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striving to take in the whole picture

striving to take in the whole picture/when the table turns

by Judy
May 23, 2013 

At one time in my life I was a Buddhist practitioner and loved hearing stories about the Buddha, the fully enlightened one. One of the stories I loved hearing was how the Buddha taught his students by what is called skillful means which meant that he would use different practices and techniques for different students depending upon their temperament, background and particular weaknesses. I thought of that recently after reading an article in The New York Times about a dermatologist who was questioning her use of extreme treatment in order to get rid of low risk skin cancers (not melanoma) in very elderly people. The article cited that one patient, 95 years old, had suffered terribly after having some growths removed that didn’t heal well afterwards. He literally had to have an ear removed and was in a lot of pain at the end of his life. The question is, was it really necessary? I was very interested in this as I recently had to decide whether to have my 97 year old mom get injections for advanced osteoporosis. After an investigation researching the pros and cons and taking in my mom’s situation, I decided against it.

Why do I bring up the Buddha in this case? Because he looked at the particular as well as the general - the particular person and their temperament and history and from there decided on the “methodology” to advance his students. And that is what struck me in reading this article - how the tendency in medicine these days is to go with the general and not the particular; in this case automatically giving a routine treatment without looking at the whole person and their needs. The dermatologist in the article was questioning this automatic prescribed medical treatment for people in their eighties and up who are frail and already not in good health. Giving treatment could lead to making the patient’s last few years on earth quite miserable while not treating would not necessarily lead to further complications.

There is always the option to do nothing and wait and see what happens. If I were a doctor, I could imagine it would feel like quite a risk to not do anything. It certainly isn’t the way of the western medical field where often less is not considered a viable option - it’s usually more and more treatment. Where does the human element come into this picture? How deeply is the whole picture taken into account? Of course one would have to see the patient again and watch over the situation but it’s so contrary to how the medical field in general operates. In this article it said that it’s rare – something like 3 percent of doctors don’t do anything in cases like this.

The more I reflect on this situation it really becomes impossible to take one position about it all. I definitely don’t want to create any polarity between the medical field and patients. Certainly I believe doctors on the whole are very well intentioned and want to help. It’s not easy work at all…I have incredible respect for what they are doing. We are dealing with a very complex situation where the patient often has forfeited their responsibility and the doctor is in some ways at the mercy of a whole system that does not give him/her a lot of room to navigate. But there is a way out or at least the beginning of a way out. More and more I feel it’s really about bringing back the human element - bringing back a dialogue between patient, doctor and primary caregiver in wanting to find out what the best next step is. It’s so much about communication on a very human level. And isn’t this true in all parts of our life, not just the medical field.

What strikes me most is how much attention, care and independent thinking has to go into every situation whether we are the doctor, the patient or primary caregiver. We can’t put it all in one box which is what systems and the scientific viewpoint often try to do. And that is not to deny how much we need systems and science. They have contributed enormously to our well-being and advancement of our culture. However now we are all being called wherever we are; caregiver, doctor, nurse, patient to rise to another level of attention. It’s the easy way out to blame the other, whoever the other is and requires much more of us when we strive to take in the whole picture and keep looking and assessing. And there are no easy answers either but the direction is always toward our humanity and toward feeling the weight of responsibility on our shoulders. This is a huge topic and I feel I’m just scratching the surface, but I wanted to bring this dialogue with myself and with you to our attention as we are all implicated.

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