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A Medical Dilemma
By Fran Levin

At a recent symposium on Self-Care, co-sponsored by the Institute for the Study of Human Knowledge, the New Human Services Institute of the CUNY Graduate School, and the Office of Urban Health Affairs of New York University Medical Center, health care professionals pondered the crisis in medical care today, pointing out the paradox that "although our faith and resources are placed in professional medical care, our health is largely determined by factors which operate outside the medical domain." It was not intended to be an indictment of the medical profession, but a recognition of the social and historical forces that contributed to a system that is now not meeting the needs of the people.

Our preoccupation with medicine grew at a time when infectious diseases were our prime target, and doctors were trained to treat acute conditions. Now, heading the list are chronic diseases, which means that the emphasis has changed from cure to care. Unfortunately, doctors are not generally equipped to handle this aspect of treatment. One participant urged that doctors make it clear to patients what medicine per se is capable of doing and what it cannot do, and then the approach to the patient's problem can be more realistic. There must be understanding and acceptance on the part of the patient as well, that is, not to expect that some miracle drug will suddenly change the picture. Health is a very complicated process, dependent primarily on nutrition, hygiene, behavior and environmental factors that are outside the range of medicine.

A major problem it seems is that although many patients are not satisfied with the information they receive, they are afraid to ask too many questions and bother the doctor. One educator spoke about programs that were set up at Senior Citizens Centers. They tried to explore this aspect of people's fears, to encourage them to get more information, and to help them realize that if they were not satisfied with the information given, and the goals of their doctors, that they were free to find alternative methods. This is a particular problem for older people who are so conditioned to placing their faith in a medical person, and in essence, giving the responsibility for their health to someone else. It is a difficult concept for everyone to grasp - that each one in part has to take the responsibility for his own health in that he has the choice of how he wants to be treated. In throwing the choice back to the patient, many were encouraged to widen their view and asked for speakers on Yoga, chiropractic and nutrition, to name a few.

The question of choice was part of the presentation of Dr. Victor Sidel of Montefiore Hospital. He showed a picture of a familiar advertisement captioned "If she could choose her iron therapy, she would probably choose Feosol." The question he said, is not that she would choose Feosol, but why can't she choose her iron therapy? He went on to speak about health care in China. One aspect of it is that a patient presents his symptoms and problems to two doctors simultaneously, one trailed in western medicine and the other trained in traditional Chinese medicine. Of course the question arises: what if the doctors disagree? It is simple; they each present their point of view to the patient and it is up to the patient to decide on the treatment. Judging from their health care statistics, it seems that many of their methods deserve imitation.

Another interesting light was shed on the use of antibiotics for the treatment of infectious diseases when it was pointed out that tuberculosis, for example, was already on the decline when isoniazid and other antibiotic preparations were introduced. In fact, only 3% of the total fall in death rate could be attributed to their use.

Barbara Ehrenreich, known for her work in the Women's Health Movement, spoke about healing being monopolized by commercial medicine and that in the past 100 years there had been a change in the nature of medical treatment. " . . . What had been governed by a network of mutual concern became a commodity that could be bought and sold and because it became a commercial venture wrapped in technological momentum, it became abstracted from human need." A factor in this approach is the hoarding of knowledge and the establishment of lengthy training for doctors, not out of necessity, but to limit access to the profession. She alluded to the Flexner Report as verification.

Throughout the weekend talks, one could sense the element of real concern. No one spoke about scrapping the system. Obviously, it has its benefits. Health, however, is a total concept, a political and commercial issue bound into a social structure. We must move society itself in the direction of health.

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