Thursday, August 03, 2017

HEALING


To be healers we will have to understand the dynamic of healing I
relationships, what makes them work. what makes them fall,
why some helping professionals learn to become healers and
why others never rise above the level of technical competence.

This book is a report on what we have learned in our effort to
study healers and healing skills in a more systematic way.
Both of us have spent our lives in health care. Churchill has
been educating medical students, hospital house staff, nurses,
and chaplains in academic medical centers since 1973.
Schenck has worked in a wide range of nonprofit healthcare
review organizations: as an administrator, as a community organizer
for health services, and as a chaplain in hospital and hospice
settings. Both of us have seen firsthand how the relational
dimension of professional help is sometimes the difference
between good and bad outcomes. Even when outcomes are
unfavorable, finding meaning in the problems is powerfully
affected by the ability to elicit trust and to empathize with others,
as well as by commitments like shared responsibility, loyalty.
Search m this book Go and deep respect for the humanity of another person. This book
is an effort to put on display what we have Iearned from
interviews with 50 clinicians recognized by their peers as
healers. lessons that we believe speak not only to doctors but to
the broad spectrum of professionals who work in health care.
We have both been deeply humbled by what we have
Iearned and b the responsiveness of the people we


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Healers: Extraordinary Clinicians at Work

To be healers we will have to understand the dynamic of healing
relationships, what makes them work. what makes them fall,
why some helping professionals learn to become healers and
— why others never rise above the level of tedinical competence.
Get this book in rim 7 This book is a report on what we have Ieamed in our effort to
p study healers and healing skills in a more systematic way.
Both of us have spent our lives in health care. Churchill has
5.1 0 been educating medical students, hospital house staff, nurses,
.H°'§'.°.r.‘?. and chaplains in academic medical centers since 1973.
an 0 Reviews Schenck has worked in a wide range of nonprofit healthcare
i Write review organizations: as an administrator, as a community organizer
-_ . for health services, and as a chaplain in hospital and hospice
'/ settings. Both of us have seen firsthand how the relational

dimension of professional help is sometimes the difference
between good and bad outcomes. Even when outcomes are
unfavorable, finding meaning in the problems is powerfully
affected by the ability to elicit trust and to empathize with others,
- as well as by commitments like shared responsibility, loyalty.
Search m this book Go and deep respect for the humanity of another person. This book
is an effort to put on display what we have Ieamed from
interviews with 50 clinicians recognized by their peers as
healers. lessons that we believe speak not only to doctors but to
the broad spectmm of professionals who work in health care.

> My library We have both been deeply humbled by what we have
Ieamed and b the res nsiveness of the eole we


3 David Schenck, Larry Church

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We have both been deeply humbled by what we have
Ieamed, and by the responsiveness of the people we
interviewed. We Ieamed much about healing, but we also
Ieamed what a rare and valuable thing it is to be able to discuss
healing, to be able to reflect on powers that both seem beyond
us and yet reside in us as human beings. A short version of our
research findings was reported in 2008 in Annals of lntemal
Medicine. Many of the numerous responses we received from
physician readers were remarkable and gratifying, but none
more so than that of an Italian physician who wrote that reading
the article was a healing experience for him, confirming the part
of his work he found most meaningful.

We hope clinical educators reading this book will pay more
attention to the phenomenon of healing, and will be motivated to

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improve both their skills and those of their learners. We hope
the general public will feel that some of the things they most
prize in professional helpers are beginning to be recognized and
valued, and will demand greater competence in these skills from
those who make claims to help them.

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We begin in Chapter 1 with a report of interviews with 50
clinicians over a 2-year period. clinicians identified by their I
peers as expert healers. Their responses to the questions we
posed were sometimes obvious and remarkably simple, at other
times surprising and complex. They consistently engaged the
subject of healing by offering practical advice—describing things
Get this book in print 7 they do, rather than discussing ideas or concepts. The
audiotapes of these interviews comprise over 600 pages oi

transcripts. Our analysis of this material clustered around eight
themes. each described as a practical skill. We have sought to
remain true to the form of the responses. and have couched
hese skills as imperatives—things to do with patients and
clients. rather than ways to think about them. Mastering these
skills would provide enduring improvements for patients, just as
practicing these skills consistently would provide the most
enduring rewards of patient rare for clinicians.

