Cultivating Hope
By: Karen Casey
Minnesota: Hazelden, 2009, 191pgs., $15.95.
Karen Casey's book is a wonderful and hopeful book about how an individual can live a life that is fearless and meaningful at a time when such virtues are so difficult to find. We live in a very troubled time, socially, personally and financially. This is why Casey's book is so important for us today. Casey also comes from a troubled background. All she really wanted out of life was for others to change. This, she thought, would ensure her security. However, she later discovered that she was the one who had to change. Although this was difficult for her to accept at first, she did keep trying to open up to the idea that if she didn't change, nothing else would either.
Understanding the true nature of anger is the key to changing our outlook. Holding judgments against anyone holds us hostage. Everything we experience can be the pathway to a more peaceful and hopeful life. Our lives can dramatically change through the power of hope. When we face obstacles in life, we must refuse to give up on hope. Our experiences are all necessary and have been invited by us at an earlier time and place. We are always where we need to be, sharing space and time with others who are part of our destiny. People who are able to understand and then apply these principles can ultimately realize an inner peace that's so complete that others are changed by their very presence.
This process of seeing and understanding anew isn't something that happens overnight. We won't get to where we want to be without patience, commitment, and a little willingness and a lot of effort. Most of us don't like to change our old ideas and our old ways of doing things. However, we need to make informed choices about our behavioral and attitudinal changes. Every person that we affect with our new hopeful vision of hope will be encouraged to see their life differently. If we want a different life, a different set of experiences, a more hopeful world, we must be agents of change.
Hope is the trigger that can change every perspective an individual holds dear. A vision of hope is what gives it all of this power. When hope opens the door to these possibilities, individuals have to decide if they want to change or live as they always have lived. It is incumbent on those of us who have been led by our experiences with hope to serve as examples to others. There is another way to think and live, other than in a gloomy and depressive way. By embracing hope, we all have an opportunity to align our thinking with this idea.
Now her life is a testament of hope. What a wonderful message this is for readers! Hope is contagious. Sensing hope in others and in ourselves is like a breath of fresh air when we are in the trappings of a problem. We are lifted by the belief that situations will improve for us. Hope can transform how we feel about a situation. Hope is the forerunner of any life-changing decision. The belief that something better is available starts the ball rolling in a new direction. Transformation of ourselves, along with the situation troubling us, is right around the corner when we dare to hope. And when we can muster up the willingness to hope, we can allow others to carry hope for us as well.
Casey's book is divided into twelve themes, one for each month. Each begins with a story of hope, followed by an essay or reflection, for each week. Additional reflections are included at the end of the book for those months that have an extra week in a given year. Knowing that other individuals have overcome unfathomable odds allows us the privilege of holding on to the belief that we can do the same and then pass on our stories of success in turn. The essays for each week can be read once at the beginning of the week or daily, if its helpful. It is best to read each essay more than once so that it implants firmly in our minds.
Casey's book is a like a breath of fresh air. I so enjoyed reading it and I will be re-reading it throughout this year. If only readers can understand and accept some of the principles, insights and personal stories in Casey's book, their thoughts and habits will be imbued with positive energy and they will gain the perspective and strength to turn away from fear and will open themselves to a future that is filled with potential and positive change. All we have to do is to contemplate all that we are grateful for right now no matter where we are or what we've done, and we will experience true hope.
Irene S. Roth
Monday, March 22, 2010
Tuesday, February 9, 2010
Chronic Care and Patient-Centered Medicine Paper By: Irene S. Switankowsky
The chronically-ill patient is a distinct kind of patient that requires a much more involved and complex kind of medical care. Given the growing number of chronically-ill patients because of our increasingly aging population, chronic care is becoming a real challenge for medical professionals. Most chronically-ill patients have been ill for sometime. Any patient who has any type of incurable, long-term disease (such as arthritis,lupus, congestive heart disease, renal disease, Parkinson's and so on) is considered to bechronically-ill. Most chronically-ill patients seek constant medical attention. Usually, thephysician and patient form a unique relationship over the many years of patient care, depending on the patient's medical, cultural and educational needs, background, and howaggressive his/her disease has been over the years. Because of these unknown psychological and physical facets of chronic illness, chronic care patients can pose special difficulties for the physician during the medical encounter.
One way for physicians to cope effectively with a growing number of chronically-ill patients is by developing a patient-centered approach for treating such patients so that they feel properly cared for during each medical interaction. The patient-centeredapproach ensures that a patient's beliefs and values are central when treatments areproposed and medications prescribed. In other words, the treatments and medicationsmust be specifically tailored to the patient's individual needs by assessing certain keyaspects of the patient's life and his/her long-term and short-term goals before proposinga treatment plan. For instance, if a chronically-ill patient is still working, his/hermedications must not be so debilitating that (s)he is always mentally foggy. Alternatively, if the chronically-ill patient is in a lot of pain and feels unable to properly function at work, his/her medication dosages must be amended to suit his/her needs.
Further, the chronically-ill patient's character traits and personality must be taken intoconsideration when treatments are proposed. For instance, some chronically-ill patients may have a difficult time coping with their disease because of their unique emotionalreactions to the disease and coping mechanisms. Some patients can tolerate pain much more readily than others. Other patients have difficulty coping with increased disability,pain, and problems with mobility. This is especially the case if a patient is just newlydiagnosed with a chronic disease, because (s)he is still trying to get accustomed to the physical and psychological affects of the disease on his/her life. Alternatively, some chronically-ill patients who have suffered with the disease for a long time may still find it difficult to effectively cope because of the continuous and/or increased pain that they are experiencing. One of the most significant problems for chronically-ill patients is that they have difficulty to function as normal people do because of their illness. Thus, the physician has to determine what the patient precisely needs, given his/her life and responsibilities, before (s)he can specifically tailor the treatments.
