health care revisited

FROM CURING AND CARING TO HEALING

An essay written for the NLZorgForum in its struggle to combat ever increasing costs and understaffing in (health) care (availble on http://tinyurl.com/yz74uzc)

by Hans Leewens

Summary

NLZorgForum is engaged in an effort to stem the tide of what has been called the ‘tsunami’ in healthcare that will have doubled the costs of by 2038. This effort will include all types of possible political, economic, managerial and executive considerations and measures. These will include emphasis on prevention.

In the present essay an attempt is made to put an almost totally different light on the issue, be it that there will be overlaps with what is already stressed as the importance of prevention. As the title indicates the essay starts from the belief that modern medicine and (health) care has tended to concentrate on the efforts coming from outside, the technology, the physical.

The essay puts the issue in the light of an expected 21^st Century Renaissance, a general lift in consciousness and spirit. Hence the title ‘from curing and caring to healing’ in which ‘healing’ stands for ‘making whole’ – an art that reaches beyond the physical and mental into the realm of the emotional and spiritual.

In the essay it will be stressed how the field of health care is in fact one of the most suited, if not THE most suited for a lift in consciousness and spirit. It is here that a total integration of the physical, mental and emotional is not only demanded, but more easily obtainable than in almost any other work or profession.

All that is necessary is the willingness for all involved to ‘consent’, to be willing to follow disciplines that, although totally traditional, have been neglected in modern society.

A quote

“Immediately next in order after consent to suffer death, consent to the law which makes work indispensable for conserving life, represents the most perfect act of obedience which it is given to Man to accomplish.

It follows that all other human activities, command over men, technical planning, art, science, philosophy and so on, are all inferior to physical labour in spiritual significance.

It is difficult to define the place that physical labour should occupy in a well-ordered social life. It should be its spiritual core.”

Simone Weil, “The Need for Roots”

Note: The above quote is a translation from the last lines of the epoch making essay “L’Enracinement”, written by Simone Weil in the year of her death 1943 for the Free French of General de Gaulle in London. It was meant as a pre-constitution for a France to be reborn after the Second World War.

A telling anecdote

While this is being written, our lovely young cleaning lady is hovering in the corridor. To my surprise I hear the sound of music. Her portable radio. Kindly, I believe, I ask her to put off the radio and whether she would like to become holy? I explain to this obviously devout R.C. girl that ‘holy’ is related to ‘whole’. And that if her ‘whole’ attention would be on the ‘working surfaces’, that would greatly benefit both her and the work.

She listens humbly, puts off the sound, but it is clear that she not only doesn’t understand me, but, much against her sweet nature, now ‘hates’ me. Leaving the house she ‘forgets’ to greet me -as she always does – and that on Christmas eve.

A lost discipline

In the Rule of St. Benedict it states among the duties of the cellarer in chapter 31:10: “He should regard all the tools and possessions of the monastery as the vessels consecrated for the service at the altar.” It is one of the reasons, says a well known Dutch writer, that you always know when you are approaching a Benedictine monastery: “everything is tidy and light”. Exercises in ‘one-pointed attention’ are well known in schools of spiritual development. In the Hindu tradition this is part of karma yoga, yoga or linking to the Self through attention on the working surfaces. Exercises in calligraphy are well known for this purpose. As are Cinderella’s task to sift her pearls from the ashes and the continually mixing and then sifting of different grains that the wise man uses to sharpen his powers of attention and discrimination.

What caused the scorn of our lovely, young and demure cleaning lady? Well, two things. First of all my unexpected exercise of ‘authority’ probably did that and secondly the fact that she certainly did not ‘see the point’ of one-pointed attention. She probably never heard of it neither in school, nor at home.

The need for authority, hierarchy and discipline

‘Authority’ became a dirty word in the ’60 ties. One of the reasons was without a doubt the reaction against the deadly (e.g. in the Holocaust) German ‘Befehl ist Befehl’. Also there was the general revolt against hierarchy and discipline in which ‘authority’ became confused with ‘authoritarian’.

It is time we, both managers and professionals, woke up to the truth that ‘authority’, like ‘author’, derives from the Latin ‘augere’ meaning ‘augment’. True authority increases the consciousness of both the person in charge and of the person being addressed. In the same vein, ‘discipline’ is not restriction, but the possibility to be a ‘disciple’, to learn by following, the teacher, mentor, the experienced colleague. Lastly, ‘hierarchy’ in its true meaning is not power, but ‘holy order’, from the Greek hieros archè.

