By Jeff Kane, MD
When I entered my medical training in the early 1960s, disease demographics were undergoing an oceanic change we still haven’t fully addressed. Before then, most patients saw doctors for “acute,” meaning short-term, conditions such as infectious diseases and trauma. Now a full two-thirds of medical visits are for “chronic” conditions.
As the name implies, chronic means long term, often lifelong. Most cases of hypertension, diabetes, arthritis, autoimmune diseases, cancer, and heart disorders are chronic. They’re chronic because we’d cure them if we could, but we can’t: that is, “chronic” is a euphemism for incurable. Despite the media’s relentless touting of “breakthroughs,” most patients can’t reasonably expect cures. They can reasonably expect relief from some symptoms and a limited prolongation of life.
And if people actually matter in healthcare, they can reasonably expect relief from their suffering.
Chronic diseases differ dimensionally from acute ones. An acute disease visits temporarily. In a relatively short time we either get over it or it does us in. A chronic one moves in as a troublesome roommate. It sets up house for the long run, and we have to learn how to accommodate. Over time it changes who we are, and our relationships with others as well.
Having facilitated cancer support groups some three decades, I can tell you that people only rarely suffer from their tumors. Sure, there’s pain sometimes, and we’re learning to treat that rather well. But most of cancer’s suffering is emotional. Try going through this disease without experiencing anxiety, depression, anger, disorientation, and isolation. That’s what actually bedevils people, and it's a normal response to having cancer.
Medical training is built around finding what’s wrong and fixing it. You can “fix” a tumor by removing it in various ways, but since you can’t fix emotions, they’ve been essentially excluded from consideration. This deficit leaves most physicians unprepared to deal effectively with suffering. (Still, I know a few docs who are existential masters--a result of their personal development, not their professional training.)
Authentic healthcare reform must include considering what we can do to help our patients live with incurable diseases. Part of that is alleviating their suffering. It’s not hard to do. It doesn’t require a specialist. Virtually all of us are already competent, having led a human life.
Reposted with permission from Healthcare as Though People Mattered.