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How to make yourselves redundant

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4706 (Published 08 November 2018) Cite this as: BMJ 2018;363:k4706

Re: How to make yourselves INDISPENSIBLE

I realized a few years ago a self contradicting mindset in our human culture that, even though doctors literally are the most important healthcare workers, everybody, including most doctors and the health secretary, have a deep down habitual mindset that doctors are really responsible for disease (under the mindset of biomedical system developed 400 years ago by Descartes) and that people should look for health elsewhere away from their personal doctor. Doctors really stand for unhealthy. This is a residue of the bipolar categorized thinking for research purposes from the Cartesian mind-body split mentality continuing as health-disease split mindset as quoted by the anthropologist Ashley Montagu, who said that doctors are taught to be interested in disease but not health and the public is taught that health is absence of disease. There was an article in The BMJ in 2002 that it is time to move beyond the mind-body split (https://www.bmj.com/content/325/7378/1433). It s long overdue.

Many patients develop dis-ease from unhealthy but normal social communication skills with the environment leading to the body speaking through illness or as disease. Carol Oates said that "Homo sapiens is the species that invents symbols in which to invest passion and authority, then forgets that symbols are inventions." Our duty assigned from society is to negate labels or make symbol on patients so that we have the authority to ask for money from insurance company or the government to treat them with material intervention. Those who felt ill or unhealthy but were not yet labelled as having an individual organ disease are neglected and they look for homeopathy, etc, elsewhere. In the past 2 decades we have expanded our segmental label to medicalize them under our care. As a society we forget that ultimately doctors should be creators of health for each individual patient in front of them during consultation and that treatment of a disease label is one method.

Almost every patient has general adaptation disorder (GAS) as diagnosed by Dr. Selye 80 years ago. It really is true that every patient is either suffering from hurry sickness asking for quick fix or deep down impatience about their discomfort causing chronic inflammation of their cells leading to organ disease (https://www.sciencedaily.com/releases/2012/04/120402162546.htm). They unconsicously create or catalyse their illness. Apart from material intervention, if this GAS label from doctors can attract rebate from government or the insurance company and doctors then use Dr. Engel’s extended biomedical model mindset (bio-psychosocial medical model 1977) to make patients aware of their ultimate single disease of automatic stress response, add education and training of individual patient to improve their relatively unhealthy but normal communication skills with their environment, doctors can really lead patients to health rather than educating them on the road to disease. Yet actually many of us doctors suffer GAS from our system/culture and we pass it on to patients. There is an old saying in medical culture that doctors “cure sometimes, relieve often, comfort always”. Nowadays we are legally required to add stress to patients as demonstrated in the Montgomery case. Then we comfort patients with more intervention.

As a profession we should ditch our thinking that we only do material intervention, we should educate and train patients to focus their mind to produce endogenous drugs from their own brain (http://rstb.royalsocietypublishing.org/content/366/1572/1790) through developing healthy connections in the brain and supplement it with exogenous drugs when indicated. Only then can patients rely less on tokens and rituals from doctors sometimes in form of placebo surgery to relieve brain pain arising from dis-ease about peripheral imaging.

Sir William Osler once said, “The good physician treats the disease; the great physician treats the patient who has the disease." In Ancient Chinese wisdom, the great doctor treats the country/system, good doctor treats the person, ordinary doctor treats disease. If we as doctors forget to train a healthy thinking pattern for patients in front of us and delegate the duty to other professions, we end up ourself focusing on disease mindset and disease communication pattern and create more and more chronic patients for life long exogenous drug usage.

Our medical schools adopt the biomedical model and develop disease mindset for doctors and we sell sickness to society for a living. Medical schools should adopt the integrated biopsychosocial medical model which is the ultimate solution to develop a healthy mindset for future doctors so that doctors can sell health to patients for a living (my article - https://www.bmj.com/content/346/bmj.f2809/rapid-responses). Should we as doctors be trained in society to develop a disease mindset or health mindset?

As we struggle to overdiagnose patients to bring them back to us, the sick society responds by telling people to look for health elsewhere away from doctors. Yet only doctors have the proper basic western medicine training to avoid risk of delayed diagnosis by natural therapist and we should make ourselves indispensible for real health in an unhealthy society!

Competing interests: No competing interests

17 November 2018
Kam-Fai Cheung
Integrated General Practitioner
Hong Kong Integrated Mind & Body Medicine Centre. Hong Kong Positive Medicine Association.
8A Lin Fook House, 3 Jardine's Crescent, Causeway Bay, Hong Kong.