Sunday, April 9, 2017

INTUITIVE MEDICINE


In this present age of evidence-based medicine, the value of Intuition in medical practice is under-rated. Generally, it is regarded with indifference if not contempt. An experienced doctor will know the importance of an intuitive approach to the patient and the patient’s problem. He can differentiate between intuition and a blind guess. Delving into and understanding Intuition is essential to make the best use of it.1

What is Intuition and where does this come from? From the medical stand-point, Intuition can be considered to be the feeling within oneself about the nature of a disease or its management. It is based on one’s past knowledge and experience. This knowledge or experience might have been acquired in the recent or remote past and one may not be consciously remembering as to when exactly it was acquired.

The process of acquiring knowledge may vary from being purely logical (based on evidence), to being intuitive and corroborated by the intuitive experience of others. In the present day, most of the medical knowledge in use is apparently of the first type. However, much of the knowledge we presume as being evidence-based can be shown to be intuitively acquired in the first place.

An example is the use of several drugs that are derived from herbs. For centuries, they have been used intuitively (e.g. ginger, turmeric, aloe vera).2 Only recently the active ingredients have been isolated and their chemical structure and mechanism of action understood. Here we see that logic has merely fine-tuned the knowledge acquired by intuition.

In fact, any new discovery is first ‘intuitive’ for the discoverer but later is put to test and accepted, based on ‘evidence’. Intuition precedes logic. ‘Knowledge’ is acquired when the understanding is ‘meaningful’, whether by intuition or logic. The present tendency to glorify logic at the expense of intuition smothers creativity, makes the academic approach mechanical and reduces learning to mere acquisition of recorded information. At the field level, this allows medical practice to be converted into protocols that are convenient for use and can be legally and commercially exploited.

The flawed approach to academic and consequently practical medicine entails setting up of logic-based goals, while dampening intuition and freedom of the creative spirit. Curricular evaluations tend to become stereotyped and reproduction of known information accepted as evidence of learning. Inevitably, doctors are being ‘produced’ through a conveyor belt process where the students are made to ‘learn, reproduce and forget’ on their way to become ‘qualified doctors’. Even practical and clinical exams tend to become stereotyped. Instead, actual work-based evaluations help encourage creative and intuitive learning.

Predominantly evidence-based medicine makes clinical practice mechanical, distancing the doctor from the patient and contributing largely to physician dis-satisfaction. Intuitively applying whatever knowledge one has acquired allows creativity in clinical approach, makes it patient-friendly, ensures physician satisfaction and is cost-effective. Being open to Intuitive medicine allows the seamless practice of Body medicine (that constitutes only about two-thirds of medicine) alongside Mind-Body and Mind-Body-Spirit medicine (constituting the remaining one-third of medicine).3,4

While logic cannot be sacrificed and there is need for basic fundamentals, medicine needs to be open-ended in theory and practice with a fine balance between logic and intuition allowing creativity at all levels. Excessive emphasis on evidence-based medicine tends to worsen the problems plaguing the field of medicine, while increased emphasis on Intuitive medicine tends to simplify them. The paradigm of Intuitive medicine needs to be strengthened at all levels.

Key words: Evidence-Based Medicine, Intuitive Medicine, Logic, Intuition.

REFERENCES

1. Trisha Greenhalgh. Intuition and evidence--uneasy bedfellows? Br J Gen Pract. 2002 May; 52(478): 395–400. [Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314297/]

2. Boca Raton (FL): Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Benzie IFF, Wachtel-Galor S, editors. CRC Press/Taylor & Francis; 2011.