Many of the practitioners we interviewed recognized that
patient care inevitably involves ritual processes. Chapter 2
steps back from a locus on healing skills as separate capacities
to consider how they function together as elements in a larger
ritual structure. In Chapter 3 we turn our interpretive lens to a
finer focus. this time explicatlng and interpreting one particularly
fruitful interview in detail.

Caring for the sick has always been of extraordinary

importance to human beings and. coupled as it now is with the

power of modem science. parallels and interconnections
between healing in health care and healing in religious and

. spiritual traditions are natural and inevitable. These parallels
and interconnections are the subject of Chapter 4.
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But what about the patient perspective on healing? In

Chapter 5 we review some of the most articulate and prominent
BUY EBOOK - $14.39

Get this book in print 7

patient narratives about illness and clinician—patient

5,1 0 relationships. from ‘the other side of the bed rail.”
t,Hc.‘\‘!°_.y‘_'§ One of the most exciting facets of healing is the amount of
,, _ recent research on the biological pathways involved and the
g 0 REVIEWS subsequent rethinking of just how healing occurs. Chapter 6
. Write review reviews the considerable amount that is known from scientific
C . studies on healing, drawing from work in behavioral science,
'/ physiology, neurology, immunology. and placebo studies. In this

chapter we argue for a rethinking of the placebo effect as an
element in a larger phenomenon we term the ‘healing
response.” Here we also make suggestions for a model of
medical education that would integrate training in healing skills


__ more completely into health professions curricula.
. All of our infonhants recognized that their power to help
Search In this book Go others is closely intertwined with their own well-being. Healers

need wholeness in themselves to evoke the healing potential
inherent in others. One of our interview questions sought to

Ab°”t ""5 b°°k elicit ways that professionals sustain their health and find
wholeness in the midst of very demanding practices. This is the
, focus of Chapter 7.
' My “brary In the final chapter we connect healing with ethics, focusing







     












My Elder Brother  Who is








View as Exhibit
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Ras-related C3 botulinum toxin substrate 1 drug:DB04315
Retinoic acid receptor RXR-alpha drug:DB00210
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from WIKIPEDIA

SPARQL (pronounced "sparkle", a recursive acronym[2] for SPARQL Protocol and RDF Query Language) is an RDF query language, that is, a semantic query language for databases, able to retrieve and manipulate data stored in Resource Description Framework (RDF) format.[3][4] It was made a standard by the RDF Data Access Working Group (DAWG) of the World Wide Web Consortium, and is recognized as one of the key technologies of the semantic web.[citation needed] On 15 January 2008, SPARQL 1.0 became an official W3C Recommendation,[5][6] and SPARQL 1.1 in March, 2013.[7]
SPARQL allows for a query to consist of triple patternsconjunctionsdisjunctions, and optional patterns.[8]
Implementations for multiple programming languages exist.[9] There exist tools that allow one to connect and semi-automatically construct a SPARQL query for a SPARQL endpoint, for example ViziQuer.[10] In addition, there exist tools that translate SPARQL queries to other query languages, for example to SQL[11] and to XQuery.[12]

