Thursday, 11 April 2013

First do no harm?

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 conversations become.

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 its true.

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 treatments.

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, and aliveness.” 

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?

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