[Available at: https://www.ncbi.nlm.nih.gov/books/NBK92771/]

3. Vijayaragh P. Becoming Aware of Mind-Body-Spirit Medicine. Future Health, Apr 2014; (Accessed on 5th March 2017) [Available at: http://www.futurehealth.org/articles/Becoming-Aware-of-Mind-Bod-by-Vijayaraghavan-Pad-Attitude_Body_Compassion_Comprehensive-140426-607.html]

4. Vijayaragh P. Fixing the Basic Flaw in Medical Education and Health Care; Opednews, July 2016; [Available at: http://www.opednews.com/articles/Fixing-the-Basic-flaw-in-M-by-Vijayaraghavan-Pad-Doctors_Empathy_Health_Health-And-Fitness-160710-26.html ] (Accessed on 5th March 2017).
[Published in March 2017 issue of IJMRP www.ijmrp.com]

Friday, July 8, 2016

Fixing the Basic flaw in Medical Education and Health Care


There is a basic flaw in the commonly held concept of Medicine that lies at the root of all the maladies prevailing in the field of medical education and health care. Successful practice of Medicine consists of about 2/3rd body medicine and 1/3rd mind-body and mind-body-spirit medicine. But only the 2/3rd component of body medicine is generally recognized as Medicine. The remaining 1/3rd is considered, if at all, under alternative medicine. While body medicine is based on structure and is therefore objective and easily teachable, mind-body medicine and mind-body-spirit medicine are more subjective and picked up by doctors after years of practical experience.

Medical colleges with their present curriculum can teach only the 2/3rd component; the rest of 1/3rd is mostly self learnt by students and doctors through observation of peers and teachers who teach by setting an example. If we consider this fact it becomes obvious that too much importance is being given to activities based on something that is incomplete by itself: body medicine-based examinations, specialisations, CME points, renewal of license and so on. It is appropriate to learn and update oneself about diseases of the body and their management but all such learning should be tempered by the fact that it pertains only to the 2/3rd component of Medicine. To be successfully utilized, this knowledge needs to be combined with the remaining 1/3rd component that is learnt through subjective experience. That is to say medical knowledge to be complete needs to be combined with a positive and empathetic approach towards the patient. Such a wholesome approach towards the patient not only treats the patient better but helps create better doctor-patient (or patient's attendants) relationship, avoids potential conflict and indirectly helps healing.
 
The incomplete and ignorant notion of Medicine that is widely prevalent not only complicates management by making its application mechanical but also results in Medicine being taught in a mechanical manner based on a curriculum that is built mainly on body medicine. The doctors thus produced, unless they are exposed to wholesome teachers, tend to behave more like machines lacking in empathy. Inappropriate glorification of body medicine encourages unnecessary investigations, escalates cost and allows third parties to take control. Instead of a wholesome approach towards patients, approaches catering to various disparate interests have come to determine medical education and health care delivery. Modern hospitals tend to become more like workshops, patients seen more as study materials and the disease burden as well as students aspiring to become doctors - fields to be harvested. Correction of the basic flaw should start with widespread recognition of the incomplete nature of grossly teachable and evaluable medicine. The Regulatory authorities should try to add completeness to medical education by emphasising the neglected 1/3rd component of Medicine and make the wholesome medical teacher the fulcrum of all learning.
At the entry point, entrance exams to UG/PG courses should in addition to testing proficiency in the required subjects, also test the candidates’ ability to feel for and render help to those in need of it. How this can be done is a matter that needs help from educationists. Mere logic based tests in the concerned subjects as at present will only worsen the malady and chaos. Being more subtle and subjective, the 1/3rd component is easily side-lined. Corrective measures need wisdom and vision. Just as diseases like obesity, diabetes mellitus and dyslipidemia need basic life style modification to be meaningfully treated, the maladies in the field of medical education and health care require basic conceptual modification. Healing by doctors should, as a rule, imply healing of the mind, body and the spirit and not merely the body.



Empathy, Research and the Medical Teacher


           In recent times, it is recognized that the quality of empathy is crucial for the successful delivery of health care.1 Empathy is a natural quality present in every medical student that needs to be fostered along with academics. It is known that students in the final year no longer feel as empathetic as they were when they joined the first year of medical course.2,3 The cause for the decline in empathy lies in the structure of modern medicine that is based on the laws of physical sciences requiring the use of predominantly logical thinking and action. Since subjectivity has to be excluded to learn objectively there is little room for development of subjective feeling leading to a neglect of intuition and empathy. Because of the tendency for decline of empathy during the course of medical education, several methods have been suggested to improve empathy among students and physicians. 4

Adding to the factors contributing to decline of empathy is the lack of understanding of the three psychological aspects of being a doctor: (1) Doctor treating the patient (Medical Practitioner), (2) Doctor updating himself to treat better (Continuing Medical Education) and (3) Doctor analyzing data and understanding new aspects of diseases and their treatment (Research).

