Dr. Denise Nagel: Holistic vs. Fragmented Health Care

It may sound dramatic, but I got teary reading "The Talking Cure" in the Wall Street Journal this week. I thought I was going to read an article about psychotherapy, but instead it was about how doctors don't speak or listen effectively when communicating with patients. It can be true, I don't argue with that. I have written about my own experiences. But if we don't understand what underlies the problem, the tragedy will only be compounded by trying to apply a simplistic cure.

After practicing for 30 years, I continue to deeply love being a physician. I know that most of my colleagues feel the same way and are deeply committed to caring for their patients. Many tell me they have sleepless nights after making a dire diagnosis. How did we get to the point that we need special "empathy" training to learn not to say: "Your appointment is about your high blood pressure... your diabetes will have to wait until another appointment?"

Of course, the answer is complex. I surely don't expect to get at it all here, but some of it has to do with a fundamental truth. We all need to be authentically seen. In my work with patients, I find that I can say some extraordinarily difficult things to people if I say it from a place of caring and knowing them and with the goal of helping them. Doctors, too, need to have their fundamental humanity recognized. Our current model of care doesn't do that for either doctor or patient.

Somehow we have moved from a person-centered health care system to organ-specific symptom care that leads to dissatisfaction among patients and burn out in physicians. I have seen it happen in my own field of psychiatry. Now that the effectiveness of psychotherapy is finally being validated, our profession is abandoning it out of exhaustion, lack of reimbursement and a desire to appear less touchy feely and more scientifically rigorous. Twenty-five percent of patients that present to doctors for chest pain have panic disorder. Treatment reduces the suffering and the cost by 94 percent. If we don't adequately identify and treat the person inside the symptom, we will continue to spiral our health costs while sadly adding high-functioning people to our disability rosters.

While I applaud educating physicians to be better communicators, a prescriptive "say this... not that" as suggested in "Talking Cure" is not going to solve the problem. Genuine empathy is only partly conveyed by the words you say. It is a start, for sure, but what is needed is a more fundamental organizational shift that empowers doctors to treat patients as whole people and not silos of organs and fragmented symptoms. This doesn't mean just having more PCPs. It means changing what we value and putting our money behind it. It means really recognizing that the adage "measure twice cut once" applies to medicine. If doctors can take the time to truly listen to their patients more holistically it might mean a longer visit, but if it gets to the heart of the problem, it will save money and make people healthier, not to mention happier. Genuinely "being present" and looking at the whole patient in context, not as an isolated symptom or body part, is what patients need from their physicians. It is also what doctors need to be able to deliver. We will see less burned out doctors, fewer disenfranchised patients and lower overall health care costs. We ignore this common sense truth at our own peril.

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Source: http://www.huffingtonpost.com/denise-nagel-md/health-care_b_3071532.html

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