Excerpt from "Re-humanizing Medicine"

The great terror of our day in the treatment of the human body is that

physicians first separate the soul from the body. Plato

Dehumanization inContemporary Medicine

We start by recognizing that there is a problem with how medicine is currently practiced: it dehumanizes staff and clients, creating dissatisfaction,suffering, poor performance and medical errors.

Dehumanization is an iatrogenic effect of the dominant paradigms in contemporary medicine – the economic/business model and the reductionist and materialistic approach of biomedicine. In the day-to-day practice of medicine,doctors are expected to see more patients in less time and to efficiently reduce people to symptoms, diagnostic codes, prescriptions, procedures and billing codes. This leaves little time or space for people – physician or patient.

Future doctors are attracted to medicine for idealistic and humanitarian reasons, but through training they often lose this idealism. How can we preserve idealism and humanitarianism in medicine? Practicing physicians have high ratesof burnout and job dissatisfaction. How can we reinvigorate the practice ofmedicine and make it sustainable?

ACounter-Curriculum of Re-Humanization

In medical school, I realized that I had to engage in a parallel education process in addition to the standard scientific curriculum.We could even call this a ‘counter-curriculum’, focusing on re-humanization. At times I found teachers, mentors, and fellow students who practiced this counter-curriculum, but often I had to seek it out on my own in order to balance my education. This book is about that counter-curriculum of re-humanization.

Science and evidence-based interventions are one paradigm of medicine, but as human beings working with human beings, we must have a human framework as well as a scientific one.

As a medical student, the first research project I worked on was with Deb Klamen and Linda Grossman at the University of Illinois at Chicago. Our study examined symptoms of Posttraumatic Stress Disorder (PTSD) in relation to medical training and found that 13% of trainees in the study reported sufficient symptoms (relating to their internship year) to potentially qualify for a PTSDdiagnosis. The findings provide evidence supporting the need to change postgraduate medical education to reduce stress and to enhance the well-being of trainees. I went on to work with Linda and Deb on three other papers that examined medical students’ beliefs and their attitudes toward the controversial issues of homosexuality, abortion, and AIDS. These papers examined how medical student beliefs can shape attitudes that adversely impact medical care. The studies also allude to the fact that people are not purely rational beings, and beliefs, fears and stigma can undermine scientific reasoning or professional ethics. Even my student research experience was concerned with the counter-curriculum of exposing dehumanization and seeking re-humanization.

To re-humanize medicine, the people who work in medicine must be well-rounded, well-developed human beings, as well as safe and effective technicians. A great deal of time, energy, and money is spent in making sure that physicians are good technicians, but are they good human beings? Being agood technician (objective, detached, unaffected by emotion, protocol-driven) cana ctually interfere with being a good human being. Clinicians should not stop being technicians or scientists, but they have a responsibility to attend to their own humanity, as well as that of the client. The counter-curriculum provides a holistic framework for being a human being, for working with human beings, and for creating systems that deliver care by human beings to human beings.

A Holistic Frameworkfor Medicine

A holistic framework is founded on multiple interacting and mutually influencing sub-systems. Scientific medicine and the objective, observable body make up just one dimension of human health. Sometimes the physical dimension is primary, for instance in physical trauma and surgery. Sometimes other human dimensions are more important. Emotion, mind, love, self-expression, intuition, spirituality, context and time all play a role in health and illness.

A holistic framework is a paradigm for understanding and interacting with human beings. It is a human systems approach and a way of being in the world. Holistic medicine is a philosophy, or a paradigm for understanding what it is to be human, to suffer, to be ill, to be healthy; what it is to change, grow and live. It helps us understand how disconnection can lead to suffering and how connection can lead to healing. Holistic medicine is not defined by using an herb instead of a medication, or by any specific technique or intervention. Being a good technician (whether biomedical or ‘natural’) is part of being a good physician, but being a good physician is more than just being a good technician.

It is hard work to maintain a complex identity that includes being a technician and a human being, but that is what being a medical professional involves: balancing different roles for the purpose of alleviating suffering and treating disease. Re-humanization reconnects the art and scienceof medicine, the heart and the mind. A holistic framework encourages integration.

When you start to connect in a different way, you change the health care delivery system in which you work. What starts as personal dissatisfaction can become personal transformation, which changes systems.Institutions will always drift toward promoting their own interests over human interests. It is the responsibility of health professionals to ensure that they stay human, help their clients stay human, and ensure that health care delivery systems promote humanization rather than dehumanization.

Modern medicine is engaged in a struggle to find its heart, soul, and spirit. This task must begin with physicians themselves. Dr. David Kopacz’s Re-Humanizing Medicine is an excellent guide in how this urgent undertaking can unfold. Larry Dossey, MD, Author.

David R. Kopacz is a psychiatrist, writer, artist and poet. His work in psychiatry and holistic medicine aims to balance the use of scientific evidence-based medicine with the need for “human-evidence” that includes relational, creative and spiritual aspects of healing. David calls for a counter-curriculum for re-humanizing medicine and sees the need for a compassion revolution in the practice of health care. He currently works in Primary Care Mental Health Integration at the Seattle VA and is an acting Assistant Professor at the University of Washington, United States.

Re-humanizing Medicine will be published by Ayni Books, 28^th November 2014. ISBN:978-1-78279-075-4 (Paperback) £18.99 $33.95, EISBN: 978-1-78279-074-7 (eBook)£6.99 $9.99