Date Tags advice

He didn't appear to understand. That is to say, the practitioner could be ready and skilled to deliver psychosocially competent care, but the delivery system would not be ready to provide the incentives to support such care--indeed, the system may even offer active disincentives. Increasingly, as Helen McNaughton reports in article 14, care is viewed by the managers of medical units as a commodity. In keeping with the priority system of contemporary capitalism, which has in our times come to dominate not just the institutions of medicine but its value orientation as well, money is expended to enhance this commodity so that more money can be made from it (Heilbroner 1986). Thus, what counts today is not how effective the physician is in helping the chronically ill to deal with suffering, but how much time and money are spent and how much profit is left. High quality of care may not always be cost effective, at least when cost is narrowly configured by the dominant political constraints of our time. The system of medical care in the United States, and in the other industrialized countries, needs to be reformed. The situation is worsening at an accelerating pace. Critics of modern medicine have identified the central issues of inequity in access to care and of injustice in who benefits from care; Navarro 1986). But their solution would be unlikely to address the problem I have identified. There are always options available. You just have to choose! Some things will work better for you than others. The key is to relax your body as best you can, and then not worry too much if your mind refuses to cooperate. If a rogue thought appears, observe it and let it go. The worst thing you can do is scold yourself for having such thoughts while you're supposed to be meditating, because this immediately brings tension back into the picture. Don't worry if you fall asleep - this is a sign that you're relaxed, and you needed the rest! Mindfulness is a quality that's always there. It's an illusion that there's a meditation and post-meditation period, which I always find amusing, because you're either mindful or you're not.

Stress is a massive contributor to health problems, insomnia, and generally making life not as much fun. What hurt him was my brusque manner and the shortening of his allotted time. This session, he tried to explain to me, was the most important event of his week, something he waited for with great pleasure and organized his week around. And he had something extraordinary to tell me: he had been robbed again. He was so proud to tell it to me that at first I couldn't get the sense that this event had actually happened to him. I thought it might have been something he had seen on the television, dreamed, or even hallucinated. When I finally understood, I told him it would have to wait for the following week. There was no time now. He looked so terribly hurt, like a disappointed child. I didn't know what to do. The nurse kept buzzing me that there were patients who needed to see me immediately. That problem is perhaps best thought of as a cultural dilemma that captures the values of modern societies and the professions that have come to implement those values. The secular mythology and the professional ritual experts of our times serve the ill poorly. The profession may seem to be doing well, but its authorizing mission is in deep trouble, its practicing members profoundly divided, its relationship to its clients greatly disturbed. What is required is no less than a transformation in the way we think of medicine. The Health Care System Let us reconsider the health care system, then, as an enterprise centered on the care of illness experiences. Where is illness cared for in society? That is to say, what health care system handles illness problems? When health planners or public health professionals draw a map of the health care system, they usually include only the facilities of the biomedical profession: namely, hospitals, clinics, nursing homes, and rehabilitation units.

An anthropologist who was asked to chart health care in society would describe a much broader health care system with rather different components. It isn't possible to avoid all stress. However, there are at least ten ways you can use simple meditations to turn away stress when it knocks on your door. Deep meditation might be difficult when you're under stress, but you'll still benefit by doing a short, light meditation session. If you're feeling uptight, consider taking a brisk walk and meditate on each step. Feel the ground under your feet and your leg muscles working. Focus on the experience of walking, and this will help free your mind from stress. Breathe deeply and slowly into your belly. Feel the air enter your nostrils and travel into your body, and hold your breath for four seconds at the top of your inhale. Release your breath slowly to the count of four, with the idea of allowing all the air to empty out of your lung. Step into the shower and let water run over you. Yet I felt I couldn't let Paul leave so wounded. I explained to him my dilemma, to which he said something like this: That's OK, Dr Kleinman. I'm accustomed to it. I'm just a small person. I'm hardly a grownup anymore. I know the truth. I'm a half-wit like they said, aren't I? The world is too fast for me, isn't it?

The people are too big. Remarkably, most care for illness is delivered not in biomedical institutions or by professional practitioners but by the family (Kleinman 1980, 179-202). This family (or popular) sector of care is where illness exacerbation is first identified and coped with. Treatments of many kinds may be used as self- and family care, including: rest, change in diet, special foods, massage, over-the-counter medications, prescription drugs on hand, a large number of devices from humidifiers to special furniture, emotional support, and religious practices. This lay arena of care also includes advice from friends and others about what to do, when to seek professional care, where to go for it, and whether to follow the advice of current professional caregivers or change to other practitioners. The neighborhood pharmacy and health food store are frequently drawn into this lay therapeutic network. For the doctor concerned with chronically ill patients, the family arena of care is of great importance. Indeed, among certain ethnic minorities and non-Western cultures, the family, not the individual, is regarded as the locus of responsibility for making therapeutic decisions (as we saw in the instance of the Chinese patient with cancer described in article 9). Yet few physicians have acquired systematic knowledge about the family context of care or worked out ways to evaluate how their patients' illnesses are affected by the family. Not so for drug firms, whose advertising in the media--a major contribution to the cost of medication--is directed principally at the family as lay practitioner. The popular sector of care is a major source of expenditures, an enormous industry that bypasses physicians. You might want to imagine you're standing under a waterfall. Concentrate on the feeling of each drop of water on your skin. Let the water run over your face, and slowly turn so that it trickles down your whole body. Stay in the present moment and experience the water washing your stress down the drain. Sit or lie quietly where no one will disturb you. Close your eyes and picture a blank screen in your mind's eye. Think of a positive word to focus on that describes how you want to feel, and visualize it appearing on the screen. Look at the word as you breathe deeply, and slowly repeat it in your mind with your inner voice. Spend time with nature, and concentrate on small details such as the structure and color of leaves and flowers.

Listen to birdsong or the sound of a squirrel fussing. And when they get angry they can hurt you, can't they? It really is too dangerous a place for me. Maybe I should live in a home, you know what I mean, a home for people like me. I felt a deep sadness break like a wave. I think my eyes teared; I may well have cried with him. Then I felt anger--not at Paul, fortunately, but at the injustice experienced by the weak, the timid, the vulnerable in a world of maneaters. I soon consoled myself with the thought that that wasn't the whole story. Paul himself had been the beneficiary of compassionate care. But I couldn't help feeling that it was me, not Paul Sensabaugh, who should have felt shame. Commercialization, which does have the advantage of increasing the family's access to useful treatment interventions, regrettably all too frequently has brought with it inappropriate, unnecessary, and frankly dangerous practices. The challenge for medical reform is to develop the sensibility of the practitioner for the potentially adaptive aspects of lay care. Then he can help his patients and their families to increase their command over the knowledge and technical resources that will make self-care more effective. Physicians' willingness to encourage informed self-care should be tied to reform in the laws governing patients' access to controlled drugs deemed essential to their treatment. Patients and their families can now purchase devices to monitor blood pressure, to check the ear canals of children, and to test urine. Why shouldn't they be able to purchase without prescription and use under qualified supervision those medications essential to their conditions? The chronic patient is (or can learn to become) an expert on his illness experience; Videotapes and written materials can be prepared specifically for this purpose. The act of formally training patients and families as caregivers is a message of empowerment that is of symbolic as well as practical significance.