Monday, July 13, 2009

Caregiving in Bariatric Medicine

As I was flying out to the 4th Annual Obesity Network Obesity Boot Camp yesterday (more on the camp later), I happened to read this week’s Globe Essay by Arthur Kleinman titled, “Health Care’s Missing Care”.

Arthur Kleinman is professor of medical anthropolgy at Harvard University and in his essay, he deplores the loss of caregiving in today’s clinical practice. He calls this the lost art of medicine, displaced by ever-more emphasis on economically-driven concepts of “evidence-based” rationalisation and increasing reliance on science and technology for diagnosis and treatment.

He asks:

“What time has been allotted for aquiring this skill [of caregiving] in medical school and residency training? What has been done to evaluate future doctors’ skills in this respect? Has medicie turned its back on the medical art and the thousands of years of humanistic approaches to medical practice?”

In his essay he focuses on the frail and elderly, but much of what he discusses is as applicable to my bariatric patients, as it is to patients in many other fields of medicine:

“…for example, we can say that caregiving begins with the ethical act of acknowledging the situation of the sufferer, affirmig his or her efforts and those of family and friends to respond to pain and impairment, and demonstrating emotional and moral solidarity with those efforts.”

“It moves on to involve the physician in pain management, symptom relief, treatment of other “intercurrent” diseases (such as depressive disorder) that may arise during the first disease, and judicious management of the use of pertinent technology and control of unnecessary or futile interventions.”

“It includes working with a network of other health care professionals (such as physical therapists, occupational therapists, nurses, social workers, and home health-care assistants), and family and network of care givers.”

“It means spending real time with patients, empathically listening to their illness narratives, eliciting and respondig to their explanatory models, and engaging the psychosocial coping processes involved in enduring or ending life.”

I can only concur with Kleinman as he concludes that,

“The physician’s art – now so circumscribed by bureaucratic, political and economic forces – turns on both the professionalization of these inherently human resources and the impact of their routine use on the doctor’s own moral life.”

Working in a clinic where we currently look after over 1,500 patients (not to mention the over 2,000 patients on the waiting list) struggling with body weights, not seldom well over 400 lbs, these words ring only too true.

While we may not have the “magic bullet” for severe obesity, we can certainly offer compassion and understanding on how living with this cruel and devastating condition requires unbelievable daily courage and struggle.

Let us never forget who we serve!

Station Dushesnay, Quebec

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One Response to “Caregiving in Bariatric Medicine”

  1. Christina says:

    Thank you for sharing this article. In my experience working in a hospital it’s the physicians who have the best bed side manner, take time to listen and emphasize with their patients, who take full advantage of the interdisciplinary team, and who avoid condescending or patronizing comments seem to get the best results and have healthier, happier patients at discharge. This type of training can improve patient’s compliance with recommendations and it certainly helps with patient satisfaction.

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