Healing versus Fixing: Being Committed to the Whole Patient

By Weise, Roger | Aging Today, May/June 2007 | Go to article overview

Healing versus Fixing: Being Committed to the Whole Patient


Weise, Roger, Aging Today


FORUM

Helen is 79 years old. She is short, dark and very forgetful. She lives in her own home 20 minutes away from her daughter Molly, who is 43 years old, divorced and is raising two daughters. Helen would telephone Molly at least 20 times a day, both at home and at work. She was frequently frightened and anxious, telling Molly that someone had come into her home and stolen money from her purse or taken her favorite shoes from her closet. Molly was usually unable to calm her mother over the phone and so made numerous trips to her mother's house, either before work, during her lunch break or late at night to comfort her mother. This process involved a great deal of time and energy.

Recently, during one of these many visits, Helen accused her daughter of stealing her shoes and threatened to kill her with a kitchen knife. Molly had no choice but to call 911. Helen was restrained, taken to the local emergency department and sedated. After eight hours in the emergency room, Helen was admitted to the hospital's geropsychiatry unit, where Helen and Molly looked around, sighed and felt hopeless, lost and isolated. Both women felt ill and out of control and wondered what would happen next.

VALUED LOVED ONES

Helen and Molly were caught up in a scenario that happens all too often as older loved ones become ill. What is supposed to happen next, once there is professional intervention, is healing-healing of the patient and healing of the family or caregiver.

Unfortunately, what tends to happen next is fixing. Fixing by definition means to repair or to fasten. Fixing emphasizes results over relationships: parts over the whole, products over people and repair over renewal. My training in internal medicine taught me very well to fix problems, but I was rarely encouraged to facilitate healing people. All too often, today's healthcare system emphasizes fixing a faceless illness instead of healing a valued loved one.

Healthcare in the United States has become more and more fragmented, placing the responsibility for patient care in the hands of the consultant-rather than in the hands of the primary care physician. We have improved outcomes (results) in reducing the impact of cardiovascular disease, cancer, infections and so on, but at the same time, we have reduced the patient-professional caregiving relationship. This diffusion of care has diluted our responsibility for the total patient. Too often, the technological repair of the part has become more important than the renewal of the whole person.

TRANSFORMING ILLNESS

Just what is healing? It's the process of transforming illness into wellness. Healing emphasizes connection over outcome, the whole person over individual organ systems and revitalization over simple preservation. Healing stresses that the healthcare professional become a true partner in care rather than just a service provider.

In general, dictionaries define illness as an unhealthy condition. Illness in older adults is defined by physical dependency, disconnection and discouragement. Because people age physically, emotionally, socially and spiritually, illness in old age can negatively affect each one of these domains of normal aging. Illness in old age most often leads to some type of physical dependency, which is characterized by decline in activities of daily livingthat is, decline in the ability of older adults to care for themselves, live independently in the community and enjoy life.

Illness also fosters emotional and social disconnection, leading to spiritual apathy and a palpable loss of hope.

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