Given all of these factors, the medical interaction between a chronically-ill patient and the physician can be time-consuming. Chronically-ill patients usually come and see the doctor when they feel desperate to find for some kind of comfort and relief from pain. The medical interaction between physician and patient is very different from other patients with acute problems. Some of a chronically-ill patient's reasons for seeking medical help may be nebulous and difficult to measure and/or to determine decisively. This makes it difficult for a physician to understand precisely what (s)he could do to help the patient. Sometimes, a chronically-ill patient needs reassurance that she'll be okay and will be taken care of. Other times, the patient simply needs to know that (s)he is doing the best that (s)he can for him/herself, given his/her illness. The nebulousness of the chronically-ill patient'sconcerns can make the medical interview difficult for physicians.
I. Difficulties for Physicians
To most effectively care for a chronically-ill patient, the physician should rely on an interactive, patient-centered model in which both the patient and physician play an active role in gathering information about the patients illness and prognosis. In order for the medical interaction with the patient to be most effective, the patient must provide thephysician with an idea of how the illness is affecting his/her life and how (s)he is coping with the disease overall. Given the nature of chronic illness, some medical interactions willbe more successful than others. Occasionally, the terminally-ill patient's personality or character may interfere with obtaining objective and precise data about the illness and treatments. Every patient has a unique personality, but because of the stress which accompanies chronic illness, a patient's coping behaviours may become exaggerated or even dysfunctional. Patients can sometimes use different communication styles during thedoctor's appointment. It can be beneficial for the physician to determine which style the patient is relying on mostly during the medical appointment so that (s)he can be of most assistance to the patient most effectively. Here are a few of the most common ones.
First, some chronically-ill patient's may be dependent and demanding. Such patients try to impress the physician with the urgent quality of their requests. They usually need specialattention, a lot of reassurance, constant advice, and when they don't get it they becomewithdrawn or complain needlessly. Such chronically-ill patients are difficult to deal with because sometimes the physician has no idea how to most effectively reach the patient inhis/her need. Regardless of how much care the physician offers, the patient still appearsdissatisfied. This can be very frustrating because the physician usually has manychronically-ill patients to care for in his medical practise. Sometimes by being empathic aphysician can help dependent patients to cope better. Other times, empowering patients to not be so out of control can help them to feel more able to cope with the disease.
Second, some chronically-ill patients may become overly controlled by trying to gain as much knowledge about their illness as possible. Given the Internet, patients can get information overload and sometimes misinterpret information. Such patients are usually punctual for appointments, and overly preoccupied with the right and wrong ways of taking their medications. Chronic illness, threatens loss of control for patients who cope this way. Such patients must be permitted to take charge of their own health care by giving positive feedback about their efforts and abilities. To most effectively care for such patients, physicians should methodically search for solutions to the unique problems that a patient has to endure living with a chronic illness.
Third, some chronically-ill patients may exhibit a guarded or paranoid style. Such chronically-ill patients are inclined to be suspicious of health care professionals and the medical system even before they become ill. Illness may sometimes exacerbate suchparanoia. They may have a long list of slights from relatives and friends about how a similar chronic illness was badly handled by other physicians. Suspicious patients are really difficult for physicians to care for because they will look for even the slightest things to be unhappy about in relation to their treatment. Further, guarded patients are poor communicators, making it difficult for the physician to know how to most effectively helpthe patient, given his/her unique medical concerns.
Fourth, chronically-ill patients may also engage in somatization. Somatization occurs when a patient describes his/her symptoms of illness vaguely and inconsistently, denies any emotional distress, has a hysterical personality style, and has difficulty describing emotions or inner processes in a concise manner. Somatization usually occurs when patients amplify the symptoms of their disease, or they may report physical symptoms of a condition, while de-emphasizing emotional or psychosocial symptoms. One example of this is masked depression, in which a depressed Chronically-ill patient emphasizes symptoms, such as fatigue, headache, insomnia, or weight gain while being unaware of, or disinclined tovolunteer information about his/her depressed mood or hopelessness.
The medical interaction between physician and patient is very different for the somatizing patient. One thing that a physician should do is to listen carefully to the patient, and respond empathically. This will lay the foundation for developing an interactive, patient-centered approach during the medical encounter. It is necessary for the physician to builda trusting relationship with the patient to validate his/her suffering. In addition, it is essential for the physician to devote even a few minutes to 'healthy talk' during a medical encounter with the chronically-ill patient. What I mean by 'healthy talk' is that chronically-illpatients need to focus on something positive beyond the disease in order to feel better, and during the medical interaction, the physician should engage in such talk with the patient.By being genuinely empathic, the physician may be able to break through the 'body' barrier and allow the patient to be more open with the physician. Lastly, the physician should schedule a follow-up appointment so that the patient does not feel that (s)he can needs a new symptom in order to come and see him again. This will also help the chronically-ill patient feel more cared for by the physician.
II. Difficult Emotions Exhibited by Chronically-ill Patients
Chronically-ill patients usually exhibit difficult emotions such as anxiety, anger, depression, and denial because of the disease. These difficult emotions frequently complicate the medical encounter between the physician and patient. Strong negative emotions can produce behaviours that prevent the physician from obtaining accurate information, makinggood clinical judgments, educating patients, and establishing therapeutic relationships. Empathic responses by the physician can facilitate the medical interaction with chronically-ill patients by making it more efficient and therapeutic. By providing an empathic interaction with the patient, a physician can provide patient-centered medical care that is necessary for chronically-ill patients to feel genuinely cared for.