So why continue to ‘sleep and dream’ in the wake of the ‘60 ties? The renewal of that period had its use and purpose in ‘aggiornamento’ as the RC church called it. But, as we are now perhaps willing to recognise, quite some ‘children were thrown way with the bathwater’. It seems time to wake up.

The power of attention

“Attention consist of suspending one’s thinking, to let it be available, empty and available to be penetrated by the object, to maintain in oneself close to the thinking, but at a lower level and without contact, the various pieces of knowledge that one is forced to use. […] And above all the thinking should be empty, waiting, looking for nothing, but ready to receive in its naked truth the object that is going to penetrate it” Simone Weil, “Attente de Dieu”)

What a wonderful insight by this young philosopher, trade unionist, teacher, factory worker, resistance fighter, mystic. In the sentences quoted she captures the whole of the discipline of attention which is, I believe, the magic want, the tool which, if mastered by our doctors, nurses and managers alike, will totally transform the whole health care practice.

Research I remember from the early ‘80 ties, showed that most work only knows to rally at maximum 70 % of people’s capacities. In fact I believe this is true. The lack of attention one observes, first in oneself and then in all around, workers, doctors and nurses alike, is blatant. I don’t think it from the mark to believe some 15 % of costs are caused by errors – and the need for rectifying them – and another 15% by simple lack of attention slowing down the work process. And this is just the ‘material’, the ‘instrumental’ side of attention and its lack.

The healing power of attention

We don’t have to go back to the NT‘s stories about the healing power of Christ’s simple attention. Most of us have either experienced, or heard about, the effect of a simple ‘listening ear’, a comforting touch.

By the way, research among both general practitioners and specialists, of which two psychologists told me, again in the ’80 ties, would have shown that only some 26% of the ‘messages’ sent out by the patients were observed by the doctors.

However, the healing power of attention does not stop at the relation between patient and the provider of care. Patients too can be trained, and encouraged, in the use of the power of attention. As a layman I can only speak of experiences with ‘haptonomy’ and meditation in relieving the body (and mind) of stress.

May this essay encourage to unleashing the (note EM: or 'a' ?) flood of experiences and research data on this point that should become general knowledge, and a stimulus to all, practitioners, patients and elderly persons alike.

Some other vital disciplines

Appended is a Note ‘Growing in contact with sources of value’ that gives some vital disciplines, as given by Prof. Derkse for the personal life. In this paragraph some suggestions are given for collective disciplines. Most of these are in fact practised in the leading Dutch Outplacement/Career Counselling firm Van Ede&Partners. It won them a Spirit at Work Award in 2005, as the first consulting firm ever. Among earlier winners were quite a few hospitals and other health care institutions.

Intervision. The Balint method of intervision was in fact introduced early in the 20th century in the medical profession under the impulse of a wise doctor (Van Lidth de Jeude) who had been aware of the lack of open communication between medical professionals. He had witnessed how the young and lower ranked hardly got the space to speak and question in sessions among professionals. The Balint Method, if strictly adhered to, allows for a beautiful, open dialogue, much increasing mutual understanding, exchange of experience and mutual love (or a least reverence/appreciation). Intervision is a must, both between colleagues at the same level, and between levels and disciplines.

Singing and silence. Consultants of Van Ede, and their clients and sponsors, are used to the highly beneficial effect of community singing. Equally useful would be to introduce in each working day some periods of silence, certainly at the beginning of any group discussion – to allow it to become a dialogue instead.

Reflection/contemplation. It has proven very useful to start any meeting with some ten minutes of reflection on a longer or shorter text from the scriptures, or poets or the wise. After a silent reflection what was experienced is shared with the group if small) or the neighbour. With this start, meetings tend to be much shorter and even delightful.

Checking of experience. It is useful during the work from time to time to stop and reflect on what was observed – if possible with the help of a colleague. These short interruptions avoid the building up of tension and the lowering of the level of attention and speed of work.

Witnessing. For personnel and patients alike it is useful to come together from time to time to listen not to learned speeches but to the testimony of some victim of illness, accident, drugs and the rest, who has overcome his handicap or has learned to live with it. This can work wonders in the process of healing others.

Exchange of jobs. It is a proven tool in raising levels of awareness and sense of unity and belonging to have every person working in Health Care change jobs from time to time. So, for instance, no manager should be allowed to take his/her position but after a period of working in the field. And this should be repeated every 2/3 years – and certainly while preparing for, or introducing, major changes in working methods. Also nurses and doctors should be allowed, or forced, to work in other capacities or other departments, particularly those that have an impact on their own specific jobs.