The first aspect of treating the patient is the basic urge that drives the student to take up the career of medical profession. This interest in treating patients is what the society first expects from the medical profession. The purpose of medical education is to train doctors who can treat patients having different diseases with competence and compassion. The first task of the regulatory authorities should expectedly be to ensure that the medical colleges are equipped with appropriately qualified manpower (as well as infrastructure) to carry out this task.

The second aspect of being a doctor is the urge to keep abreast with new developments in the medical field so that he/she is able to improve the care given to the patients. This is a desirable trait and every doctor naturally has this to a greater or lesser extent. However for a qualified doctor who is already equipped with compassion and basic competence, the need to update oneself with medical knowledge is arguably best left to his/her own judgment.

The third aspect is the urge to learn from the information available while treating patients to understand unknown aspects of diseases and devise new treatment. Many doctors do this either by observation of patients over years or by methodically collecting data in designed studies, analyzing them and publishing their findings in journals.

The first aspect of being a competent and compassionate doctor does not depend on the second aspect of being updated with latest knowledge and even less on the third aspect of having interest in research and publication. Individual doctors who may be good in research may be found lacking in the ability to adequately care for the patient and vice versa, since different skills are required for these two functions.

When the regulatory bodies for medical education and practice do not understand the above three psychological aspects of being a doctor, it spells trouble. Though familiarity with research is needed, making publication of research papers compulsory for deciding the standing of a medical teacher seeks to whitewash all medical teachers into one category of having the capacity to do research whether or not they have the core capability of providing adequate patient care. In reality there is heterogeneity of medical teachers; some are good in patient care, some in doing research. Medical students learn different sets of skills from different teachers.

Given the central importance of empathy in patient care, the regulatory bodies have to ensure that under-graduate medical students are trained to treat patients with knowledge as well as empathy and the medical teachers set an example in this respect for students to learn from. While the medical teacher needs to be updated on the latest medical knowledge, the ability to do medical research is not a must for imparting basic medical education. Post-graduate medical education needs teachers who are capable of managing all types of cases while imbibing new medical knowledge with the added ability to impart their knowledge to post-graduate students. An ability to do research is only an added skill that may be taught to the students. Any doctor is welcome to take up research in a full-fledged manner if he/she is so inclined but that should be the individual’s choice.

Making publication of research papers mandatory for medical teachers is basically unsound. It can only ‘force feed’ research into those who are not inclined to it and spawn low quality and questionable research publications. It will shift the focus away from the need to train competent and compassionate doctors, which is of core importance from the point of view of a good health care system. The number of years of teaching medical students should remain the criterion to decide on the standing of a medical teacher, and not the number of research papers published by them. A nuanced approach by the regulatory bodies in matters of health care, medical education and research would help to avoid loss of the quality of empathy among doctors and medical students and prevent deterioration of the health care services.

References:

1. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J.Health Hum Serv Adm. 2009 Spring:31(4):412-50
2. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007 Oct;22(10):1434-8. Epub 2007 Jul 26. http://www.ncbi.nlm.nih.gov/pubmed/17653807
3. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH  Characterizing changes in student empathy throughout medical school. Med Teach. 2012:34(4):305-11. http://www.ncbi.nlm.nih.gov/pubmed/22455699
4. Ziółkowska-Rudowicz E, Kładna A. Empathy-building of physicians (Parts I to IV). Part I--A review of applied methods Pol Merkur Lekarski. [Polish] 2010 Oct;29(172):277-81.