quackery

Stress Reduction through Cognitive and Behavioral Strategies 20 Selling snake oil Over the centuries there have been many unproven or fraudulent practices that promised to bring relief from a huge variety of ailments. Some could be used to treat just about anything, whereas others were meant for specific ailments. Quacks, a term that comes from the Dutch "quacksalver" which refers to individuals who falsely maintain that they have medical skills or varied potions to eliminate illness, have for centuries shamelessly taken advantage of desperate people. It could be argued that if there's no actual cure for an illness, then some ointment and lotion that itself causes no harm might serve as an excellent placebo to diminish the strain of illness, provided that it doesn't strain the patient's finances. However, there are occasions when these phony remedies are selected instead of conventional remedies that might provide an escape from an illness. With the notion that stressful events can cause psychological and physical illness, the "stress industry" has proliferated markedly, and there's more crud on the market than you'd find in a cow pasture. Showers with high‐pressure nozzles promise to reduce the aches and pains that come with stress, squeezing soft rubber balls has replaced counting religious beads to diminish anxiety. The natural products market has moved in as well, offering herbal products, neutraceuticals, which are certain to give you what you need to combat life's challenges. Neuroscience has also been bandied about to promote products, and you can't get away from ads that emphatically assure us that their product enhances well‐being, including our failing memory through "the science of neuroplasticity." There are also recommendations that we join a gym, drink one tea or another, get a hobby, engage in deep breathing, meditation, different forms of yoga, artistic expression, spa treatments, or somatic training, spend time in nature, listen to relaxing music, and spend quality time with pets or loved ones. Together, they've done an excellent job in attracting a market share from the products of earlier days when nothing could get rid of stress more readily than "a good smoke" or "a double on the rocks." But how effective are these purported remedies to prevent or diminish stress?

specialty referral

With the understanding that a medical practice is a small business enterprise,
why would I, as proprietor, want to turn away customers by
referring them elsewhere? Much is written in the lay press and on the
Internet about the importance to patients of finding just the right doctor,
meaning one with whom they will have a good rapport. It is not considered
proper, however, to acknowledge that the physician does not have
the same flexibility of choice when “selecting” his patients. To my dismay,
I must report that not all elderly patients are sweet little old ladies or their
male counterparts. Some older men or women can be quite nasty or rude.
Nothing demoralizes doctor and staff and sours a day of patient care more
than a scene in the office with a belligerent patient. Referral is a professionally
respectable way to unload a difficult, nasty, or noncompliant patient.
On the surface, I am upgrading their care while, practically, I am cleaning
house. This will sound crass and insensitive, but it is important to
acknowledge that not all physician-patient relationships are destined for
success. Specialty referral can defuse a tense situation and offer a divorce
without abandonment.


Specialty referral is becoming, by necessity,
a calculated business decision based on time management


When some patients go from their generalist to a partialist (Bodenheimer
2008, 1064), they have a sense that they have lost more than they
Poly-Doctoring 79
have gained. Patients often return from consultations with a feeling of
detachment.



medical
training teaches young physicians not to think of zebras when they hear
hoof beats. We were taught that common things were common. For the
specialist, however, it is acceptable, if not expected, that he should be the
one to think about zebras. To tell the truth, finding the zebra can be a lot
more exciting, and certainly is more financially rewarding, than managing
the more common maladies of man. In medical school and residency the
more esoteric a doctor’s differential diagnosis (a list of possible diseases
that fi t the symptoms), and the more obscure the right answer, the more
impressed would be his superiors and his colleagues. Unfortunately, the
long-inculcated one-upmanship of medical training and the challenge of
the zebra hunt can suck a patient into a black hole of medical diagnostic
excess from which there is no escape. It begins with the phrase, “I’d like to
obtain a few additional tests.”


a kind of diagnostic arms race. To health care economists, this escalation
is a form of health care value-added tax. The specialist, however,
has not completed his mission until he has searched for zebras.

Remarkable as it may seem, some patients return to me disappointed
and dissatisfi ed when the specialist’s work-up is unrevealing or negative.
I cannot count the number of patients, over the years, who paradoxically
expressed dissatisfaction that the specialist could fi nd nothing wrong!
Since zebras are by defi nition rare, this poses a real problem in customer
satisfaction, as patients often may return from a specialty consultation
with no apparent benefi t, but defi nitely poorer for the experience.

icu story medicare fraud MCI

Patients were said to “die the Harvard death” when they underwent every
imaginable blood test, biopsy, scope, scan, or surgery before passing, leaving
behind a challenging case study worthy of publication in the New England
Journal of Medicine but ending in a tragically miserable and coldly
technological death.


