June 10, 2012 | Posted By David Lemberg, M.S., D.C.

Medicine as treatment or medicine as healing? Despite facile responses, these two constructions are distinct. It is possible that the failure to distinguish between the the modalities of treatment and healing is responsible for much of the current health care mess. Such failure may also account in large part for the abject failure of medicine to provide meaningful solutions to the epidemics of type II diabetes and overweight/obesity. Similarly, when a person ill with cancer or a person ill with a cardiovascular disorder encounters the health care system, the orientation of his physicians to treatment or healing will have a significant impact on the person’s long-term health and well-being.

The differences between treatment and healing are not strictly related to the nature of the intervention as such. A person's health may depend on a cholecystectomy. An acute gallbladder in danger of rupture and a chronically inflamed gallbladder clogged with small stones and fatty detritus may both warrant surgery. If treatment is posited as actively doing something to the patient, e.g., prescribing medication or performing surgery, and healing is posited as providing an environment in which the patient, as manifested in his physical body, can heal himself, then gallbladder surgery is treatment. But such treatment facilitates healing. Wherein lies a substantive difference?

As with much else, such as language, choice of reading material, and politics, context is decisive. Conceive of a person who has been in a motor vehicle accident. She has a great deal of lower back and neck pain. Her doctor prescribes NSAIDs, but after a while she continues to experience significant pain and the doctor prescribes Norco (hydrocodone/acetaminophen). The opiates dull the pain response and she feels less pain. This is treatment. Something is actively being done to the patient. That may be well and good if symptoms improve over the long-term, but with opiates this may not be the case. For example, The New York Times recently reported that opiates such as OxyContin, Percoset, and Duragesic are often prescribed for common conditions such as back pain, but there is little evidence demonstrating that they provide long-term benefit.

In the example, the opportunity for healing is not being provided. Treatment is the order of the day. The doctor is doing something to the patient, i.e., prescribing medication, regardless of the consequences. Pain persists, more opiates are prescribed, and very soon the patient is opiate-dependent, set up for years and possibly decades of opioid use. In contrast, healing would require assessment of the patient as a person. Is she getting sufficient rest? Is she able to exercise, and if not, how can exercise be facilitated? Is the patient drinking enough water and getting healthful food? These are simple questions, but sufficient rest, regular exercise, and healthy, balanced nutrition are the hallmarks of wellness and well-being.

In certain circumstances it may be necessary and appropriate to render active treatment. However, in the majority of patient-physician contacts what is required is healing. The profound problem is that doctors are woefully unprepared to interact with their patients from the perspective of healing. The first requirement in the process of causing an overall shift from treatment to healing is to recognize that the individual sitting on the examining table is a person, not a “patient”.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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