Your life story is a reflection of our health care

In my day to day clinical practice, every patient I meet, greet and treat has a remarkable story that tells a tale of our health care system. Your real life stories are the customer feedback of our health care. If your health has been improving that is a true indicator of our success of delivering health care. If you are repeatedly going to a doctor with the same illness and the doctor is providing symptomatic control and accept that is optimum medical treatment, we, doctors are giving a strong message to the public that the practice of Medicine is only capable of suppressing the symptoms and not removing the underlying cause.

The underlying cause of most conditions of ill health is not in the body. Body has effects of an underlying cause related to a pattern of behaviour or life style or the living environment of the patient. For example, chronic cough may be associated with asthma, chronic obstructive airways disease or a chest infection or lung cancer or any other respiratory illness. Cough is a symptom of respiratory illness and until we treat the cause of respiratory illness cough may not be cured by suppressing cough by cough medicine. Cough is a clearing mechanism of unwanted products of the body. We go to the toilet every day to get rid of unwanted products of the body from our intestines and urinary tract. Cough is a mechanism of removing infective and pollutant phlegm from our respiratory tract. Treating cough is like making us constipated and stopping passing urine.

Symptoms are also the warning signs giving us signals that something is wrong in that area where the symptom is indicating to. They are like the warning lights on a dash board in a motor vehicle or a cockpit of an aeroplane. Treating symptoms are like removing or covering up a warning light when it is indicating danger. We invariably look for the cause for the warning signal and correct it before we drive a car or fly a plane. But when it comes to dysfunction of the human body we think differently and remove the warning signal and continue to use it.

Symptoms are so discomforting to us for a reason. That is to make us be aware of the danger and look for a cause.  But if we are not in the right mind we suppress or ignore the symptom that is warning us of an underlying cause for the symptom. It is important to treat the discomfort of the symptom to ease the distress caused by it without forgetting to correct or eliminate the cause. The cause may not be obvious and therefore we must begin to make  a full inquiry into the cause immediately, otherwise, the disease will keep growing in the body spreading from one area to another causing symptoms in other areas too in a sequential pattern starting from the weakest organ to the next weakest and so on depending on the strength of their defence mechanisms. In a smoker, the weakest organ is the directly affected part by smoke which is the respiratory system. Smokers are  more susceptible for respiratory infections than others because of that reason. They also get diagnosed to have asthma than non smokers. So, the infection or pneumonia or COPD or lung cancer may have been the underlying disease that produced cough. If the patient has pneumonia, we give appropriate antibiotics depending on the organism that is harbouring the infection. COPD is treated with medications to reverse narrowing of airways caused by spasms of muscles in the breathing tubes of airways. These spasms are also protective mechanisms to minimise entry of unwanted substances during smoking. The smoking makes airways to become extra sensitive to avoid any foreign matter entering into airways and they start coughing with a slightest stimulus such as cold air in the Winter. In case of lung cancer it is harder to treat unless we explore all aspects of the patient. When we get involved in treating the underlying disease we almost forget about treating the cause of the disease. That is the most important part of the treatment plan. The immediate and apparent cause of the underlying disease in the above example is smoking, but further inquiry into the whole person without limiting this inquiry only to involve the physical body, it will allow us to discover the real reason for the whole scenario including the reason for smoking. That is when we have a possibility of curing even cancer.

Respiratory illness may have been caused by smoking or living in a polluted environments such as living with others who smoke, in a house with closed windows and dusty closets or closer to building sites, main roads and dry parched land where air is carrying a heavy load of dust or even poor personal hygiene etc. It is obvious to us in some situations of polluted environment is the cause for the illness. Hay fever is one such condition that we all have denied responsibility and offer symptomatic relief by medication because  it is caused by Nature. There are many causes for that we can take individual or collective responsibility and we shy away by highlighting and naming them. Why don't we advocate stop smoking, house cleaning etc as a way of removal of the cause, instead of turning the blind eye to such preventable measures and continue to medicate to suppress symptoms?. It may not be obvious to the person who lives in a polluted environment for a considerable length of time that it is contributing to his or her illness unless he or she has experienced living in a different setting. Lack of awareness is a major cause of illness. Therefore inquiry into patients’ life style and environment is important for us to identify and make the person aware of any contributing causes and to remove them. Unless we do that the patient develops a chronic disease unnecessarily while there is a cure.

