(Originally published at
www.hospitalimpact.org)
I have written a number of blog
posts recently about bringing time, relationship, caring, continuity, trust and empathy back into the healing model. While many readers agreed that these are important aspects of healing, others "bucketed" these items as "fluff," impractical, and unimportant to scientifically valid medicine.
So I'll make the connection between this "fluff" and optimal healing outcomes.
Newtonian scientific principles view the universe and its subsystems as machines. Under this view, linear cause and effect models can predict future outcomes and/or behaviors. Or in other words, by identifying the straight-line cause of a defect and addressing that cause at the root, improvement can be made with a predicted effect.
Complexity Science views systems as non-linear with parts (subsystems) that adapt and evolve(i.e., Complex Adaptive Systems). It focuses on a web of patterns and relationships amongst and between the subsystems to assess the unpredictable nature of effects. It is critical to not only study the individual subsystems but also the interconnections and relationships between the subsystems.
Why is the distinction between the two views important?
The current medical model tends to follow Newtonian scientific principles and thus linear episodes of care, linear metrics to assess outcomes and success, and linear causes and effects.
For example, consider the myriad of stories you have heard of patients showing up at the doctor's office, being diagnosed as obese and subsequently instructed to eat "right" and exercise. A linear cause and effect, i.e., not eating right and/or not exercising has led to obesity. Address the cause (improper diet and/or lack of exercise) and impact the effect (obesity).
And yet many of these individuals never achieve their goal of losing weight. What happens? These patients are typically labeled non-compliant, many are shamed, many change doctors, and many over time incur health issues related to their obesity.
This is a basic example of Newtonian scientific principles in healthcare. This is also an example of a failed healing encounter and a broken healthcare model.
Now let's bring time, relationship, caring, continuity, trust and empathy back into healing and change the story.
A patient who is clearly overweight walks into a doctor's office to see HER doctor, the doctor she knows and who knows her. The doctor and patient have ample time together to develop a relationship. Through this relationship they develop trust. With time, relationship and trust they share empathy. This healing encounter becomes a safe place. This is a place where the patient can share non-linear aspects of her life, which are impacting her ability to address her weight challenge.
Perhaps this individual has an unhealthy relationship with food due to an abuse issue from when she was a child. Or maybe this individual has an unhealthy relationship with exercise due to a traumatic series of events in organized sports promulgated by a coach who clearly should not be coaching. Perhaps there are family dynamics, economic factors, and other environmental inputs all impacting this individual's weight.
This patient is a complex adaptive system (as we all are). Understanding the connections of all of the sub-challenges and then addressing the non-linear root causes, interconnections and relationships will best position this individual to achieve their health goal. But without time, relationship, caring, continuity, trust and empathy, the physician-patient encounter is limited at best (with minimal information sharing and lack of mutual understanding) and must rely on the suboptimal Newtonian linear cause and effect methods of healing.
Leveraging the "fluff" and seeing each patient as a complex adaptive system leads to an optimal healing encounter in which both parties together identify the non-linear factors impacting the patient's health and co-create a patient-specific healing protocol that addresses those challenges.
Healthcare leaders must remember that connecting time, relationship, caring, continuity, trust and empathy to the healing encounter is truly a key to reforming healthcare and for best positioning ourselves, our families, and our communities for optimal healing.