Perceptions of Person-Centred Care Amongst Individuals with Chronic Conditions who Consult Complementary Medicine Practitioners - Foley et al 2020

https://www.sciencedirect.com/science/article/abs/pii/S0965229920305112

 

Like a great many other people I had the odd dabble with Complementary Medicine when first ill. Largely encouraged by other patients, it seemed there was a new miracle cure every other month & you want to get better, right?

Maybe they do help some people & maybe they don't. I do know I spent a fair bit of time and money trying things with virtually no evidence base. I might have felt a bit more relaxed but I can't say there was ever a significant difference in my ME - except for the odd bout of payback.

However,

This care may reflect holistic philosophies but, in my opinion, also reflects that you're a paying customer and if they want you to come back they will treat you with courtesy, respect and make sure you feel they have been listening.

In the UK, doctors are not paid directly by the patient but they are paid per patient. Patients choice of GP is often somewhat limited so they're a hobbled if not captive audience. Somehow, this leads some doctors to act as though they are doing the patient a favour, instead of being paid to do a job. At least some of which should be developing a relationship of trust.

The system has evolved in such a way that even doctors who do want to build a relationship with their patients often can't due to restraints imposed upon them. The system has evolved to optimize the system itself and individual patient care can suffer.

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That's all anyone needs to know. Almost no one makes alternative medicine their first choice. It's after being told to get lost by standard medicine that people have no choice. When a monopoly does not provide needed services, people still find ways to fulfill those needs. Even if it doesn't work, the need remains there and people don't simply plop down and abandon all hope.

It's quite fascinating that patient-centered care is a thing. If your care isn't centered on the person, then it isn't really care. It's like "bedside manners", a specific euphemism for basic human decency, aka don't be a jerk and treat people with respect. A basic concept has to be given a special name because it's something we actually expect children to be able to do, but somehow physicians can act like prima donas and be excused by giving it a special name. We're not in the middle ages anymore, people, when doctors were the only educated people around. This time is over, being pedantic by default is not an acceptable standard anymore.

Literally just do your job. If you have nothing to offer to a patient population that means working to fill that ignorance. It make take years and be expensive but there is literally no alternative. It's when you don't do that that people flock to alternative medicine, because it may be equally useless as not providing adequate medical care, but at least it doesn't come with insults. I guess that's a surprising finding but people don't like to be disrespected. Super weird, I know. I mean who could have predicted that?

 

With fibromyalgia (and maybe approaching the hem of ME), the only docs who had knowledge and empathy about my disease were the specialists treating it at the time, rheumatologists. I don't know how neurologists do these days, as it falls into their category.

But all the 'care' after diagnosis falls to the general practitioner or as they are called Stateside, the family medicine doc, or primary care doc. They are at the kindergarten level in their knowledge and, of course, interest in it.

I come out of the obligatory appointment (for a low-dose opioid taken for 18 years without straying, you'd think I could get a pass on these appointments) feeling like I'm five years old. The same mantra each time: how is your sleep, how is your exercise, do you stretch? As if the doc is showing off his knowledge. Makes me feel dehumanized.

I would rather have a discussion (topic of my choice with him listening) during the ten minutes allotted about the difficulties having the disease, getting chores done, withstanding emotional stress, pacing, handling pain flare-ups and PEM, anything to make me feel understood by someone without the illness. Now that might feel transiently healing. He could learn something.

Better yet, let me stay home. I don't need to be hauled it for such nonsense.