Reductionism in healthcare
This is a topic I talk to patients and colleagues about a LOT.
And every time I talk about it - it is met with nodding, affirmations, agreement.
Medicine has become reductionist. And we have forgotten the human at the centre of it all.
So let’s start with a brief clarification - I’m all about modern medicine - the drugs, devices, technical tools, treatment regimes, complex understanding and wealth of knowledge about human health (and other biology) is incredible. We can cure diseases that used to mean certain death, we can prevent conditions, and make lives safer and more comfortable in so many ways now. And it seems that almost minute-by-minute we discover something new and important that revolutionises the way we treat illness and disease. I have been the direct recipient of many modern medical wonders - antibiotics, anaesthetics, surgeries, imaging, blood tests, diagnostics. And I am grateful for all of these things, and for how they have helped me in times of need.
As a trained healthcare professional myself - I understand how research is conducted. Often a complex issue must be extracted from context, simplified and then reduced to very specific elements in order to be studied thoroughly and effectively. If we are to understand a genetically transmitted disease - we must drill down to the level of DNA to understand it. If we are to create a drug to treat a specific virus - we must focus at the cellular level. These processes are essential for building our understanding of the world we live in, and thanks to advances in scientific tools and methods, we can can analyse and collect data in ways never before done.
And I hope that we continue to fund, support and share the research and work required to keep learning and helping people.
But - what I equally hope is that in the search for the perfect diagnosis or cure, that we don’t forget the human attached to the pathology. Whilst a disease or health problem can be incredibly complex, arguably so is the human who is experiencing the problem.
Humans exist in a multitude of dimensions. How and where we live, what we eat, our work, our exercise regime, our personal beliefs, our education and health literacy, our family of origin, our sex, our race, and so many more factors contribute to making us who we are. We garner a unique set of experiences over our lifetime that culminate in an expression through our bodies, and our health is directly related to this.
As a healthcare professional, I must remember that whilst I can explain the collagen healing times for tissue repair, or provide a detailed diagnosis and anatomical explanation of an injury, this information might not be what matters for my patient. If I reduce my patient to their pathology and treat them as such - I am missing a huge piece of the puzzle. What happens when my patient experiences an injury - they cannot work, or play sport. Their sleep is disrupted, and their mood affected by pain experiences. Perhaps tension builds in their relationship as they become dependent on additional support, or stress increases due to financial burden of disease. Add in layers of fear about the future, or loss of identity, and the injury is no longer simply a dislocated shoulder joint - but a person whose life and entire context needs care.
Understanding this helps us as health professionals helps us “rebuild” the picture of a patient from a reductionist scientific problem, and into a rich tapestry of human experience. It informs how we can best treat and support a patient during recovery - including when and how to refer them to additional services such as psychology, financial aid, specialist consultants or doctors. And it allows us to see and feel how a patient lives through their experience of illness. This is called empathy.
Empathy is a core skill required for health professionals, and yet, it is rarely - if ever- taught in universities.
When we provide healthcare through the lens of empathy and understand how reductionism might impact our ability to best treat patients, we begin to practice better medicine. Our patients feel seen and heard, and are more likely to engage meaningfully with advice and treatment regimes when they feel supported and understood.
A recent experience I had really hit this home for me.
A woman attending my clinic was struggling to return to normal activities following a painful infection of a lumbar disc with referred pain. She had been hospitalised for several weeks due to illness, and had been allowed to return home after a week of inpatient rehabilitation. When she attended her first session - she was using a walking frame, was terrified to move, sitting down was unbearable, and she had an intense fear of lying down. She was emotionally devastated and worried about her future. Her pain was still significant, and she was having trouble seeing a way forwards.
If I had reduced her to her diagnosis - an infected lumbar disc with local and referred pain into the lumbar and legs, I could have worked on all the things that evidence tells me to. Exercise for core stabilisation and strengthening, education about walking mobility and pain science, manual therapy and so on. And to be clear, we did all these things. But there was a bigger issue beyond the pathology. This woman was stuck in the role of patient. She had forgotten that she was a person, with a life and purpose and future beyond her current health problem.
When I asked her to reframe thinking of herself as a person on a recovery, not a sick patient, she fell silent. And then cried with joy as she realised this could indeed be her reality. The shift was immediate, she left my rooms with signifcantly less pain (some manual therapy helped this of course!) and an improved sense of self. One week later she came to my clinic with a renewed level of wellbeing - she had enjoyed coffee with friends, organised a “very quiet” family dinner, and had upgraded herself to using only a walking stick to get around. She was taking it very slowly, but rather than sitting around identifying as unwell and thus incapacitated, she had decided she was a person on a healing journey. Whilst she was still in recovery, I realised that I had to build out my understanding of her as a whole person, and find ways to connect my interventions to her needs, well beyond the treatment indicated by her diagnosis alone. At one of our follow-up sessions I prescribed a return to her art as a home exercise - because she is a practicing artist but had not picked up a pencil or paintbrush for months. This inspired her to do her physio exercises to build strength for the task. It gave her a “why” far more compelling than any medical explanation I could give her about the role of exercise in rehabilitation.
So I ask you to reflect, do you ever get caught in reductionism? And how do you rebuild a holistic, integrated view of your patient? If this is hard to do - it might help to think about a time you were a patient yourself, and had an interaction with a health professional that left you feeling unheard or wanting for more input? What could that health professional have done to help you feel more connected and understood?
Afterall, we’re in the game because we want to help people be healthy. We want to do good in the world. And if we recentre the human in healthcare, we make it better for everyone.