Many chronically-ill patients suffer from some form of psychological anxiety or depression. Common sources of anxiety are feelings of helplessness, fear of pain and disability, inability to accept warmth or tenderness, fear of expressing anger, and uncertainty about the future. To minimize anxiety, the physician should allow the chronically-ill patient to express his/her feelings as much as possible by actively listening to the patient without interrupting, and making sure that his/her psychological needs and expectations are met as much as possible.
Anger is a much more difficult emotion for chronically-ill patients to overcome and for physicians to cope with during medical appointments. Angry patients usually act and respond to treatment in a hostile manner. This hostility usually has nothing to do with the physician personally but rather results from a background of negative emotions which relateto the patient's own medical situation, such as inconsiderate care by previous health careprofessionals, life disappointments, or perceived injustices. One way that the physician could help a chronically-ill patient who experiences such emotions is by continuing to listen while explaining aspects of his/her illness as neutrally as possible. Sometimes this approach can help chronically-ill patients to better cope with their chronic illness.
Many chronically-ill patients experience some form of depression because of the continuous pain and discomfort that they feel from the disease. Major depressive disorders may be the underlying problem in a substantial percentage of patients who complain of fatigue, weakness, lack of energy, insomnia, backache or headache. Sadly, depression is a common response to chronic illness. Depressive characteristics include feelings of worthlessness, hopelessness, apathy, and guilt, together with a profoundly empty andlonely feeling. These usually become apparent in the patient's manner, tone of voice, posture and speech. The patient may think slowly and speak very little, or (s)he may become teary and excessively emotional. One way that the physician can help such a patient is by being empathic and making statements such as, "You look sad," or "You look as if this has gottenyou down". Such statements can help a chronically-ill patient feel more at ease and to openup and discuss how (s)he is feeling more readily.
Some chronically-ill patients are in denial about the disease and sometimes even about their symptoms. Such patients have a tendency to play down their physical symptoms or to even deny the emotional impact of their diagnosis and/or prognosis. Denial can lead to serious delays in seeking care, but it may also be a useful mechanism for coping with badnews. There are some patients who are especially prone to denial. These are usually patients who don't want to worry others (such as family members) about their illness and how they are feeling. Such patients don't feel comfortable receiving support from others. They don't want to make a nuisance of themselves. This can be a real drawback to getting the medical care that the chronically-ill patient needs.
The physician must earn a patient's trust by being empathic, respectful, and genuine towards him/her, regardless of how (s)he reacts. Some clinicians believe that patients do not trust them. Some of these clinicians would like to see their patients not be as demanding as they are and to be much more silent and accepting. However, this is no longer a reality for most clinicians since the culture of paternalism towards patients is gone. Today, patients want to be acknowledged and to actively participate in their own health care as much as possible. This presupposes that physicians must now earn a patient's trust in each medical encounter. Patients are encouraged to assert themselves if they feel betrayed, injured or uncared for. And this is especially the case for chronically-ill patients who suffer from pain and discomfort all the time. As we saw in Part I, chronically-ill patients can be difficult to handle. Several strategies need to be in place for physicians to empathically treat chronically-ill patients.
Empathic communication can help a physician to build rapport with the patient in order to establish trust. It consists of open, honest communication with a patient. Physician honesty consists of not withholding important information related to the patient's diagnosis and treatment nor biassing a patient's prognosis and/or treatments through exaggerations such as: if you don't take such a medication or undergo a particular surgery you will be ina wheelchair. Even if the physician strongly believes that a particular treatment or surgery will really help a patient, (s)he should not try to enforce it by exaggerating the effects of nothaving it.
Empathy requires that the physician puts him/herself in the patient's medical predicament. For instance, the physician could ask him/herself the following questions:
How would I feel if I was always experiencing pain, fatigue, and total exhaustion?
How would I feel if I couldn't sleep well for months or even years?
How would I feel if the disease was constantly reducing my ability to do even the ordinary things that I did with ease even a few months or weeks ago?
How would I feel if I couldn't do what I loved doing in the past, such as jogging, sailing, going to the theatre, travelling, and so on.
By answering some of these questions, the physician will be able to get a general idea as to what the chronically-ill patient may be feeling. This can fundamentally help the physician be empathic and honest in his/her communications with the patient.
III. How Can Physicians Best Help Chronically-ill Patients?
In order to discuss the patient's unique needs, the physician should engage in open and honest communication as much as possible. To achieve this, the physician must first actively listen to the chronically-ill patient by allowing enough time to talk for the patient to share his/her feelings about the illness. There is nothing worse than for a physician to be pressed for time when (s)he is talking to a Chronically-ill patient. One way to ensure that the patient has a sufficient amount of time is by booking an hour slot for the patient's appointment. That way, the physician will not feel pressed for time and appear hurried.
It is advisable for the physician to allow the patient to do as much talking as (s)he needs to without interrupting. The physician should allow the patient to state his/her concerns, even if they don't surface in the first few minutes of the appointment. The physician should listen not only to what the chronically-ill patient says but to what (s)he doesn't say but may be feeling. Many patients exhibit nonverbal cues in the form of gestures or facial expressions that the physician can only pick up on if (s)he is attentive to the patient. The physician should avoid inadvertently trivializing a patient's experience of illness.
In conclusion, the patient-centered approach encourages the physician to treat the chronically-ill patient in a way that is respectful and empathic. Chronically-ill patients seem to be in a category of their own when it comes to determining how to treat them in an honest and respectful manner. Chronically-ill patients are always in pain, experience fatigue andcontinuous debilitation because of their illness. Therefore, they need a different kind of careby the physician and specialists. In other words, chronically-ill patients need a lot of encouragement and psychological/emotional care. There's no getting away from all the emotional turmoil and physical pain that a chronically-ill patient experiences. Chronically-illpatients can be difficult to appease and treat so that they feel completely cared for. Usually,chronically-ill patients have a whole medical team of professionals to care for them, ranging from specialists to physiotherapists, and counsellors and general practitioners. Each level of assistance must be geared towards the patient by physicians who are in the most prominent position to offer humane care.
