures used in the mechanistic model of measuring symptoms and function can be applied, however, new ways of measuring all areas in conjunction with each other must be identified to give the individual the opportunity to make informed decisions about his or her health. The metrics of “quality of life” need to be developed and to be as sophisticated as the outcomes measures for the “maintenance of life” or the dis-eases and symptoms of life.
Tuesday, November 24, 2009
The Slinky
The slinky is a wonderful analogy for how the life of a business or a person happens. It begins, physically, with one coil, spirals on for a maximum length and then ends, with each coil representing various events in our life or each coil representing a “change” in our life. Each coil representing a dialogue, insight, action, reflection, and moving to the next based on the dialogue that occurs from the reflection. Each coil representing a decision, a choice, based on the preceding coils and the impact of other slinkys that come into contact with our life/slinky. A slinky, like our life has a beginning and an end and anchoring the slinky helps to prevent kinks in, or misdirection of, the slinky much the same as a vision, purpose, or values provides us with a direction that helps us to make choices in our life. Naturally, we never know what the impact of other slinkys or events on our life are going to be or how long our slinky/life happens to be. Most of us want to think of the events in our life as separate and distinct unto themselves. That we can “fix” a link and move on as if nothing has happened and most of us know that this is not true, but we really want it to be and so some of us live as if it is true. I like to think that in acknowledging that there is an end to my slinky that I can, in some way, help anchor my slinky with a direction and that by having a vision or purpose I will more likely do things to avoid kinks or a break in my slinky and it will be able to function right up to the end.
An aside on slinkys occurred to me was that our life/slinky has multiple additional slinkys that spin off of each event/link, connections to other people and other aspects of our life. Many times we impact other people without even knowing it by a word or action that creates ripples along the multiple slinkys that make up this existence. Kind of starts to take on the visual appearance of a fractal depiction in my mind and makes us realize that our actions do not only effect us, they effect others in multiple ways that we most likely will never know or understand.
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