What Is Good Medicine?

Hal Gunn

After practicing as a family doctor for 14 years, first in Tumbler Ridge and then in Vancouver, I came to recognize what many of my colleagues and, more recently, clinical research have discovered; an empowered, engaged patient who is active in supporting their own health optimizes outcomes and reduces treatment costs.[1-3] At that time—18 years ago—Dr. Roger Rogers and I recognized the importance of engaging people living with chronic disease in their own health, and we founded InspireHealth, based on the following basic principles of good medicine:

  1. Patient empowerment, including supporting our patients in learning about their disease and about the ways that they can support their own health.
  2. Healthful nutrition, exercise, love and connection, and stress reduction, including the options of meditation and yoga.
  3. Patient choice. An essential foundation of patient empowerment and engagement is the full support of informed choice, [4-6] even if (or from a practical perspective, especially if) the informed choice is different from the one we would make ourselves or recommend. Honouring and supporting patient choice and informed consent are fundamental and essential aspects of good medicine, professionalism, and patient empowerment..
  4. Recognition of the value of standard medical treatments.
  5. Modeling health and happiness. We communicate more through who we are than through our words. Physician heal thyself.
  6. Above all, do no harm.[7]

When InspireHealth was founded in 1997, like today, many physicians tried as best as they could to bring these simple principles into their daily practice of medicine to support their patients’ health. However, at the time, these principles were sufficiently unconventional that some of our more conservative colleagues referred to InspireHealth (known at that time as Centre for Integrative Healing) as complementary or alternative medicine, a characterization that I’ve always considered odd. The principles above are, after all, essential aspects of good medicine, and they have guided Sir William Osler and many other physicians interested in the healing arts throughout the history of medicine. We do our profession an injustice by characterizing medicine that values patient empowerment, engagement, health, and choice as “alternative,” “complementary,” or “integrative.” These are, after all, basic principles of good medicine and are as important to the practice of medicine as technical skill and knowledge.

Most people know that a healthful diet and exercise are good for them and that smoking isn’t. The barriers to health engagement are typically more meaningful than simply a lack of information. These barriers are often unconscious, limiting patterns and internal barriers to self–love and acceptance. As human beings and physicians, we can’t take responsibility for someone else’s healing. If, instead, we take responsibility for our own healing, we inspire others to do the same. The more we heal, the greater our capacity to facilitate healing in others becomes, not because we are taking responsibility for their healing, but because we are taking responsibility for our own. If we have faced and released our fears (e.g., our fear of death) and our limiting patterns, we can be in a compassionate and empathetic relationship with our patients without our own fears and patterns being triggered by their suffering. As we embrace the fullness of our humanity and of our own healing and learn to more fully love ourselves, our capacity for compassion increases, and we inspire others to connect with their own healing. At InspireHealth, we witness inspiration and joy in our patients as they release their limiting patterns and connect to their capacity to more fully love and care for themselves, which ripples out, inspiring their family and friends.

Patient empowerment is essential for health engagement. Full support of informed patient choice is an essential component of empowerment. When we empower patients, it means that we fully support their right to choose, even if their informed choice is different from the choice we would make for ourselves. If we wish to engage patients in their health, we must honour and support their right to choose.

Most physicians did not enter into medicine solely to master technical skills or knowledge. While these are important aspects of medical school education, they are only one aspect of what makes us a good doctor. Most physicians enter medicine because they had—and have—an interest in the human condition and healing and an interest in learning to empower, engage, and optimize healing, while minimizing unnecessary suffering. Most physicians have a longing to connect with their patients on a more meaningful level than simply prescribing treatments. At InspireHealth, we have sought to make the six principles above explicitly important in our work and to recognize and honour the important role that they play in empowering and engaging our patients in health and healing – in other words, to practice good medicine. Not alternative or complementary medicine. Good medicine.

A holistic approach to care, one that honours and cares for the whole person, including patient empowerment and choice, has a lineage in medicine. It is important that we claim this lineage because it is the basis of good medicine. It is about understanding how to be more fully in compassionate empathy in the midst of human suffering. It is about connecting to our own life force and happiness and about celebrating life, death, and birth. This is what it means to be human. This is what it means to be a good physician.

To relegate these essential aspects of healing and health to “Eastern” or “complementary” medicine is to admit the inadequacies of our own profession and of ourselves as physicians. It takes courage to embrace human suffering with empathy. It takes courage and humility to be a compassionate guide rather than an “expert.” It takes courage, humility, and wisdom to recognize that we know far less about the human condition, healing. and the mystery of life and death than our schooling readily admits. It takes courage to embrace this mystery, to recognize the limitations of our own training, and to recognize that other healing traditions might have something positive to offer our patients, even if it is not part of our own training or easily researched. Good medicine includes humility and an openness to new ideas and to other ways of thinking.

If we are afraid of our own inadequacies, we label what frightens us as “other.” Good medicine includes a humble embrace of the mystery of the human condition and of the six principles above. Our connection to these principles, as human beings, is as strong in us as it was in Sir William Osler. In embracing these principles, we are rewarded with the remarkably fulfilling practice of supporting our patients and ourselves in a deeper understanding of health and healing and what it means to be human. This is not complementary or integrative medicine; this is good medicine.

DISCLOSURES

Dr. Hal Gunn is the co-founder CEO of InspireHealth, a not-for-profit society that provides supportive care for people living with cancer.

REFERENCES
  1. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change. Health Affair. 2015 Mar;34(3):431-7.
  2. Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; Delivery systems should know their patients’ ‘scores’. Health Affair. 2013 Feb;32(2):2216-22.
  3. Mitchell SE, Gardiner PM, Sadikova E, Martin JM, Jack BW, Hibbard JH, et al. Patient activation and 30–day post–discharge hospital utilization. J Gen Intern Med. 2014 Feb;29(2):349-55.
  4. Brown SJ. Patient-centered communication. Ann Rev Nursing Res. 1999 Jan 1;17(1):85-104.
  5. StayWell. Creating successful patient engagement within your ACO [Internet]. Yardley(PA): Krames Print Patient Education; 2013 Sept [cited 2015 Jun 11]. Available from: http://cdn2.hubspot.net/hub/36339/file-341022444-pdf/docs/aco_white_paper_sept._2013.pdf.
  6. Buetow S, Davis R, Callaghan K, Dovey, S. What attributes of patients affect their involvement in safety? A key opinion leaders’ perspective.  Brit Med J Open. 2013 Aug 13;3(8):1-6.
  7. Hippocrates. De Morbis Popularibus (Of the Epidemics) [Internet]. Jones WH, Greek translator. Adams CD, English translator. New York (NY): Dover. c1868 [cited 2015 Jun 11]. Available from: http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0248%3Atext%3DEpid.

Gunn H. What Is Good Medicine? UBCMJ. 2015: 7.1 (16-17).