One way for physicians to cope effectively with a growing number of chronically-ill patients is by developing a patient-centered approach for treating such patients so that they feel properly cared for during each medical interaction. The patient-centeredapproach ensures that a patient's beliefs and values are central when treatments areproposed and medications prescribed. In other words, the treatments and medicationsmust be specifically tailored to the patient's individual needs by assessing certain keyaspects of the patient's life and his/her long-term and short-term goals before proposinga treatment plan. For instance, if a chronically-ill patient is still working, his/hermedications must not be so debilitating that (s)he is always mentally foggy. Alternatively, if the chronically-ill patient is in a lot of pain and feels unable to properly function at work, his/her medication dosages must be amended to suit his/her needs.
Further, the chronically-ill patient's character traits and personality must be taken intoconsideration when treatments are proposed. For instance, some chronically-ill patients may have a difficult time coping with their disease because of their unique emotionalreactions to the disease and coping mechanisms. Some patients can tolerate pain much more readily than others. Other patients have difficulty coping with increased disability,pain, and problems with mobility. This is especially the case if a patient is just newlydiagnosed with a chronic disease, because (s)he is still trying to get accustomed to the physical and psychological affects of the disease on his/her life. Alternatively, some chronically-ill patients who have suffered with the disease for a long time may still find it difficult to effectively cope because of the continuous and/or increased pain that they are experiencing. One of the most significant problems for chronically-ill patients is that they have difficulty to function as normal people do because of their illness. Thus, the physician has to determine what the patient precisely needs, given his/her life and responsibilities, before (s)he can specifically tailor the treatments.
Given all of these factors, the medical interaction between a chronically-ill patient and the physician can be time-consuming. Chronically-ill patients usually come and see the doctor when they feel desperate to find for some kind of comfort and relief from pain. The medical interaction between physician and patient is very different from other patients with acute problems. Some of a chronically-ill patient's reasons for seeking medical help may be nebulous and difficult to measure and/or to determine decisively. This makes it difficult for a physician to understand precisely what (s)he could do to help the patient. Sometimes, a chronically-ill patient needs reassurance that she'll be okay and will be taken care of. Other times, the patient simply needs to know that (s)he is doing the best that (s)he can for him/herself, given his/her illness. The nebulousness of the chronically-ill patient'sconcerns can make the medical interview difficult for physicians.
I. Difficulties for Physicians
To most effectively care for a chronically-ill patient, the physician should rely on an interactive, patient-centered model in which both the patient and physician play an active role in gathering information about the patients illness and prognosis. In order for the medical interaction with the patient to be most effective, the patient must provide thephysician with an idea of how the illness is affecting his/her life and how (s)he is coping with the disease overall. Given the nature of chronic illness, some medical interactions willbe more successful than others. Occasionally, the terminally-ill patient's personality or character may interfere with obtaining objective and precise data about the illness and treatments. Every patient has a unique personality, but because of the stress which accompanies chronic illness, a patient's coping behaviours may become exaggerated or even dysfunctional. Patients can sometimes use different communication styles during thedoctor's appointment. It can be beneficial for the physician to determine which style the patient is relying on mostly during the medical appointment so that (s)he can be of most assistance to the patient most effectively. Here are a few of the most common ones.
First, some chronically-ill patient's may be dependent and demanding. Such patients try to impress the physician with the urgent quality of their requests. They usually need specialattention, a lot of reassurance, constant advice, and when they don't get it they becomewithdrawn or complain needlessly. Such chronically-ill patients are difficult to deal with because sometimes the physician has no idea how to most effectively reach the patient inhis/her need. Regardless of how much care the physician offers, the patient still appearsdissatisfied. This can be very frustrating because the physician usually has manychronically-ill patients to care for in his medical practise. Sometimes by being empathic aphysician can help dependent patients to cope better. Other times, empowering patients to not be so out of control can help them to feel more able to cope with the disease.
Second, some chronically-ill patients may become overly controlled by trying to gain as much knowledge about their illness as possible. Given the Internet, patients can get information overload and sometimes misinterpret information. Such patients are usually punctual for appointments, and overly preoccupied with the right and wrong ways of taking their medications. Chronic illness, threatens loss of control for patients who cope this way. Such patients must be permitted to take charge of their own health care by giving positive feedback about their efforts and abilities. To most effectively care for such patients, physicians should methodically search for solutions to the unique problems that a patient has to endure living with a chronic illness.
Third, some chronically-ill patients may exhibit a guarded or paranoid style. Such chronically-ill patients are inclined to be suspicious of health care professionals and the medical system even before they become ill. Illness may sometimes exacerbate suchparanoia. They may have a long list of slights from relatives and friends about how a similar chronic illness was badly handled by other physicians. Suspicious patients are really difficult for physicians to care for because they will look for even the slightest things to be unhappy about in relation to their treatment. Further, guarded patients are poor communicators, making it difficult for the physician to know how to most effectively helpthe patient, given his/her unique medical concerns.
Fourth, chronically-ill patients may also engage in somatization. Somatization occurs when a patient describes his/her symptoms of illness vaguely and inconsistently, denies any emotional distress, has a hysterical personality style, and has difficulty describing emotions or inner processes in a concise manner. Somatization usually occurs when patients amplify the symptoms of their disease, or they may report physical symptoms of a condition, while de-emphasizing emotional or psychosocial symptoms. One example of this is masked depression, in which a depressed Chronically-ill patient emphasizes symptoms, such as fatigue, headache, insomnia, or weight gain while being unaware of, or disinclined tovolunteer information about his/her depressed mood or hopelessness.
