Monday, August 31, 2015

The patient is not an object. The physician is not a technician.

A year ago, it was the death of Robin Williams, who played the role of Oliver Sacks in Awakenings.  And now Oliver Sacks has also died.

I reviewed my own posts in which I was sure I would have referred to Sacks.  I have, yes, but I am shocked that there was only one post.  Shocked because I have read quite a few essays by him and every one of them was profound.

Like many, I too read more than one obituary piece on Sacks.  In this one, at the New Yorker, I found something especially insightful:
 He resisted the powerful current of modern practice that seeks the generic. He rejected a monolithic mindset, and retrieved the individual from the obscuring blanket of statistics. This put him outside of the academy, exiled to chronic-care institutions. Through his writing, Sacks ultimately received recognition for advancing a unique form of clinical scholarship that was largely abandoned: the study of the single person within the context of his own life. Ever the acute observer, his case histories confirmed that under a single diagnostic term was a spectrum of human biology. No two patients are ever the same, he emphasized. ...
Every dimension of the patient was meaningful in his thinking.
 Against the generic.  No two patients are ever the same.

Powerful ideas.  Ideas that are relevant not only to the medical practice alone and, instead, they are applicable to every walk of life.  We often forget that no two people are the same.

In any professional practice, there is a reason, I suppose, that we go with the generic--it is "cost efficient."  But then, I have problems getting even the best fitting shoe because my feet are not the generic 7.5 size!  If that is the problem with the feet, then think about the brain, the biochemistry, the ... In the modern economy, we value and prize "efficiency" so much that we have even begun to forget that every individual is different.

In my own profession, education, this generic approach is leading us deeper and deeper down the rabbit hole of "cost savings."  Students are no longer individuals but are mere products to be shaped in a Fordist factory.  We put them in larger and larger classes, without any consideration of the differences between John and Jon, leave alone John and Jane.  At "prestigious" universities, we pile students in classes of 300 and 500, oblivious to the 300 and 500 different individuals that they are.

As I recall the faces of students with whom I have interacted, and whose stories I know at least a little bit, every one of them is so different.  I can see how I customized my feedback to them, even if the questions were the same.  But, of course, being in small classes, to talk with students, not to use the generic and standardized test formats, are not consistent with the favored "cost efficient" practices and, for all I know, I will soon be without a job.  It will not be "efficient" to retain me on the payroll.  How easily many educators and politicians seem to have have forgotten why they liked and appreciated and loved listening to Another brick in the wall!

Even though Sacks kept the individual patient in the front and center,
This did not mean Sacks was a Luddite. He was an avid reader of scientific journals, fascinated by scientific advancements in imaging the nervous system at work. He engaged in dialogue with Nobel laureates and lab scientists about the nature of consciousness, providing what they lacked—the insights of a naturalist, a field worker.
Indeed.  Sacks showed us that being an "artisan" didn't therefore automatically mean being opposed to scientific and technological advancements.  He made it seem easy how to use those advancements in order to make his individual-centered approach that much more rewarding to his patients.

I saw Sacks in person, and heard him, when he was in Portland on a book tour, which was soon after the publication of Uncle Tungsten.  Even from the back rows of the auditorium, it was clear that he was full of energy.  I had no idea at that time about the complicated and miserable life that he had lived in his younger years; reading about those made me appreciate his energy and commitment all the more.

His own words, from a couple of weeks ago, seem to be the best way to end this post, especially because of the references to the meaning of life and inner peace and happiness, about which I often blog:
And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual, but on what is meant by living a good and worthwhile life — achieving a sense of peace within oneself. I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.


Anne in Salem said...

I've never heard of Sacks or seen the movie. It is nice to hear of doctors who think for themselves rather than thinking only in terms of insurance - how should I treat so I don't get sued? I had digestive problems six years ago and went to a gastroenterologist with an assumption of my diagnosis. He kept asking questions, saying a dog can have fleas and ticks, his way of reminding me that I could have more than one problem. He ordered two tests. One proved that I was wrong, and they both proved that he was spot on. I went in expecting one diagnosis and walked out with two different ones. He treated me as an individual, was relentless in asking questions and probing, and found the problems. He is still one of my favorite doctors and is an excellent man as well.

Sriram Khé said...

The more we move into the age of machines, big data, and everything else, the more we will experience the patient as an object instead of the patient as a human. Oh well ...
The kind of physician you write about is rare these days. Good for you ...

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