My comment, "No one knows how to “do” health" on last night's #hcsm radio session brought some puzzled tweets my way. Let me expand:
Health is learned
On the most fundamental level, a health encounter in our system is a learned transaction. It is a learned experience. No adult or child knows how to “survive” cancer, or “beat” diabetes, or be a parent for that matter when he or she starts on day 1. Quite the contrary.
Health is developmental
Health is a developmental process, a series of baby steps deeply and inextricably linked to cultural norms and expectations. Since so many of those norms are being challenged right now, it is a great time to think about how we learn to navigate the health system and what opportunities exist today to make improvements.
Oversimplifying this I realize, but if you were taught not to ask questions of your doctor, then you'll probably need more encouragement to start asking questions and participate more. If you were taught (from experience or environment) that medicine is a crap shoot, then you may be more comfortable advocating for yourself or another in a health care setting. You might feel righteous ... as many do. Or, you may simply give up from the stress of it all and become uncompliant.
We learn by participating
My point is that we learn to "do" health. We learn by participating. By showing up and "muddling on through" in many cases. We learn by accepting uncomfortable treatments, procedures and interventions; by asking questions and wrestling with the answers we get until we are able to take a step forward. The maddening paradox is that healing often brings discomfort, at least initially.
And more discomfort is hard to tolerate when you're in a healing crisis.
"Just right" health care
A patient learning how to participate in her own care can look a lot like Goldilocks from the children's classic. An empowered, participatory patient won't stop looking and learning until she finds what feels "just right" right to her. While the social web can help a patient climb a steep learning curve, so may pharma, tech, friendship, prayer, play, and (____you name it here___). These are all powerful cultural modalities in the healing repertoire.
So, while we don't start out knowing how to "do" a health crisis, the silver lining is that wherever you begin your challenge along the continuum of health, you will have an opportunity to learn and develop. That's right; we are all beginners. Even doctors and nurses are beginners when it comes to their own health crises. And while anything can happen, there is no guarantee that it will.
Get better at health by practicing it
Whether it is learning to eat better and exercise; stay calm and organize a response to a terrifying diagnosis; work like hell to seek alternative treatments; or advocate to “free the damn data,” as ePatient Dave says - adults learn how to “do” health by participating in it.
The good news is…we get much better at "doing" health with practice. Start when you are healthy.
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Related posts:
Communicating with doctors: Practice when you're healthy
Are we betting on the "me" in medicine?
While (some) others were puzzling at the use of "do health," I was practically purring with delight.
ReplyDeleteStudying with an ethnomethodologist during the mid-1970s has provided the theoretical and practical ammo for great conversations over the decades.
For example, I fondly remember the time I told a post-operative male-to-female transsexual (which is what they were called then and the shift in nomenclature to transgender is another great example of...something) that I thought she seemed to "do masculine" a lot more effectively than she was "doing feminine."
This type of discourse was also accepted and acceptable back in the day and instead of challenging my political correctness, she and I and a couple of other sociologists had a wonderful tussle over the "being" and "doing" distinction.
All this is to say that I loved your comment on last night's #hcsm special, but not only for the memories. Seems as if comments about how to "do" status, role or ethos still generate puzzlement and thus another opportunity to teach a more nuanced way to understand individual and social behavior. And you've done so wonderfully in this post.
Thank you, Christine, for such a thoughtful post. Last night, during the #hcsm twitter session, I was pretty sure I understood what you meant by "doing health"; but I am thankful that you have elaborated here.
ReplyDelete"Health is learned" is such a simple but powerful statement. The process of education for a patient is unavoidable, and we should concentrate on which social, environmental and cultural components are placed in this process.
Perhaps some of the reticence to the concept of "doing" health can be found in the internal conflict that Meredith referred to with regard to "being" and "doing". The claim that a person does not "do" health can be misinterpreted as an affront to their existential sense of self. (in other words what they "are" or as Meredith has said theirs since of "being"). When we understand the process of doing health as an educational one rather than a definitional one, we can overcome the initial resistance to the process.
I would also add that this educational process must also include caregivers and practitioners. The landscape upon which health care is provided is changing. The fact that patients are becoming empowered to learn about and actively participate in their care is something that will cause growing pains for those who were previously in positions of authority vis-a-vis health care.
Your post has provided a useful template with which to understand this evolving process.
Thoughtful post. Like Chukwuma, I was pretty sure I understood the concepts you reference in the HCSM chat... and I am also glad you chose to expound on them in this post.
ReplyDeleteI can not over-emphasize the need for the physician community to step up and engage the e-patient, participatory community. Without us, as teacher, counselor, coach or team member --- many patients are at risk for suffering from analysis paralysis. Many patients can vet and triage the information and *file* it away in an organized manner... yet many can not. Those patients may be harmed in an environment that focuses on going at it alone. Physicians need to step up, engage and become active participants in the e-patient movement. After all, WE ARE ALL PATIENTS
Soul Sista Christine, love the piece, but: if only we had a 'health system'!
ReplyDeletePer Dave Matthews, 'jump in the mud of love, get yourself filthy..' vs. sitting on the sidelines rehearsing 'getting it right'.
Way too many people concerned with 'doing things right', vs. doing the 'right things'. This deal is organic and therefore at best managed chaos. Let help each other learn.
The illusion is that perfection is even an option merely creates a fantasy state as an assumed outcome.
Dig the journey. We are all students in this 'trust walk' game. My prayer is we let go of the addiction to perfectionism and 'just do it'.
There is a vital role for the shaman energy of the healer, yet there is also a duty of the afflicted to engage responsibly.
Keep it open, keep it real!
Thanks for taking a few minutes to read and comment on this post Meredith, Chukwuma, Howard, Gregg. I appreciate your helping me clarify these ideas and look forward to following up with you.
ReplyDeleteLet's keep pushing the needle using a multidisciplinary approach.