The medical interaction between physician and patient is very different for the somatizing patient. One thing that a physician should do is to listen carefully to the patient, and respond empathically. This will lay the foundation for developing an interactive, patient-centered approach during the medical encounter. It is necessary for the physician to builda trusting relationship with the patient to validate his/her suffering. In addition, it is essential for the physician to devote even a few minutes to 'healthy talk' during a medical encounter with the chronically-ill patient. What I mean by 'healthy talk' is that chronically-illpatients need to focus on something positive beyond the disease in order to feel better, and during the medical interaction, the physician should engage in such talk with the patient.By being genuinely empathic, the physician may be able to break through the 'body' barrier and allow the patient to be more open with the physician. Lastly, the physician should schedule a follow-up appointment so that the patient does not feel that (s)he can needs a new symptom in order to come and see him again. This will also help the chronically-ill patient feel more cared for by the physician.
II. Difficult Emotions Exhibited by Chronically-ill Patients
Chronically-ill patients usually exhibit difficult emotions such as anxiety, anger, depression, and denial because of the disease. These difficult emotions frequently complicate the medical encounter between the physician and patient. Strong negative emotions can produce behaviours that prevent the physician from obtaining accurate information, makinggood clinical judgments, educating patients, and establishing therapeutic relationships. Empathic responses by the physician can facilitate the medical interaction with chronically-ill patients by making it more efficient and therapeutic. By providing an empathic interaction with the patient, a physician can provide patient-centered medical care that is necessary for chronically-ill patients to feel genuinely cared for.
Many chronically-ill patients suffer from some form of psychological anxiety or depression. Common sources of anxiety are feelings of helplessness, fear of pain and disability, inability to accept warmth or tenderness, fear of expressing anger, and uncertainty about the future. To minimize anxiety, the physician should allow the chronically-ill patient to express his/her feelings as much as possible by actively listening to the patient without interrupting, and making sure that his/her psychological needs and expectations are met as much as possible.
Anger is a much more difficult emotion for chronically-ill patients to overcome and for physicians to cope with during medical appointments. Angry patients usually act and respond to treatment in a hostile manner. This hostility usually has nothing to do with the physician personally but rather results from a background of negative emotions which relateto the patient's own medical situation, such as inconsiderate care by previous health careprofessionals, life disappointments, or perceived injustices. One way that the physician could help a chronically-ill patient who experiences such emotions is by continuing to listen while explaining aspects of his/her illness as neutrally as possible. Sometimes this approach can help chronically-ill patients to better cope with their chronic illness.
Many chronically-ill patients experience some form of depression because of the continuous pain and discomfort that they feel from the disease. Major depressive disorders may be the underlying problem in a substantial percentage of patients who complain of fatigue, weakness, lack of energy, insomnia, backache or headache. Sadly, depression is a common response to chronic illness. Depressive characteristics include feelings of worthlessness, hopelessness, apathy, and guilt, together with a profoundly empty andlonely feeling. These usually become apparent in the patient's manner, tone of voice, posture and speech. The patient may think slowly and speak very little, or (s)he may become teary and excessively emotional. One way that the physician can help such a patient is by being empathic and making statements such as, "You look sad," or "You look as if this has gottenyou down". Such statements can help a chronically-ill patient feel more at ease and to openup and discuss how (s)he is feeling more readily.
Some chronically-ill patients are in denial about the disease and sometimes even about their symptoms. Such patients have a tendency to play down their physical symptoms or to even deny the emotional impact of their diagnosis and/or prognosis. Denial can lead to serious delays in seeking care, but it may also be a useful mechanism for coping with badnews. There are some patients who are especially prone to denial. These are usually patients who don't want to worry others (such as family members) about their illness and how they are feeling. Such patients don't feel comfortable receiving support from others. They don't want to make a nuisance of themselves. This can be a real drawback to getting the medical care that the chronically-ill patient needs.
The physician must earn a patient's trust by being empathic, respectful, and genuine towards him/her, regardless of how (s)he reacts. Some clinicians believe that patients do not trust them. Some of these clinicians would like to see their patients not be as demanding as they are and to be much more silent and accepting. However, this is no longer a reality for most clinicians since the culture of paternalism towards patients is gone. Today, patients want to be acknowledged and to actively participate in their own health care as much as possible. This presupposes that physicians must now earn a patient's trust in each medical encounter. Patients are encouraged to assert themselves if they feel betrayed, injured or uncared for. And this is especially the case for chronically-ill patients who suffer from pain and discomfort all the time. As we saw in Part I, chronically-ill patients can be difficult to handle. Several strategies need to be in place for physicians to empathically treat chronically-ill patients.
Empathic communication can help a physician to build rapport with the patient in order to establish trust. It consists of open, honest communication with a patient. Physician honesty consists of not withholding important information related to the patient's diagnosis and treatment nor biassing a patient's prognosis and/or treatments through exaggerations such as: if you don't take such a medication or undergo a particular surgery you will be ina wheelchair. Even if the physician strongly believes that a particular treatment or surgery will really help a patient, (s)he should not try to enforce it by exaggerating the effects of nothaving it.
Empathy requires that the physician puts him/herself in the patient's medical predicament. For instance, the physician could ask him/herself the following questions:
How would I feel if I was always experiencing pain, fatigue, and total exhaustion?
How would I feel if I couldn't sleep well for months or even years?
How would I feel if the disease was constantly reducing my ability to do even the ordinary things that I did with ease even a few months or weeks ago?
How would I feel if I couldn't do what I loved doing in the past, such as jogging, sailing, going to the theatre, travelling, and so on.
By answering some of these questions, the physician will be able to get a general idea as to what the chronically-ill patient may be feeling. This can fundamentally help the physician be empathic and honest in his/her communications with the patient.
