|Whole Person Medicine
– A Step Ahead
(by WAJIHA JAWAID )
Dr Marie Andrades is a doctor of family medicine and Assistant Professor at the Department of Family Medicine, Aga Khan University Hospital (AKUH). She did her MBBS in 1990 from Dow Medical College. Later she did her residency in family medicine from Aga Khan University in 1997, and also did FCPS from the College of Physicians and Surgeons, Pakistan. Currently she is the Director, Family Medicine Residency Programme at AKUH. She has also been rendering her services as a faculty member in the university and is also a member of Royal College of General Practitioners, UK. MAG contacted her to talk about the whole person medicine concept and the importance of its implementation in clinical practices. Excerpts:
Did you always want to be a family physician?
No, I actually always wanted to be a teacher. I am glad that although my profession is medicine, I am also associated with teaching as being a faculty member in a medical university.
As a family physician what are your main areas of practice?
The areas of my interest are women's health and dermatology. Other than that, I can also provide medical consultation to patients of all ages.
Could you please elaborate the concept of whole person medicine?
This concept is relatively new in our part of the world. It is something that takes us beyond treating people as patients. It demands a combination of curing and healing. It gives emphasis on the overall treatment of a person and not just the disease. Treatment is completely a biological process in which infection gets treated with the medicine. But healing deals with the concept where a patient even after the medical treatment is feeling upset and tense. It demands a doctor to not just give medicine for the disease but also listen to the patients problems to rightly identify the root cause of his illness.
In most of our medical colleges, we are purely geared towards the biological way of treating people. When a patient comes to a doctor with a specific illness, he gets a long list of medicines and nothing else. A doctor never bothers to ask a patient what is happening in his life, how his illness has affected his life, work and relationships etc.
After visiting the doctor a patient should feel satisfied but in our society it is the opposite and this satisfactory rate is not very high. This is the point where a whole person medicine approach is needed. It focuses on treating people completely that includes spiritual, psychological and social factors.
So could you please explain in detail how psychological and social factors can help in the treatment?
Sometimes psychological and social factors are involved behind a person's illness. For example when a person with high blood pressure comes for treatment, a doctor must ask him why his BP levels increase suddenly. In reply, he may disclose that he saw an accident on his way home and after that he is not feeling well or may be the work load at office is disturbing him. From there a doctor can conclude that the actual illness is due to some changes in his social circle and nothing else.
So the 'whole person medicine' concept is something related to stress and anxiety?
Yes, whenever a person gets ill, his stress and anxiety levels also get elevated. The best way to overcome it is to give an ear to patient's woes. When his story unfolds, multiple facets of his illness may emerge which help in diagnosis. The patient also feels important when someone else values their story and listens to them.
And how do you treat patients with spirituality?
Here spirituality means a person's connection with God. It has nothing to do with his religious practices. A person may not pray five times a day but there is a possibility that he has a special bond with the Creator. For some people listening qawwali is spirituality as it soothes their souls. While for others, visiting mazar is found to be helpful in the treatment rather than the medical approach and drugs. A doctor can incorporate such beliefs of patient in his clinical practice for better and quick results. A doctor has to be aware of how these aspects play a role in their health occupation.
How can a doctor better understand his patient's problem?
The simplest way to do so is to understand the patient's life and see things from his perspective. It is very necessary to understand his emotions and feel compassion with him.
In your opinion what are the advantages of implementing whole person medicine concept in clinical practices?
The biggest advantage is that the patient will become healthier from every aspect as his infection not only gets treated but also improve his overall health. His stress level will decrease and he will be able to lead a healthier life. His positive attitude will also leave good impacts on his family life.
How important is it to involve the family in the patient's treatment?
It is an essential part of the treatment as it helps a lot in properly diagnosing the disease. Family members know their loved ones better than anyone else. Personal input from family supports the healing process and can improve the outcome.
How can we create awareness about the whole person medicine concept in the society?
Media is an extremely powerful medium; it can be used to spread awareness. It is strongly needed to develop this sense in people that it is their right to ask questions about their ailments to doctors. It is a responsibility of the doctor to give an ear to the patient's woes. It is also very important to include this concept in the curriculum of medical universities so that future doctors can understand and implement it right from the beginning of their career.
Have you done any special courses and training related to whole person medicine concept?
I attended a conference in UK in October related to it. It has helped me a lot in understanding of this concept.
What message would you like to give to aspiring family physicians?
They are the cream of medicinal community. Our country needs good family physicians because they are the first contact of care. If they do their work with sincerity then many health problems will get solved very easily. To be successful in your field, try to equip yourself with latest information and researches happening in the health sector.
Whole Person Medicine Concept
A whole person approach means using a mixture of resources, techniques, skills, and the practitioners wisdom and intuition to bring benefit to their patient. It means considering the mind-body connection in every patient or client, taking account of their emotional state and exploring their spirituality. It is looking at the bigger picture that includes relationships, the community and the physical environment. The whole person approach strives to create health and healing as well as treating illness. In it the person's own story is at the heart of the process. The person is accepted and valued and their personal experience recognised as being of importance. The patient is encouraged to grow in understanding the impact of their story on their health, concentrating on the ways in which they themselves have affected their health and how they can influence it in the future. Whilst the patient's subjective experience is valued and explored, this is matched by an objective analysis of the story by listening therapists. This is then shared with the patient. An integrated approach is taken with three therapists exploring the patient's health and illness from three main perspectives - somatic, psychological and spiritual. The patient is a part of the therapeutic team and determines the final conclusions and plan of action.