Communicating about Alternative Medicine

Who’s Listening...Who’s Listening...

James Hallenbeck, M.D.

There’s no place like home...

• Importance of home and comfort for the dying.

• Home-– a place– a reflection of self

Cancer- a threat to self

• Cancer eats away at the self, not just the body

• Tasks of the cancer patient:– physical healing– preservation/restoration of self

• self healing

• finding one’s home

Cancer as an experience

• More than physicalMore than physical

• Change in lifestyleChange in lifestyle– Healthcare system part of cancer experienceHealthcare system part of cancer experience

• We may be seen as part of threat to selfWe may be seen as part of threat to self

Alternative Medicine

• Philosophies, therapies vary greatly but tend to recognize healing of self as a goalhealing of self as a goal

• Examples:– Chinese Medicine– Modern American Herbal/Vitamin Therapy

Underlying principlesUnderlying principles

Western Medicine

• Exception to this principle

• Mechanistic approach– tends not to recognize self healing as a goal of

therapy

Active Listening

• Letting go of my agenda

• Recognition of patient’s agenda

• Listening as healing– Examples

• THE STORY• THE LEGACY

Are you listening, Doc?

• The story

• The test

• Sensitive subjects– such as the use of alternative medicines

• Example: Of fish and lightening...Of fish and lightening...

Addressing alternative medical practices

• Self reflection– ? Knowledge base, opinions, perceived threat

• Respect for the patient– recognize/acknowledge effort to participate in

own healing– courage required to discuss with Western

practitioner

Understanding the patient

• Common themes:– Return to traditional practices– Need for self-expression/control– Need to emphasize healing in addition to

curing– Distrust of Western medicine

What does the practice choice say about the patient?

Understanding the practice

– Why did the illness occur?– How did it happen?– What is the normal course of such an

illness?– What is proper therapy?– How should various people relate to this

episode of illness?

Kleinman’s Explanatory ModelKleinman’s Explanatory Model

Explanatory ModelChinese Medicine

• Why, How?– Imbalance of inner forces, affected by outside forces

such as wind

• Normal course?– Progressive imbalance, unless corrected

• Proper therapy?– Herbs, massage/acupuncture to restore balance

• Relationship of people?– Healer prescribes/treats, patient complies

Explanatory ModelWestern Medicine

• Why, How?

– Mechanistic. Due to attack, bad luck, bad choices, obsolescence

• Normal course?

– Progressive malfunctioning, unless repaired

• Proper therapy?

– Destroy invaders, replace damaged parts, tune-up

• Relationship of people?

– Prescribes/mechanic, patient complies

Synthesis

• With compliance

• Healing of self

• Example: a cup of tea...

Understanding alternative practice helps:

SUMMARY

• Healing of the self and the body are important tasks for cancer patients

• Alternative therapies may address the need to heal the self

• Addressing alternative medicines can be less a barrier than an opportunity to create a healing relationship, helping us understand our patients and ourselves

If only we can...

Just ListenJust Listen