5. Medical Council of India: Minimum Qualifications for Teachers in Medical 
 
Institutions Regulations, 1998  
 
http://www.mciindia.org/Rules-and-Regulation/TEQ-REGULATIONS-06.08.12.pdf

 

Friday, July 1, 2016

Quantum View of Medicine

Medicine is learnt more as a science and applied more as an art. While this is the practical reality, some may consider this to be a compromise of scientific principles. On deeper study it appears not be a compromise but something that is natural and inevitable.

The term 'quantum' refers to the smallest amount of a physical quantity that can be counted or measured. The name Quantum mechanics is derived from the observation that some physical quantities can change only in discrete amounts (Latin quanta), and not in a 'continuum' way. The theory and practice of medicine needs to be understood in a similar 'quantum' rather than the 'continuum' way if the observed phenomena in the world of medicine are to be fully accounted for. For example, when a disease is understood to be nearly incurable by conventional medicine and is cured by an unexplained alternative medicine, it is usually overlooked or disregarded as an 'exception'. The quantum view of medicine can explain such apparent variations or exceptions.

We understand the theory of a disease (its causation and treatment) based on some scientific principles. There is a flow of understanding from one aspect to the other like the continuous form as is familiar with Era 1 or 'body' medicine (structure-based). The recently understood Era 2 or 'mind-body' (thought-based) and Era 3 or 'mind-body-spirit' (feeling-based) medicine have their own way of understanding disease causation and treatment. In practice, all these three 'Eras' of medicine operate simultaneously (involving structure, thought and feeling) in varying proportions in different situations with both conventional and alternative medicine having components of all three 'Eras' within them.

If such a phenomenon of simultaneous working of different 'Eras' is to be explained, we need to visualize medicine as consisting of 'quanta' of these different 'Eras'. While conventional medicine is currently having Era 1 as its main component (with the nursing profession mainly providing the Era 2 and Era 3 components), the various streams of alternative medicine have Era 2 (e.g. hypnotherapy) or Era 3 (e.g. faith healing) as their main component. The outcome of a disease process would be decided by the 'quanta' of Era 1, 2, or 3 medicines in operation for the disease in question at the causative and therapeutic levels. The physician would use one of these 'Eras' preferentially depending on his own training and temperament.

While we see quanta of different systems in operation in the same patient, each quantum will have its effect independent of what precedes, follows or accompanies it. Medicine in real time operates in such a quantum way. This is supported by the fact that a high proportion of all patients who are treated by conventional medicine are apparently benefited by concomitant use of some form of alternative medicine.[1] The Era 2 and Era 3 components of the different forms of alternative medicine largely contribute to their unexplained effectiveness.

The 'quantum' framework helps in understanding conventional and alternative medicine in terms of the three 'Eras' in medicine. While it is inevitable that students study and learn mainly one of the three 'Eras' at the curriculum level, practical experience with patients leads to the optimal use of different 'Eras' by the patient-centred physician when he treats the patient from his 'heart' rather than from the 'head'. For what is learnt by the 'head' (mainly body medicine), when applied from the 'heart' acquires the positive and empathetic qualities of 'mind-body' and 'mind-body-spirit' medicine respectively. Understanding the interaction of science and spirituality helps in making medicine simpler, more satisfying for both the patient and the physician and improve health care delivery.[2]

References:
1. The Use of Complementary and Alternative Medicine in the United States https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm
2. A Conversation about the Future of Medicine http://www.dosseydossey.com/larry/QnA.html 

Friday, April 18, 2014

Becoming Aware of Mind-Body-Spirit Medicine

There are apparently two aspects of mind-body-spirit medicine that need to be understood. First is the hidden reality of mind-body-spirit medicine working through the body's built-in mechanisms of healing as brought out in the article 'Improving the quality of health care from within'. 1   Briefly, faith is essential for healing to take place regardless of the kind of treatment that is actually given. Without faith the mind is active and restless. This has repercussions on the immune system. Where there is faith, the feeling is positive and this helps the body's built-in mechanisms of healing.

