First do no harm?
When I first started work in charities I found
people would tell me their stories, first of diabetes, more recently
with breast cancer. Taxi journeys became sources of information, a
litmus test of services and experiences of living with these conditions.
It's amazing once the flood gates are opened how revealing the
And more recently as my work focuses on the
lived experience of care, these are now my landscape. Discussions may
start differently but in time I hear a story of care......or let's be
honest often it's just the opposite. By Friday afternoon I wanted to put
my head on the desk and weep at the poor care and insensitivity I had
heard about in that one day alone. It grieves me sorely to say it but
A book I read as a student nurse came back to me "
Limits to medicine" by Ivan Illich . It's not a lazy read for a Sunday
morning under the covers. It demands your full engagement and for those
like me, time to stop and recover from its challenging messages. It was
written in the 1970s but as I have dipped back into the text I am
reeling from its contemporary resonance.
Illich describes three levels of iatrogenesis. Clinical iatrogenesis is the injury
done to patients by ineffective care and potentially at times toxic
Social iatrogenesis results from the medicalisation
of life. More and more problems are seen as amenable to medical
intervention. Pharmaceutical companies arguably then developing
expensive treatments for previously unknown diseases. Society finding
solutions to its ill-health in medicine alone.
Worse than all of
this for Illich is cultural iatrogenesis, the destruction of traditional
ways of dealing with and making sense of death, pain, and sickness. “A
society's image of death,” argues Illich, “reveals the level of
independence of its people, their personal relatedness, self reliance,
Do we recognise these levels in the crisis we
hear about daily in healthcare?Are we dealing with those very issues in
our care systems now? Our communities in the developed world have seen signs
of losing their potential to care for and support their own.
Individuals have lost the same capacity to self care, persuaded by
modern medicine that a pill instead will offer salvation? And our
welcome recent focus on patient safety a much needed response to the
potential of care and treatment to cause harm.
But it can be
different once we recognise the need for change. Look at the success of
the patient safety programmes. The self management fund in Scotland a hugely valuable
approach to enabling people and communities too unlock their own
capacity, to find non medical solutions to improving their well-being.
The new public health not only talking about asset based approaches (
traditional healthcare tends to focus on deficits) but on all the
dimensions of the Fifth wave......including dare I say...love being our
force for change. A heartful driven approach.
I'm an optimist at
heart...I need to see the potential to change. Consequently I like the
point made by Phil Hanlon and Sandra Carlisle in After Now. "The lesson
of history is that we should be hopeful ........we have already
observed how traumatising it was for the crofters to be pulled off the
land and into factories...Yet each of these transitions represented an
important chapter in human history. Each transition brought in new ways
of living which brought many benefits. That, we hope , is whats next for
a healthy Scotland."
Reasons to be heartful
What Illich drew
to our awareness thirty years ago now in many ways is received wisdom.
At some levels we are now responding to it. That gives me hope for the
future but also begs the question.......who aren't we listening to now? Who could really help us avoid learning the hard way?