The inquiry into causes must not be limited to the environment we live in. Our life style and behaviour also can harm our health. Exploring habits, such as smoking is another layer of inquiry. Then we can see the real cause for the illness is beyond our physical body. Real cause of illness is not only smoking but also the reason for smoking such as anxiety.

We have created a culture in medical practice, medical education and in society to accept that symptomatic control is all we can do in medicine and the rest is up to the patient. We also have created a culture that it is acceptable for people to be irresponsible of their health and use substances that has proven evidence of harmful effects such as tobacco, marijuana, cannabis, alcohol, fizzy drinks, processed food with excess sugar, chemicals etc. If we are not accepting speeding while driving a motor vehicle as it can kill people, why smoking is allowed it too can kill? Is health care driven by beneficial health outcomes or economical benefits?

Current medical practice is shying away from inquiring into the real cause of the illness.  There are a number of reasons for that. Firstly, the Medical education is not teaching doctors how to inquire into causes of disease outside of the physical body. This inquiry extends beyond looking into physical aspect of the patient. This inquiry is beyond investigations limited to blood tests, ECG, X rays, CT scan, MRI and all other physically based investigations, but are based on simple conversation connecting with the patient. Connection is the key word here. With that connection the patient will reveal the real reason for smoking, comfort eating or taking alcohol or drugs looking for a way of comfort to suppress another type of discomfort that they may not even be consciously aware of.

Anxiety is one of the predominant condition associated with smoking and substance abuse. The reason for anxiety may have originated from childhood. Some causes are deeply hidden away in their unconscious suppressed memory that they have no access within the state of consciousness they operate and are used to from their childhood.

Second reason for lack of inquiry into the real cause of disease is that our collective unawareness or ignorance is keeping us locked in systems formed with collective unconsciousness. Our cultures, educations, norms and beliefs have kept us in the dark by suppressing our own ability to make open unbiased inquiry into our experiences rather than looking through pre-conceived ideas we have learnt from others. Our evolution and survival is dependent on our ability to see from an inquiring mind with originality to allow us to see what is truly unfolding in front of us every moment.

The third reason for failure to look for the cause of the disease is that the main stream Medicine is not geared to look for causes of illness outside the physical body. All investigations and technology is about screening the physical body. Medical research and education is not funded well in exploring influence of human perception in disease causation. The idea that our perception causes our behaviour which influences our health is not incorporated into the system of Medical Practice. As a consequence of that doctors are forced to treat physical symptoms and investigate into physical parts of the body treating it like a machine. If we openly inquire without preconceived views we will come to know that the body is a dynamic process constantly interacting with the mind and the environment we live in. The causes of diseases may well be outside of the body and the body is showing the effects of our own interaction with the mind and the environment. Ultimately we will come to know that it is our own unawareness or ignorance is causing illnesses and open inquiry is the way to identify and treat illnesses.

This inquiry can begin right now in this moment by looking at our sense experience that is what we see, hear, smell, taste, and touch and also what we think without a judgment or preconceived belief or a concept. That requires alertness into this present moment. This process will open up our minds to look at our patients in a new way, removing the blindfolds that were keeping us from seeing hidden causes of illnesses.

This moment to moment self-inquiry, without prejudgment is the skill we learn by practicing Mindfulness. This sounds very simple but living by it takes diligent and regular practice. As we train ourselves it expands our awareness into new dimensions making new discoveries. When we deliver health care mindfully we can see that every patient's life story is the story of our health care.