III. How Can Physicians Best Help Chronically-ill Patients?
In order to discuss the patient's unique needs, the physician should engage in open and honest communication as much as possible. To achieve this, the physician must first actively listen to the chronically-ill patient by allowing enough time to talk for the patient to share his/her feelings about the illness. There is nothing worse than for a physician to be pressed for time when (s)he is talking to a Chronically-ill patient. One way to ensure that the patient has a sufficient amount of time is by booking an hour slot for the patient's appointment. That way, the physician will not feel pressed for time and appear hurried.
It is advisable for the physician to allow the patient to do as much talking as (s)he needs to without interrupting. The physician should allow the patient to state his/her concerns, even if they don't surface in the first few minutes of the appointment. The physician should listen not only to what the chronically-ill patient says but to what (s)he doesn't say but may be feeling. Many patients exhibit nonverbal cues in the form of gestures or facial expressions that the physician can only pick up on if (s)he is attentive to the patient. The physician should avoid inadvertently trivializing a patient's experience of illness.
In conclusion, the patient-centered approach encourages the physician to treat the chronically-ill patient in a way that is respectful and empathic. Chronically-ill patients seem to be in a category of their own when it comes to determining how to treat them in an honest and respectful manner. Chronically-ill patients are always in pain, experience fatigue andcontinuous debilitation because of their illness. Therefore, they need a different kind of careby the physician and specialists. In other words, chronically-ill patients need a lot of encouragement and psychological/emotional care. There's no getting away from all the emotional turmoil and physical pain that a chronically-ill patient experiences. Chronically-illpatients can be difficult to appease and treat so that they feel completely cared for. Usually,chronically-ill patients have a whole medical team of professionals to care for them, ranging from specialists to physiotherapists, and counsellors and general practitioners. Each level of assistance must be geared towards the patient by physicians who are in the most prominent position to offer humane care.
Wednesday, January 20, 2010
Critical Reflection for an Authentic Life
If there is one thing that can help individuals to live an authentic life, it is to reflect critically and rationally. And this is useful in all areas of our lives.
Over the next few weeks, I will be blogging about the different areas of our lives and how critical reflection is key to making us more self-actualized and knowledgeable individuals. I will argue that without reflection, each individual is reduced to whatever the media, society and other individuals want him/her to believe.
In other words, without reflection, an individual cannot make an informed and autonomous decision about any aspect of their lives. We simply become pones that people can manipulate and win over. However, if we want our lives to be much more than just a series of unreflective actions, we must learn how to be critical reflectors.
Before we could become critical reflectors in our lives, we must know our deeply held beliefs, desires, values, and long and short-term goals. These constitute our personality and character. And unless we are unhappy with aspects of our character and personality, we must accept our beliefs and desires as features that define our deeply held self.
Of course, many reflective individuals find that after they have determined what their beliefs and values are by perhaps writing them down that there are inconsistencies between their belief sets and their values. If such inconsistencies exist, then the particular individual may want to revise them in favour of beliefs and values that can define us accurately.
For myself, I discovered that I had a few contradictions between my need for organization and rationality and my religious views. I went through a period of revising my religious beliefs about a decade or so ago. I now have a much more coherent set of religious beliefs that don't conflict with my attitude of critical reflection. I now believe in much more humanitarian theological beliefs that I did before to accommodate this critical reflective stance.
The best way to achieve this is to sit down and write down about your beliefs and if they all cohere to create an authentic body of beliefs. Ideally, an authentic body of beliefs don't contradict each other; however, when I did this exercise with my students, I discovered that most of them had inconsistencies among their beliefs. Then they chose which ones to revdesires. Also include your values and what you believe in strongly. Then look over your beliefs and see ise and then found that they lived with much more integrity and they were much less likely to be manipulated to act in ways that they didn't believe to be conductive to being a reflective and consistent individual.
Wednesday, January 13, 2010
The Lord is My Sheperd-book review
The Lord is My Shepherd: Healing Wisdom of the Twenty-Third PsalmHarold S. KushnerNew York: Alfred A. Knopf, 2003, 175pp., $29.95.
This is Kushner's most famous book after Bad Things Happen to Good People and Living a Life that Matters. Kushner's The Lord Is My Sheperd is about practical spirituality, inspiration, and encouragement gleamed from what may be the best-known and best-loved chapter in the Bible: the Twenty-third Psalm. This psalm has been the source of comfort in grief and courage in fear for millennia. In this book, Kushner discusses how we could live according to the strictures of Psalm 23 in our daily lives. Each chapter discusses one line of the psalm in the context of both the tone when it was written and the present day, and illuminates the life lessons that are contained within it. In this review I will discuss a few kernels of his wisdom in this book.
Reviewed by Irene S. Roth
Writer's Blog: www.irenesroth.wordpress.com Writer's Blogger: wwwirenesoniaroth@blogspot.com Philosophy Blog: www.switankowskyphilosophyreflections.blogspot.com
This is Kushner's most famous book after Bad Things Happen to Good People and Living a Life that Matters. Kushner's The Lord Is My Sheperd is about practical spirituality, inspiration, and encouragement gleamed from what may be the best-known and best-loved chapter in the Bible: the Twenty-third Psalm. This psalm has been the source of comfort in grief and courage in fear for millennia. In this book, Kushner discusses how we could live according to the strictures of Psalm 23 in our daily lives. Each chapter discusses one line of the psalm in the context of both the tone when it was written and the present day, and illuminates the life lessons that are contained within it. In this review I will discuss a few kernels of his wisdom in this book.