Some closing remarks

Instead of being a potential disaster area, Health Care, as no other field of human endeavour, is suited to guide the world from modernity to a Renaissance. It is the subtle mixture of the physical, mental and emotional that makes this field to a potential powerhouse in lifting human spirit and consciousness.

Of course it is realized that an individual approach as is implied in the above tends to meet with much resistance. Most people rather look for mechanical, instrumental solutions outside his/hers personal behaviour and attitude. But, as we hope the reading of this essay has convinced at least some to admit that no measure or policy will ever be efficient if we ourselves are not willing to submit to the soft disciplines that have been described.

This will hopefully be the case with young professionals of the pragmatic generation. They may more easily see, and desire, that the daily practice of health care is an ideal starting point for the raising of the level of attention and consciousness that is deemed necessary in bringing a cultural lift, a renaissance. It is telling that the Dutch Foundation “Beroepseer” (‘Professional Pride’) finds many adherents in the health care. Their latest book “Beroepstrots, de ongekende kracht” (Professional Pride, the unknown force) is witness to that.

Increased attention can be a major element in reducing costs. Some examples of cost reduction opportunities: over 25% of all illnesses in hospitals are caused by, or in, the hospital; as mentioned above research would have shown medical personnel to notice less than 30% of signals given by patients; higher alertness might facilitate the desired trend of a reduction in rules, regulations and control systems; higher alertness will increase mutual confidence and communication between and within departments; less need for management interventions; work related absence for illness will be reduced.

Equally important will be the effect of greater alertness, better listening and all other effects related to a generally higher level of attention on the well being of the patients. Here in particular the switch can be from curing and caring to healing. Greater attention for the patients will result in greater alertness, well being and a lift in (fighting) spirit in the patients. It will also help much in prevention by a more alert early warning system in the professional.

Without pretending to any great authority of the calculation made on the above grounds, I believe a cost reduction of up to 30 -50% possible on the above grounds. Particularly in case the lifting of the level of attention would be well prepared by, and continually sustained through, in depth training, periodical intervision and other group and personal disciplines aiming at this seemingly simple objective of, what is sometimes called ‘one – pointed attention on the working surfaces’.

HAJL/24.13.09

Appendix: From: “Growing in contact with sources of value; by Prof. Wil Derkse

From : “Growing in contact with sources of value” by Prof. Wil Derkse.

Prof. Derkse is professor at Nymegen University and an oblate of the Benedictine Monastery the St.-Wilibrordsabdij in Doetinchem. What here follows is an excerpt from a talk on the above subject to employers, employees and employer and trade union representatives. His main thesis in the talk was the importance ofpneuma. Making the comparison with the French pneu, his talk stressed the need for ‘pneumatizing’ (filling the spirit regularly) for all of us, students, workers or pensioners.

In the context of our special interest in the care for an increasingly greying population, the following quote on the vitality of the elderly monks may be of interest. Living as they are by the rules of Stabilitas, Conversio Morum and Oboedientia Derkse says: “… our ‘old sticks brigade’ are mild, ripened, tolerant men, full of humour, no ascetic dried out ‘sourprunes’. They are loyal to the daily prayer-sessions and meditation, and know through reading, study and Internet what goes on in our culture.” This provides a mighty stimulus to the younger monks and visitors from outside.

“Seven tips stemming from the monastic world to feed spiritual vitality

1. Cultivate a personal order of the day (with flexibility) Look for a beautiful and silent start to the day, for a quiet pause, for a beautiful and silent closing.

2. Cultivate daily rest and quiet, avoid noise and fuss. Rethink your attitude towards the mass media, in which rethink probably means scratch.

3. Cultivate the daily work. Even after the so called ‘active life’ it is useful to work daily and consistently on your own project’.

4. Cultivate the daily ‘study’, by a tenacious contact with texts and other clear and clean sources of which you have noticed that they feed you well.

5. Cultivate a regular contact with a concrete form of spirituality – look as it were for a ‘service station’, where you can feed your ‘pneuma’ regularly.

6. Cultivate your friendships, hospitality and the celebration of festive days.

7. Live ‘ex-centric’ by honouring and serving the others and the different – curiously enough this makes you yourself blossom best.”

HAJL. 23.12.09