Whole per­son care treats hu­man be­ing, not only dis­ease

The Standard (St. Catharines) - - OPINION - SARKIS ME­TERIS­SIAN

Oc­to­ber is Breast Cancer Aware­ness month and, as a breast cancer spe­cial­ist, there is much to cel­e­brate. Sur­vival has in­creased to 90 per cent from about 75 per cent in the late 1970s and in­no­va­tive ap­proaches have de­creased the mor­bid­ity (side ef­fects, both short- and long-term) of breast surgery.

How­ever, there is still room for sig­nif­i­cant im­prove­ment. As the med­i­cal ar­ma­men­tar­ium has blos­somed, our abil­ity to treat the hu­man be­ing be­hind the ill­ness has fallen by the way­side.

The sym­bol of whole per­son care is the ca­duceus, the in­ter­twin­ing of the white snake that rep­re­sents cur­ing (Hip­po­cratic) and the black snake that rep­re­sents heal­ing (Asklepian).

In the treat­ment of breast cancer, heal­ing refers to the pro­vi­sion of such ser­vices as psy­cho-on­col­ogy, di­etet­ics, ex­er­cise, phys­io­ther­apy and ther­a­peu­tic mas­sage. In­ter­est­ingly, none of these is cov­ered by the gov­ern­ment and pa­tients must pay out-of­pocket un­less they have pri­vate in­sur­ance. Why are these ser­vices im­por­tant? It has been shown that moder­ate ex­er­cise three times a week (eg: brisk walk­ing) im­proves sur­vival an amount equal to that achieved by ad­ju­vant chemo­ther­apy. It is amaz­ing that we spend mil­lions on chemo­ther­apy, yet some­thing as sim­ple as a su­per­vised ex­er­cise reg­i­men with a per­sonal trainer can­not be pro­vided. In ad­di­tion, women who gain weight af­ter they are di­ag­nosed also have a poorer prog­no­sis, yet ac­cess to an on­col­ogy-trained di­eti­tian is lim­ited in Que­bec.

Although cured of their dis­ease, many women suf­fer psy­cho­log­i­cally, as their body im­age be­comes dis­torted, their sex­ual func­tion is al­tered, their spouses or boyfriends leave them and their per­for­mance at work is af­fected by “chemo­brain,” an in­abil­ity to con­cen­trate for long pe­ri­ods.

So why don’t we pay at­ten­tion to these fac­tors? Be­cause the health-care sys­tem is built to treat ill­ness or in­juries, and does it very well. Un­for­tu­nately, the main­te­nance of health and the re­ha­bil­i­ta­tion to health is ne­glected. That is where pro­grams in whole per­son care come in. My col­league Tom Hutchi­son, a nephrol­o­gist in his past life and at present one of McGill’s lead­ers in whole per­son care, has writ­ten a won­der­ful lit­tle book ti­tled Whole Per­son Care: Trans­form­ing Health­care (2017, Springer) that is well worth a read. In fact McGill’s pro­gram in whole per­son care was launched in the late 1990s by Dr. Bal­four Mount, a leg­end in the field of pal­lia­tive care and a re­cent in­ductee into the Cana­dian Med­i­cal Hall of Fame.

But why are we lag­ging be­hind in the day-to-day pro­vi­sion of whole per­son care?

The rea­son is sim­ple: gov­ern­ments have not taken no­tice. Whole per­son care must be in­grained in our health-care sys­tem; it should not be con­sid­ered a lux­ury, but a ne­ces­sity, akin to chemo- or ra­dio­ther­apy.

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