For Kushner, although we cannot control what happens to us, we can always control how we respond to what happens to us. We cannot choose to be lucky, talented or loved. However, we can choose to be grateful, to be ontent with who we are and what we have, and to act accordingly. To say The Lord is my Shepherd is to say that we live in an unpredictable and often terrifying world. It says that there is someone in this world who cares about us and tries to keep us safe. God is the presence that makes our world seem less frightening to us. God's promise is not that we will be safe but that we are never going to be alone. We will hurt, but we will heal. We will grieve, but we will grow whole again. How comforting a message is this!
Human beings often neglect their souls. We need to pause often in order to restore our souls. We must take the necessary time to nourish our souls by taking a Sabbath or insisting on a day of rest on Sunday. When we are most busy, we must define ourselves by something that is beyond our work. After a burst of creativity, we need to replenish our soul. After helping another person in need, we should take the time to restore our souls. God restores our inner strength so that we could carry on and be empathic and helpful to others. God gives us the strength of soul to be human and compassionate. The straight line between us and our goals can have hidden traps or land mines. We are brought into roundabout paths to fulfill our goals. When we repeatedly do an evil action, it becomes a part of our character. When we repeatedly do a good action, the same holds true.
However, we should refuse tragedy and evil to define us. When bad things happen to us, they can cause us to lose faith in God. No one could make it without God. There is evil in the world, but this doesn't matter, because this is part of God's plan. God is beside us in our problems and He is on your side but not on the side of the selfish, deceptive people who are embittering your life. God doesn't explain why this is the case; He simply comforts us. When bad things happen, the challenge is not to explain them, to justify them or even to accept them. The challenge is to survive them and go on living. And they key to surviving misfortune is the realization that, when bad things happen, God is on our side. When we choose to affirm life in the face of loss, to affirm goodness in the face of evil, we are on God's side. He is with us and we are with Him, and the future does not frighten us.
We must be realistic of what we expect from other people too. Some people are false friends because they cannot nourish anyone, including themselves. The source of the problem is within them but not within you. When you feel abandoned by your friends and all alone, pray and you will no longer feel so alone. When human beings fail us, when friends let us down, God is there to renew our strength and give us what we need to go on with our lives with integrity and compassion. Bitter people should not make our lives bitter. If they do we have given them much too much credence. Crabby people will always find reasons to be crabby about anything and everything. They complain because of what they are like. Instead, bitter people shouldn't affect us. Some people are not grateful because of a false sense of entitlement or because they need to feel self-sufficient.They are convinced that they don't need anyone. How sad not to need anyone!
We each have a responsibility to be a messiah in miniature. We each are unique in God's eyes. We have a responsibility of making the world a bit better than it would be without us in it. God is depending on us to do just that. God recognizes us and helps us to feel special. We are the messiah for somebody if not for everybody that we encounter in or daily lives. We are all special in God's eyes. And we should believe this with our whole heart and being. Only in that way can we prosper and raise above evil and human frailty.
Thus, we each should stop pursuing happiness so strenuously and just relax. Goodness and mercy will find their way into our lives if we just have faith that it will. Goodness is feeling good about life and oneself. We should be happy being who we are. We don't have to work hard to be happy, and to feel good about ourselves. We can't let bad things and bad people define us. We can choose to be happy with who we are. Because God is with us, we do find comfort. We are all invited to dwell in God's house and to live in God's presence. All we have to do is rejoice and be glad!
Reviewed by Irene S. Roth
Writer's Blog: www.irenesroth.wordpress.com Writer's Blogger: wwwirenesoniaroth@blogspot.com Philosophy Blog: www.switankowskyphilosophyreflections.blogspot.com
Tuesday, January 12, 2010
Autonomous Decision Making
What is autonomous decision making? That is a real challenge for many people, especially non-philosophers, to make sense of. However, I think that there is a relatively simple formula to determine whether or not we are making autonomous decisions.
In order to make autonomous decisions, we must determine what our beliefs, values, and desires are, and we must act on the basis of these beliefs, values and desires consistently. These beliefs, desires and values are usually defining aspects of our characters and personalities, making us who we truly are.
Once we determine what our beliefs, values and desires are, we must act consistently on the basis of such beliefs and desires. The more consistently we act on such beliefs and desires, the more autonomously will we be acting. The less consistently we act on the basis of such beliefs and desires, the less autonomously we will be acting.
A big part of acting autonomously is knowing our characters and personalities. For instance, are we honest by nature or do we lie by nature? Are we compassionate or is that something difficult for us? Are we generous by nature or do we have to work at being this way? Do we love unconditionally or do we have to work at that?
In other words, whatever arises spontaneously and naturally while we act is probably something that we are endowed with. For instance, if we act compassionately without much effort, we are probably compassionate. If we act honestly without working hard at being honest, we are probably honest by nature. However, if we are dishonest by nature, we are probably dishonest by nature.
Acting autonomously means acting on the basis of character traits and personality features that come to us naturally and that we are endowed with at birth. As long as we act on the basis of our naturally endowed features, we will be acting autonomously.
What if we aren't happy with our naturally endowed characters? What if when we reflect on our beliefs and values we discover that we want our characters to be better? Since this is a very difficult topic to answer quickly, I will reflect on that in my next blog entry.
Irene
Thursday, January 7, 2010
Thinking Beyond The Crowd
Last time, I wrote about the importance for us to think for ourselves so that we could make increasingly educated decisions about what we buy and what we will and will not tolerate when it comes to our consumeristic culture.
Today, I will reflect on what this really means for individuals in their daily living. How can individuals make sure that they are not manipulated by the media and by advertisers? Is it difficult to make our own decisions? Are we, as consumers, even encouraged or given the opportunity to make our own choices?
Well, I think that advertisers would really wish that we weren't overly reflective. This is mostly because if we are reflective, we may not buy some of the products that they are trying to sell. But is this necessarily a bad thing? Perhaps it is a bad thing for advertisers, but is it bad for the reflective consumer?