The second aspect of mind-body-spirit medicine is the power of prayer or prayerful attitude to effect healing, in a non-local manner. This has been proved in numerous scientific studies and first brought to light with clarity by Dr.Larry Dossey, M.D. 2   He calls this aspect of 'mind-body-spirit' medicine as the Era 3 medicine, Era 1 being 'body medicine' and Era 2 being 'mind-body medicine'. Dr. Larry points out that the key aspect of prayerfulness is empathy, caring, compassion or love. The experiments do not work well if there is no empathy, caring, compassion or love for the subject they are trying to influence.

The key to the patient developing faith is the empathy of the physician for the patient. The body's built-in mechanisms respond to the empathy or compassion of the physician. And Dr. Larry points out that empathy or compassion works in a non-local manner even if the patient is half way across the globe. Thus empathy is central to mind-body-spirit medicine and it works in both the ways mentioned above. Those who naturally have the feeling of empathy towards patients and people in general, are at an advantage with regard to practicing mind-body-spirit medicine.

Interestingly the concepts of body, mind-body and mind-body-spirit medicine reinforces our understanding of ourselves. The development from Era 1 to Era 2 medicine emphasizes that we are not the body alone; we are mind-body entities. Era 3 medicine indicates that we are not confined to our mind-body. We are mind-body-spirit entities not bounded by distance. Our influence is trans-personal, non-local as proven by the studies on the effect of prayer.
 
As is the belief, so is the practice. If the physician believed that his own basis was merely the body, he would practice mostly Era 1 - plain mechanical medicine. If the physician believed that he was a mind-body entity, he would be practicing aspects of Era 2 medicine by giving importance to positive thinking. If the physician believed that he was a mind-body-spirit entity, he would include Era 3 medicine in his practice by giving importance to the attitude of 'prayerfulness' by whomsoever is concerned with the patient.

Thus the three eras of medicine, though defined as starting from 1860, 1940 and 1990 (by Dr. Larry Dossey), must have been existing for a long time depending on what the physician (and the patient) believed himself to be -- whether he is predominantly physical, mental or a spiritual entity. In the present day, most physicians probably practice all three eras of medicine to varying extent since each complements the other. The type of patient (his predominant belief) and the circumstances of treatment may influence the physician to move between different eras in a given case.
 
The practice of 'mind-body-spirit medicine' or 'mind-body medicine' is not something that is contradictory to 'body medicine'. Awareness of the three eras by the physician leads to meaningful use of available approaches and more comprehensive patient care. While it makes assimilation of positive aspects of alternate medicine quite natural, the pure 'body medicine' approach to medical practice appears artificial and unnecessarily complicated. All three eras of medicine will continue to coexist as long as there are physicians (and patients) with differing awareness of themselves.

References:
 
1.       Improving the Quality of Health Care from Within

2.       A Conversation about the Future of Medicine http://www.dosseydossey.com/larry/QnA.html

 

Saturday, February 25, 2012

Three Intelligences and Three Tendencies

The concepts of "perceived reality' and "inner reality' of an individual denoting the "self' and "inner self' have been dealt with in my earlier articles/blogs. The individual spends the day in the "perceived reality', which is practically speaking, the state of consciousness at the time of awakening from sleep. During the phase of deep sleep, the mind reaches the indefinable "inner reality' or "pure consciousness', which can be understood as the bliss of deep sleep. Upon waking up the individual enjoys the left over of this bliss, which is carried with the "consciousness' of the day and determines its quality.

Broadly speaking, the individual's consciousness is capable of three types of "knowing' or cognition or intelligence, namely, that perceived by the logical mind, that perceived by feeling and that perceived by the core of one's "being'. Popularly they have come to be known as IQ, EQ and SQ. General Intelligence or IQ was the first to be recognized, which could be evaluated through psychometric tests. Later Emotional Intelligence or EQ was found to be even more important for the individual's success in his daily life or profession. Spiritual Intelligence or SQ has recently been recognized as the most basic of all the three, which determines success in the individual's life as a whole.

Through Spiritual Intelligence (synonymous with "conscience at work'), all "knowing' by the individual is reconciled around the core of one's "self' (the "inner self' or simply "being'). When the reconciliation is complete, the mind easily reaches and enjoys the bliss of deep sleep. In the deep sleep state, there is only this bliss of "being' with the various intelligences remaining unmanifest. When the "being' becomes "becoming', the consciousness of the waking state carries with it this bliss. Thus "being' still lies within "becoming', when the intelligences are at work.