As I look out on my packed office waiting room, I must admit that I
am skeptical. Many of the frail, demented octogenarians sitting out there
can barely negotiate the short path to the lavatory, let alone navigate a
complex, fractionated system of health care, no matter how much help
and support they may get from their medical home.


How am I to maintain
my burgeoning geriatric practice, with all of its stressful demands,
while at the same time assuming the new role of clinical information manager
and expert in health information technology?

During office hours in a
busy practice there is barely time for a doctor to make a phone call, grab a
bite to eat, or even to go to the bathroom. I am not exaggerating. At present,
the image of the doctor’s office is more like a crowded bus station than
a quiet, peaceful home.



What else is wrong with this model? It incorrectly presupposes that a
physician can be either a touchy-feely relational communicator or an Oz like,
imperious, non communicating, specialty wizard, out on the rim of
the wheel. Both images are wrong. To be a physician, regardless of specialty
or narrow focus of practice, is to be both technically competent and relational,
a communicator, a teacher, and a healer.
Even the high-tech superstar surgeon must be
able to sit down and talk with patient and family in order to serve them
well. Somehow, in the course of medical specialization as a form of subcontracting,
we have all forgotten our Hippocratic mission statement.



Without doubt, none of us is as sharp as we once were. A missed appointment,
a forgotten name, or a word that escapes us is a deficit easily
attributable to normal aging. “Benign forgetfulness of the elderly” was a
clinical term once popular among neurologists (Kral 1962, 257). It characterized
the nonmalignant type of mild memory impairment that does
not presage a dreaded diagnosis of Alzheimer’s disease (AD). More accurately,
I think, it labeled the forgetfulness that afflicted older neurologists.




The physician who cares daily for hoards of cognitively impaired patients
likely will suffer from similar frustration, exasperation, early burnout,
and compassion exhaustion. Instead of the strain of round-the-clock
comprehensive care of one individual at home, the primary care physician
will be subject to a slow erosion of morale and loss of a sense of professional
purpose from an endless procession of the elderly, many mildly
cognitively impaired or even frankly demented, each with a fifteen- to
thirty-minute appointment, but absent the tireless, loving devotion and
commitment of a member of the family. Geriatric medical care, under the
auspices of Medicare, is, after all, only a government job.



it is doubtful that
even an old woman who is as sharp as a tack can take her medications
exactly as prescribed. The cognitively impaired patient certainly won’t get
them right.



Some years ago, before hospitalists had assumed the care of hospitalized
patients, I was called in late at night to see an old man in the ICU who
was experiencing chest pain and shortness of breath. He was delirious
at the time, perhaps from medication or inadequate oxygen to his brain,
Several months later I received a scathing letter from the fellow, in response
to a submitted bill, stating in no uncertain terms that we had never
met that night. He articulately, but confusedly, wrote to the fraud division
at Medicare, accusing me of attempting to cheat that federal agency of
approximately $100 for services never rendered. Shortly thereafter, with
no official investigation of the patient’s medical chart, formal notice arrived
from the government that I indeed had committed Medicare fraud.
Although there was an option provided to request a hearing on the matter,
it was of course neither practical nor cost-effective to close my office for a
day to defend myself against the insulting accusation. I let it go, but perhaps
that was a mistake, as it still bothers me years later. Shortly after this
incident, however, I did permanently give up doing hospital work and
restricted my practice to the office, then the last bastion where a doctor
still had any control over his work environment. Hippocrates wrote nothing
in his physician’s oath about having to endure the abusive ranting of a
paranoid, cognitively impaired older patient. In the future, when primary
care is regarded by all as merely a job and not a calling, who will choose to
care for the coming wave of such patients?
Self-centeredness is an undesirable persona