I would argue that it is not only a good thing for individuals to become much more reflective about what they are purchasing but it is necessary for financial livelihood. It is difficult, if not impossible, to save money or to afford to live comfortably if we are constantly buying the next best technological gadget on the market.
As reflective individuals, it is important for us to take our time and think about whether we need a particular product. To reflect, is to suspend decision about whether or not to purchase something until we have thought about whether we:
1. Need the product.
2. Can afford the product.
3. Can manage without the product.
4. Don't need right now anyway because it is a luxury item.
Once we have decided which category the particular product fits into, we should
suspend making a decision about whether or not to purchase the product for at least twenty four to forty eight hours so that we could make a more informed decision. This time frame should will give each of us a sufficient amount of time to make an informed and autonomous decision.
Wouldn't it feel better if you bought a product that you know that you really need as opposed to being manipulated by the media to buy things that you can't afford anyway?
Let's all start thinking beyond the crowd. You'll be glad that you did.
Wednesday, January 6, 2010
The Importance of Philosophy For Our Times
Over the next few months, I will be blogging on the topic of the importance of philosophy for our times. We live in uncertain times, when the media has the upper hand, people are struggling financially, and the political and social unrest. Airports are plagued with the threat of terrorist attacks. People are scrambling, trying to believe in something that is beyond the here and now, something that is a bit more permanent than all of the doom and gloom that we are constantly exposed to.
But is this too lofty a goal or is it possible for us to 'escape' from the mundane and dangerous? Is there hope for humanity and human kind? Can we be more informed consumers, more educated individuals, more liberated and autonomous in the way we live our lives, more reflective of who were truly meant to be and how we are truly meant to live? I think we can answer all of these questions affirmatively. But we can only do so if we can be more reflective, autonomous, free, and authentic than the ordinary person.
So, how can we bring this about? I think we could each achieve this by inviting philosophical thinking into our lives. This doesn't mean that we each have to receive an undergraduate degree in philosophy in order to live more meaningful lives. However, it does mean that we should become much more reflective and autonomous than the ordinary person who accepts everything that is uttered through the media unreflectively and without question.
We are bombarded by media messages 24/7 about how we are to think and act, what success really means, and why we should buy every brand new technological gadget known to man in order to live happier and more fruitful lives. The media message is that we will be happiest when we have all the lately technologies and the newest computers and iphones.
Sadly, people who buy into this picture of happiness unreflectively usually become very unhappy. They usually have to go into debt in order to afford such luxuries, only to find that our consumer culture comes up with another new gadget a few months from now, promising us even more happiness. Is there a way out of this mire of consumerism? Is there a way that we could achieve meaningfulness without being part of this buying frenzy? Is there a way to think beyond the media culture and consumerism to emancipate ourselves from all of their shackles?
I think the way out of this mire of consumerism is critical thinking and reflective thinking. I'm not saying that ALL the technological gadgets lead to problems for us as individuals. I am just making the point that if we are completely dependent on the consumerism to achieve happiness, not only will we fall short of happiness, we will also become fundamentally unhappy and possibly emotionally and financially broke.
Over the next few months, I will be reflecting on the various ways that individuals can become more reflective and 'philosophical' in their thinking habits. I will be reflecting on how individuals can learn to make autonomous decisions about wh at to purchase and what not to. I will also be reflecting on how individuals can assert themselves in a world where assertions are sometimes countered with hesitation and a lack of authenticity.
Welcome to my philosophical blog. And until I write again, please make sure to not to accept everything that the media tells you without reflection and at least a bit of hesitation.
Irene S. Roth
But is this too lofty a goal or is it possible for us to 'escape' from the mundane and dangerous? Is there hope for humanity and human kind? Can we be more informed consumers, more educated individuals, more liberated and autonomous in the way we live our lives, more reflective of who were truly meant to be and how we are truly meant to live? I think we can answer all of these questions affirmatively. But we can only do so if we can be more reflective, autonomous, free, and authentic than the ordinary person.
So, how can we bring this about? I think we could each achieve this by inviting philosophical thinking into our lives. This doesn't mean that we each have to receive an undergraduate degree in philosophy in order to live more meaningful lives. However, it does mean that we should become much more reflective and autonomous than the ordinary person who accepts everything that is uttered through the media unreflectively and without question.
We are bombarded by media messages 24/7 about how we are to think and act, what success really means, and why we should buy every brand new technological gadget known to man in order to live happier and more fruitful lives. The media message is that we will be happiest when we have all the lately technologies and the newest computers and iphones.
Sadly, people who buy into this picture of happiness unreflectively usually become very unhappy. They usually have to go into debt in order to afford such luxuries, only to find that our consumer culture comes up with another new gadget a few months from now, promising us even more happiness. Is there a way out of this mire of consumerism? Is there a way that we could achieve meaningfulness without being part of this buying frenzy? Is there a way to think beyond the media culture and consumerism to emancipate ourselves from all of their shackles?
I think the way out of this mire of consumerism is critical thinking and reflective thinking. I'm not saying that ALL the technological gadgets lead to problems for us as individuals. I am just making the point that if we are completely dependent on the consumerism to achieve happiness, not only will we fall short of happiness, we will also become fundamentally unhappy and possibly emotionally and financially broke.
Over the next few months, I will be reflecting on the various ways that individuals can become more reflective and 'philosophical' in their thinking habits. I will be reflecting on how individuals can learn to make autonomous decisions about wh at to purchase and what not to. I will also be reflecting on how individuals can assert themselves in a world where assertions are sometimes countered with hesitation and a lack of authenticity.
Welcome to my philosophical blog. And until I write again, please make sure to not to accept everything that the media tells you without reflection and at least a bit of hesitation.
Irene S. Roth
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