Through Spiritual Intelligence (synonymous with "conscience at work'), all "knowing' by the individual is reconciled around the core of one's "self' (the "inner self' or simply "being'). When the reconciliation is complete, the mind easily reaches and enjoys the bliss of deep sleep. In the deep sleep state, there is only this bliss of "being' with the various intelligences remaining unmanifest. When the "being' becomes "becoming', the consciousness of the waking state carries with it this bliss. Thus "being' still lies within "becoming', when the intelligences are at work.
 
There is the "source' or "being' or the "inner self'. Spiritual Intelligence works closest to the "source' and requires deep inner awareness to be appreciated. Emotional Intelligence comes further downstream, requires lesser inner awareness and is more easily appreciated. General Intelligence comes last and is widely appreciated in daily life. When the individual or the "self' is blissful, the working of the intelligences is optimal and imperceptible. When the "self' is less than blissful, the first to be affected is Spiritual Intelligence; next comes Emotional Intelligence. General Intelligence is preserved unless the individual is severely disturbed.

When the individual is aware of only his General Intelligence, he would consider acquiring more knowledge in his area of work to be the key for success in life. If he becomes aware of his Emotional Intelligence, he would consider "feeling' to be more important than "thinking'. When the individual is aware of his Spiritual Intelligence there is realization that the quality of everything downstream depends on the bliss of "being'. He finds that by meditating on the bliss of "being' control is maintained on everything downstream, which in turn has a subtle effect on life as a whole. He enjoys blissfulness in his life and the various intelligences work to serve his purpose.

The above narrated process of enjoying blissfulness is compounded by three tendencies the individual has to reckon with. The "perceived reality' or "self' of the individual is determined by the interplay of these three tendencies, in-born within each individual in differing proportions and accounting for the diversity in the nature of individuals. Awareness of these tendencies is needed for the individual to proceed upstream and meditate on the "source' or bliss of "being' instead of being lost in the tantalizing external world. The three tendencies (or qualities) are the serene, the active and the passive.

Of these three, the serene tendency if dominant helps the individual to acquire closeness with the bliss of "being'. The active tendency leads the individual towards exploration and action entangling him with the phenomena of the objective world. The passive tendency if dominant leads the individual towards sensory pleasure and sloth. The serene tendency uniquely heals the disturbances arising out of the other two tendencies and if lacking leads to stress and its consequences. A healthy balance between these three tendencies helps the individual to lead a healthy and productive life.

The serene tendency is the foundation upon which the expansion of the active tendency and the enjoyment of the passive tendency rest. The cause of much of the ill-health found in individuals and society as a whole lies in loss of balance between these three tendencies. While the active and passive tendencies are glorified, the serene tendency is relegated to the realm of spirituality and not considered essential. Understanding the working of these three tendencies and giving due importance to the foundation or the serene tendency is essential for restoration of health.

Thursday, November 10, 2011

Improving the Quality of Health Care from Within

The starting as well as the central point of any healing is the faith that the patient has for the doctor. Implied in this is the patient's belief that the best treatment under the circumstances is being given to heal the disease he (or she) is suffering from. When the patient is content about this, he is prepared to wait for the disease to improve and to face whatever problems that may be encountered. The reassuring words from the physician strengthen his faith.

This faith that the patient has, can also involve faith in the institution or hospital where he is undergoing treatment. He believes that the place where he has come seeking relief would finally turn out to be good for him. Faith also matters in the case of a child or an invalid who believes that his parent or guardian is taking care of him. Faith is a deep seated feeling that leads to contentment and soothes the questioning mind.

Faith is essential for healing to take place regardless of the kind of treatment that is actually given. Without faith the mind is active and restless. This has repercussions on the immune system. The new field of psychoneuroimmunology [1-5] has validated the reality of mind-body-spirit medicine [6-9]. Where there is faith, the feeling is positive and this helps the body's built-in mechanisms of healing.

