How Much of Our Health Do We Really Control?
I became interested in this issue because of my interest in psychiatry (never became a psychiatrist) , mind-body medicine , and more recently consumerism in medicine. Issues surrounding patient dependency on "MDieties" and the evils of excessive paternalism always intrigued me. Yet to this day, I remain plagued-almost haunted- by the notion that, as a doctor, my first moral principle was beneficence- to actively do good for my patients- to intervene on their behalf using my technical skill and knowledge that they could never hope to possess?
I scoured the medical literature for evidence on what % of illness was self induced through individual or collective human behaviors verses the roles of genetics.?I became interested in the psychology/sociology of accidents - still believing today that most are avoidable. I became interested in issues surrounding the environment and workplace (my chosen specialty) and how much control especially the disenfranchised really had over this?
This led to my interest in the fundamental dilemma of self- determination verses fatalism or pre-ordination and its association with belief in God verses existential self.
On a more practical note I studied the concept of Health Locus of Control (HLOC) a theory developed in @ 1976 which sought to quantify how much an individual believed health was under their own control (see http://hsc.usf.edu/~kmbrown/Locus_of_Control_Overview.htm)
I read the late Susan Sontag's book Illness as a Metaphor (1978) where she chastised the mind- body movement accusing it of "affirming the primacy of secular spirit over matter" and inducing guilt in those who contracted cancer for example- the disease which ultimately took her life too soon! Yet I personally think Sontag was wrong in her indictment of mind-body.
Now we have consumerism in medicine which is encouraging patients to become educated, to ask questions of their doctors (see Cervantes Stayin Alive blog-Tues March 14-"Don't Be Afraid to Ask Questions") and to become co-decision makers with their doctors. This latter point is a huge tectonic shift in the heretofore paternalistic doctor-patient relationship.
Here is where I personally stand today. I like the model of the doctor as a the teacher. To me the best medicine of all is "helping people become themselves". I loathe the concept of victimhood. Yet, in the end, genetics is real, viruses and bacteria are real, environmental and workplace biological insults are real, natural and man-made catastrophies are real , some accidents I suppose just "happen", and certainly social injustice is VERY real.
When I consider the above external realities my ideas about helping my patients achieve "the gift of themselves" yields to my sense of moral obligation as a physician to offer the hand of benevolent paternalistic intervention to my patients to the best of my abilities with the knowledge and skills that contemporary western medical education and my years of practice have afforded me.
Please let me hear from you. I really need your input, your stories, your hopes your fears on this topic of importance to all of us.Thanks