"Current Medicine ... is derived from a reductionist methodology that emphasizes parts.... It is excessively specialized. It fixates on moments, rather than on the whole process.... The locus of control in Current Medicine lies outside, not with, the individual: someone else is in charge of your potential."1(p114)
This description of current medical philosophy and practice by Walter Bortz, MD, is prelude to his call for a new kind of medicine, "Next Medicine" as he calls it, with a focus on health, wholeness, a systems approach, and a transfer of control to the individual. Of course, with control comes self-responsibility and self-advocacy, 2 characteristics that demand encouragement in the current system.
Consider this scenario: Anita is confined to a wheelchair because of the advance of her multiple sclerosis. She has not walked in years, has experienced significant weight gain, is prediabetic, and has lost upper body strength to the degree that she has difficulty transferring herself from wheelchair to attend to bodily functions or to retire at night. A friend recommends Anita to a community-based health center that uses a holistic, transdisciplinary model of care delivery. The focus on the person, their resources and potential is primary. The first assessment question is, "Tell us who you are." not "Tell us what is wrong with you!" In this center, behavioral health is "primary" and the presenting problem is viewed within the perspective of the individual and family's capacity to engage in the necessary behavioral and other changes to improve total health. What level of "health" can Anita achieve? In the context of defining health as the "total absence of disease," Anita cannot achieve that perfect state. Then again, who can? The staff works with Anita's potential, helps her to tackle her depression, gets her to focus on healthy eating to improve nutritional status and achieve modest weight loss, and, most important, gets her moving with the assistant of a physical therapist and a specially developed regimen that she practices daily in the health center's fitness center. Anita's progress is remarkable-she has developed upper body strength to a degree where transferring herself is easy, she is beginning to walk again, she has lost weight, and is not depressed. Anita is an empowered patient who comes to the health center to practice her healthy living interventions most of which do not involve medication or other invasive treatments. I think this is what Bortz had in mind in his brilliant expose of the current ills of medicine and his call for reform.
Bortz' Next Medicine is nothing new to readers of Holistic Nursing Practice, a journal that has espoused a holistic approach to practice and care for 30 plus years. Consider the whole system, individual, family, and community; promote self-efficacy, self-responsibility, and self-care; put patients and families in charge of their own health; appreciate the impact of family dynamics on health and illness; respect culturally based health practices; practice in ways that integrate body, mind, and spirit; and, most important, build an evidence base to demonstrate that holistic approaches work.
-Gloria F. Donnelly, PhD, RN, FAAN
Editor
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