Therefore, a basic requirement for a successful health outcome would be to ensure that the care given at the healthcare setting strengthens the faith of the patient. The physician should live up to the faith reposed in him by arriving at the cause of the disease process just as the archer aims at the "bull's eye'. He needs to use his medical knowledge and clinical acumen to zero-in on the cause as soon as possible and start the appropriate treatment. The rest of the healing should be left to the body's built-in mechanisms; or in lay-man's term - to "nature'. It is unnecessary as well as virtually impossible to understand and "utilize' every mechanism underlying "nature'.

The central role of faith has implications on how medicine is taught to students. The young medico needs to learn the bio-medical aspects by acquiring a sound knowledge of the basic sciences. Even as he learns the basics of clinical examination, he needs to learn the art of dealing with the patient and his concerns. He needs to understand the central role of faith in healing and that his own medical knowledge and skill only help to supplement the body's built-in mechanisms of healing.

Post-graduate learning in medicine should concentrate on the student's ability to manage various disease conditions and lead to perfection of clinical acumen. Acquiring more and more theoretical knowledge of diseases without actual case management is of little use and would only serve to distract the budding physician from developing the habit of targeting the "bull's eye'. Sir William Osler's well-known emphasis on learning medicine by the bedside acquires added importance in the context of the new-found validity of mind-body-spirit medicine.

Presently modern medicine does not recognize the role of faith and the reality of mind-body-spirit medicine. Relying purely on the bio-medical aspects has led to a mechanical approach to diseases with loss of human touch. In addition there is uncertainty in the face of rapid medical advances, on how much of medicine is to be learnt and how best to evaluate the newly qualifying doctors.

The quality of health care would eventually depend on how well the roles of the health care professional, health care facilities, medical advances and medical education are synchronized to supplement and support the central nature of faith and the hidden reality of mind-body-spirit medicine. Otherwise the different aspects of health care would remain as disparate entities, one contradicting the other. For example, doctors may know the value of spending time with the patient and making a good clinical diagnosis, but may not be in a position to follow it in practice because of the necessity to make use of inappropriately built-up diagnostic facilities.

In these times of escalating health care costs and sorry state of national health services, quality health care for all is still attainable if the basics are got right.


References: (All references accessed on 2nd July, 2011)

1. Mausch K. The Psyche, the Immunological system and the problems of Health and Disease. Psychiatr Pol. 1995 Jul-Aug;29(4):435-41. http://www.ncbi.nlm.nih.gov/pubmed/7568516?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

2. Lutgendorf SK, Costanzo ES. Psychoneuroimmunology and health psychology: an integrative model. Brain Behav Immun. 2003 Aug; 17(4): 225-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12831823

3. Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Emotions, morbidity and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002; 53:83-107. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11752480

4. Kiecolt-Glaser JK, Glaser R. Psychoneuroimmunology and cancer: fact or fiction? European Journal of Cancer. 1999 Oct; 35(11):1603-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10673969

5. Robinson FP, Mathews HL, Witek-Janusek L. Stress reduction and HIV disease: a review of intervention studies using a psychoneuroimmunology framework. J Assoc Nurses AIDS Care. 2000 Mar-Apr; 11(2): 87-96 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10752051

6. Seaward BL. Alternative medicine complements standard. Various forms focus on holistic concepts. Health Prog.1994 Sep; 75(7): 52-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10136081&query_hl=13
7. Seaward BL. Stress and human spirituality 2000: at the cross roads of physics and metaphysics. Appl Psychophysiol Biofeedback. 2000 Dec; 25(4): 241-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11218925

8. Brian McMullen. Spiritual Intelligence. Student BMJ 2003 March; 11:60-61 http://archive.student.bmj.com/search/pdf/03/03/sbmj60.pdf

9. Recognizing the Mind/Body/Spirit Connection in Medical Care. Samuel E. Karff, DHL. Virtual Mentor. Oct 2009, Vol 11, No 10: 788-792 http://virtualmentor.ama-assn.org/2009/10/msoc1-0910.html