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DR. STEMMLER'S MONTHLY TEACHING ROUNDS

Winter, 2005

CARING FOR THE PERSON IN WOMEN'S HEALTH CARE

(COPYRIGHT STEMMLER, 2005)

The Current Scenario

"Next week I'm going for my Pap smear" is how many women announce that they will see a doctor for their annual health care. They have been indoctrinated by our health care system that the standard for their care is usually a breast and a pelvic exam, a Pap smear, a mammogram after a certain age, and some general blood tests, done on an annual basis.
And, unfortunately, women expect little more than their five to ten minutes with the doctor, although with increasing frequency, they might not even meet the doctor, but rather their nurse practitioner or physician's assistant. In a medical world distorted by the business of managed care, a high volume of patients is often the only way physicians may still be able to remain solvent. Thus, the doctor-patient relationship has been lowered to a very brief encounter, or even completely delegated to paramedical personnel. Third party payers do not honor time spent with the patient, while they are more apt to pay for procedures and expensive tests. The result is that patients rarely have enough time to discuss their physical concerns, and are almost never given a chance to ask for help with emotional or spiritual issues that may be contributing to their symptoms. The care is given quickly so as to move on to the next patient, and patients repeatedly complain about the length of time elapsed between their visit and the report of their tests. In some cases they are even told that they will only be called if something turns out to be abnormal, a policy that can bring on a lot of anxiety for women already bombarded by drug company ads, using scare tactics to promote themselves.
So what, if anything, is wrong with this picture?
What is wrong is that a woman is more than the sum of her female parts: breasts and pelvic organs. A woman must be validated as the person she is, and that takes time, listening skills, an understanding of human nature, and compassion. It also requires that the physician have passion for his or her work, as well as respect and consideration for every patient consulting for his or her services.

 

Welcoming the Person in the Medical Office

It really is not that hard to care for the person when delivering health care. Perhaps the easiest place to start is when the patient first calls to make an appointment. A friendly and helpful voice will set the tone for a pleasant experience even before the patient reaches the office. And a well-trained, reliable answering service outside office hours is going to be much more appreciated than an automated program with a monotonous computerized voice, instructing the poor patient to punch in a series of menu options that eventually take them nowhere.
The patient should then arrive at a well-illuminated, cheerful office, with fresh flowers, and with a pleasant, non-institutional décor. Reading material would best include up-to date magazines, art and travel books, as well as any material the doctor has personally contributed to patient education. Handouts prepared by drug companies and health institutions can be helpful, but what the doctor usually writes in his or her own words is a lot more meaningful to patients. If there is enough room in the waiting area, patients should be pampered by offering them a nice hot cup of tea, preferably served in porcelain rather than in Styrofoam cups. Such a small amenity can go a long way to relax a patient just coming off a trying Houston freeway, or having endured a nasty boss for the previous 8 hours.
And of course all that follows would be in line with the patient's first impression of the practice. A detailed history focusing on all aspects of the patient's life, with an interest in who they are, their line of work, family life, talents and hobbies, travels, accomplishments and perceived shortcomings, will validate the patient as a person. As a result, the person in the patient will soon connect with the person in the doctor, and with the person in the nurse. And it is only then when real holistic care can take place in the medical office.

 

Connecting the Symptoms Within the Wholeness of the Person

Careful listening and observation of the patient allows the physician to form a picture of the patient's total health condition. Symptoms that may seem to be unrelated in our system of medicine are understood as being interconnected in a logical sequence in other medical systems. Therefore, when a patient is viewed as a wholesome being rather than just a "gyn exam", evaluating the "non-gyn" symptoms together with any presenting complaints pertaining to the reproductive system, will shed new light on the diagnosis and most effective treatment for each patient.
But even if a physician would gather all of his or her data on each of their patients in great detail, our Western approach to health care does not have a format to understand such connections. Most of our diagnoses are formulated on a conceptual base that rests on an arbitrary division of human beings into a body and a mind. The spirit has even a fuzzier and poorly understood place in this whole equation, and rarely becomes a factor to be included when diagnosing a patient.
That is when Chinese medicine can be of great assistance to the physician puzzled by the complexity of the person being treated.

 

Integrating Chinese and Western Medicine to More Effectively Treat the Person

Mary Louise arrives for her yearly exam at 4:00 PM. She sits down for a few minutes to savor her cup of green tea, and then she is ready to be seen. She is only 29 years old, yet troubled with bouts of depression, irritability, headaches and dizziness, and even a loss of appetite, mostly a few days before her periods. In addition, her periods are heavy and dark, with blood clots. She has seen other physicians in the past, who have treated her with a variety of migraine medications, tranquilizers and antidepressants, but the many side effects of the drugs had taken a toll on her.
From a Chinese medical perspective, Mary Louise's history and physical exam point to a syndrome called "liver Qi stagnation", and the treatment for this condition includes dietary changes, acupuncture and an herbal combination. Mary Louise would not be well served taking drugs such as prescribed to her in the past, since they may further injure her liver energy. It was suggested to her that she avoid alcohol and coffee, both of which overload the liver, since it has to do extra work to clear its toxins. She was also advised not to use too many hot spices, although some spices could be very beneficial to activate her liver Qi, such as garlic, rosemary, saffron, marjoram, and basil, but only in small quantities, since larger amounts may actually injure the liver. She could also try chicken livers, celery, spelt, and plums, given that they all relax the liver energy, and so do shallots, red beets, leek, ginger, and peaches.
Her acupuncture treatment would incorporate points to address all of her symptoms at once, although they might change as her condition changes with treatment. The choice of an herbal combination for her would have to take into account her constitution, her age and length of symptoms, her findings on exam, and the hierarchy of her symptoms by intensity and duration. It would be perfectly appropriate to let Mary Louise know that she stood a very good chance to completely recover from her symptoms and enjoy her youth to its fullest with this medical approach.

Here is a beautiful haiku, a Japanese form of poetry, which is ever so brief, yet, effective in dealing with the most human concerns; it touches on our topic of the person behind the woman, in a profound and subtle way:

 

Woman-
How hot the skin
She covers.

                                      Lady Sute-Jo (1633-98)

 

My spring issue will address the special health care for men, since our guys are often overlooked, and they need as much attention and pampering as women do.
Until then, have a wonderful 2005, packed with love from your family and friends, good work, and the simple joys of life!

 

Christina Stemmler, M.D.


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