DURHAM, N.C. -- A group of clinicians at Duke University Medical Center is concerned that the doctor's primary function has become to extend human life rather than to relieve human suffering. They say this technological approach has left an emotional, spiritual and even medical void among patients and care givers alike.
Intent on swinging the pendulum back to a more balanced position, the group will hold a conference Oct. 31 and Nov. 1 to discuss the scientific basis behind the public's growing interest in "complementary" or mind-body therapies, and how these techniques can be used to enhance patient satisfaction, improve medical outcomes and impart a sense of fulfillment to the doctors and care givers.
The conference is especially important in an era when managed care has reduced the doctor-patient interview to a perfunctory exchange of symptoms and quick-fix "cures" that leave both patients and doctors yearning for more connection and real-life answers, said Duke cardiologist Dr. Martin Sullivan, one the conference organizers.
"We have a tendency to impose a medical model onto what is often a life-altering disease or illness for the patients," Sullivan said. "As Sir William Osler once said, ?It's more important to know what sort of person this disease has, than what sort of disease this person has.' "
Organizers of the second annual conference, "Integrating Mind, Body and Spirit in Medical Practice," say the conference reaches far beyond the usual healthy-lifestyles lectures espoused by the medical establishment. Instead, the issues delve far deeper into the human experience by exploring, for example, the biological basis for human touch's palliative effects, the power of spirituality in curing addiction, and the importance of social support in treating and healing cancer patients.
But perhaps most practically, the conference will address ways to overcome the growing discontent among medical professionals who recognize that the symptoms they fix often fail to cure the underlying problem. Toward that end, a major theme of this year's conference is the doctor-patient relationship and how it can be improved despite the restrictions of managed care.
Through mini-dramas played by actors called "standardized patients," the audience will learn practical ways to communicate more effectively with their patients, and how to treat the whole patient rather than just the illness, said Joan Tetel-Hanks, director of the medical school's standardized patient program.
Along the same vein, the conference will help practitioners learn how to more effectively communicate with dying patients, an issue that traditional medical education has failed to address, said Duke radiologist Dr. Larry Burk.
With dozens of life-sustaining techniques like CPR and ventilators, the death and dying experience is ever more complex these days, yet doctors lack the tools they need to communicate bad news and help patients make end-of-life decisions, Burk said.
Drawing on the research of Dr. James Tulsky, a medical ethicist at Duke and the Durham VA Medical Center, Burk said that effective communication is a skill that can be learned, much as students learn to thread a catheter or biopsy a tumor.
The real goal is to get care givers to stop talking about medicine and start talking about how the patient feels about dying -- what dying is doing to his or her life, said Tulsky, whose medical school curriculum on death and dying is one of only five in the nation.
"Physicians tend to talk about treatments that can extend human life," Tulsky said. "I believe we need to be learning about our patients' values, so we can help them plan their deaths to be in accordance with how they have lived their lives."
The primary roadblock to discussions about death is fear, said Jon Seskevich, a nurse clinician at Duke who practices healing touch and other relaxation techniques. Seskevich uses humor to reduce tension and to open channels of communication with patients and family members alike. Talking about death, he said, lowers the stress associated with the sensitive subject, and in the end, improves the quality of life and assists the patient in planning for his or her death.
Conference speaker Dr. Melvin Morse, a pediatrician and author from Seattle, will take the issue one step further as he discusses spiritual visions surrounding death and dying, commonly known as near-death experiences. Evidence by such notable researchers as Elisabeth Kubler-Ross and others suggests that near-death experiences do not represent psychopathology nor are they meaningless hallucinations. Instead, they are life-changing events that transform the individual's personality to reflect a new set of values based on compassion toward others and unconditional love, Morse said.
Moreover, spiritual experiences such as these can play a vital role in helping patients deal with issues of grief surrounding their own impending death or the death of a loved one, he said, and they are important in the alleviation of human suffering.
Keynote speaker Dr. Rachel Naomi-Remen, author of Kitchen Table Wisdom: Stories That Heal and an associate professor at the University of California at San Francisco School of Medicine, will discuss issues along this theme. She will talk about how clinicians can reclaim compassion and personal meaning in their work, especially during times of crisis and change, in an effort to heal both the medical system and those served by it.
Among the other speakers are:
Dr. David Spiegel, professor of psychiatry at Stanford University School of Medicine, who will review the principles of good psychotherapeutic leadership, including personalization, facilitating emotional expression, maintaining group boundaries and safety, and encouraging active coping.
Dr. Roy Matthew, professor of psychiatry at Duke, whose brain imaging techniques have shown that drug use and spiritual experiences stimulate the same regions of the brain. He will outline states of mind beyond the bounds of normal experience, and explain such phenomena on the basis of neurophysiological mechanisms.
James Blumenthal, Ph.D., professor of medical psychology at Duke, whose research has shown that mental stress is a better predictor than physical stress of who will experience adverse cardiac events. Along with his research, Blumenthal will present ways to reduce stress to prevent cardiac events.
Dr. Redford Williams, professor of psychiatry at Duke, who over two decades of research has shown that factors like hostility, depression and social isolation all increase the risk of heart disease and early death via biological mechanisms. Williams, together with his wife, Virginia Williams, Ph.D., will help participants identify and evaluate negative feelings as well as increase positive interactions with others.
Anita McLeod, R.N., B.S.N., a health educator in Durham, who will discuss the cultural and personal beliefs about menopause that undermine a woman's health, challenge unhealthy beliefs and discuss practices that enhance a woman's health as menopause occurs.
Suzanne Crater, R.N., Jon Seskevich, R.N., B.S.N., Dr. Mitch Krucoff, all from Duke, who will discuss how healing, imaging and stress relaxation can affect the outcomes of patients with unstable coronary artery disease, and how modern scientific methods can measure and demonstrate such effects without introducing bias.