Healing Lecturenorwaycamay2010 Reilly
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Dr David Reilly Consultant Physician & Scottish Government’s National Clinical Lead Human Caring for Integrative Care Views through a window In the Age of Science Slides from the Keynote talk by David Reilly ICCMR 2010 Conference, Tromso, Norway. Centre for Integrative Care Linked audio file on dialogue page Glasgow Homoeopathic Hospital www.davidreilly.net Scotland Human Caring In the Age of Science Lost the will Is There Hardening of the Heart During Medical School? Newton BW, Barber L, Clardy J, Clevelanes E, O'SullivanP. Ac. Med. 2008;83(3):244-249 link First 3 yrs medical education significantly decreased students' vicarious empathy… Vs Norm M< F During first basic science Map? Current Our & initial clinical years ENTRY * > = A coping or survival mechanism where empathic feelings are EXIT = * < suppressed? ..proposed empathy be constantly M&F < non-core reinforced cynicism may increase, and ethical and moral development can be stunted 2050 Three broad idea waves, four broad Public Health policy waves 2000 1950 Diminishing Returns from the Previous Wave/Old Map 1900 are the Call for Change In Our Systems Hunter Gatherer Agriculture Industrial Knowledge ? And in Ourselves ? ? 1800 Modernism Materialism Enlightenment 2050 1800 1750 1900 1950 2000 Nothing fails like success I’m Glad Efficiency Yes/No/Later Is General Practice Delivering Holistic Holistic Approach? Care? The Views of Scotland’s GPs. • Essential to providing good health care? • 2311 (62%) returns – 9 out of 10 GPs (87.3%) • from 3727 GP’s in Scotland’s. • Primary Care currently delivering it? – 1 in 5 (21%) Haratuma Hasagawa, David Reilly, • Current organisation of primary care made it Stewart Mercer possible? Annemieke Bikker – 1 in 15 (6.8%) BMJ 2002 Nov 23;325(7374). Primary Health Care Research & Development, 2005; 6(4):320-328. Your Consultations? Constraints on Holism Contributing Significantly to Increased?: Drug £ !120% • Average Length: 9.2 minutes 00-08 £11bn • PRESCRIBING? " Not Taken • How often do you feel rushed by the end – Yes 73% No 18% Neutral 7% BMJ08: 995 of your consultations? • REFERRALS TO 2nd CARE? Quite-Very Often 60% – Yes 63% No24% Neutral 12% • How often do you feel that you rush the • DEMAND FOR CAM? patient in your consultations? – Yes 57% No 10% Neutral 31% USA $287bn Adverse Drug Reactions ADRs: Quite-Very Often 45% GLOBAL $712bn 1/4M Admission UK’08 5yr !30% BMJ 2002 Nov 23;325(7374). BMJ 26April08 p908 th BMJ 2002 Nov 23;325(7374). Hosp ADR >100K † USA 4 th Primary Health Care Research & Development, 2005; 6(4):320-328. Primary Health Care Research & -6 cause death JAMA 98 Development, 2005; 6(4):320-328. Possibilities?Imagine? What Shall We Create Now? Imagination is more important than knowledge… Einstein What is now proven was once only imagined… William Blake Nothing Fails Like Success. Arnold Toynbee, historian. Hunter Gatherer Agriculture Industrial Knowledge ? ? ? Nothing fails like success 1983 - Young doctors' views on alternative medicine. ImaginePossibilities? for you? I00 trainees at the National Conference: • Over 80% wanted training • 1 in 3 had received treatment • 1 in 10 treated by alternative practitioner. It is impossible to create a world that differs from your inner map of the world Reilly DT.BMJ 1983 Jul 30;287(6388):337-9 Anti 1983 - Young doctors' views The Age of Intervention on alternative medicine. The Four Waves: I00 trainees at the National Conference: “… Instead of taking your headache to a neurologist, your First Great Question anxiety• Over to a 80% psychiatrist, wanted and your training search for a tonic to the chemist, you now knock on the door of the acupuncturist, hypnotherapist,• 1 in 3 had and received health food storetreatment in your quest for health. What can we (the expert) The whole person deserves a whole doctor who can assess his whole• 1 inproblem 10 treated and who can by refer alternative him to a specialist, practitioner. orthodox or do to help alternative, if required”. this situation? outside in Reilly DT.BMJ 1983 Jul 30;287(6388):337-9 The Statue+self-healingThe Age of Enablement Our - Evidence Based Science & Art of Our - Selves Medicine Chisels Intention Remedies Attention Drugs Compassion CARING TOOLS Herbs The Fifth Wave Empathy Needles Kindness Art Science Scanners 2nd Great Question Honesty Integrity Scalpels Listening Lasers What can be done Time Cuts to help release Touch Qualitative Quantitative Massage self-healing Silence Oils capacity? Atmosphere conditions Manipulations Motivation meaning Trances inside out Expectation relationship Awareness Words Perspective Foundations of Healing Our - Evidence Based Art & Science of Our - Selves Medicine Chisels Intention Remedies Attention Drugs Compassion CARING TOOLS Herbs Empathy Needles Kindness Art Science Scanners Honesty Integrity Scalpels Listening Lasers Time Cuts Touch Qualitative Quantitative Massage Silence Oils Atmosphere Manipulations Motivation Trances Expectation Words Awareness Perspective Healing and Creativity Human Caring In the Age of Science The Healing Enquiry – creating a shift in health care Inspiration… Emerging Maps? What Does The Rise & Impact of CAM Mirror? !78% of (40) Doctors were still using Homoeopathy integrated in Too fucked up their NHS General Practice 2 years after introductory training. SO WHAT WAS HAPPENING BEFORE? “Listen more/less dismissive” “Re-learned history taking” “Now finding expectations for antibiotics etc difficult” “More aware of natural healing” “More broad-minded” “Now see patients as a whole, not cellular biochem levels” “Rekindled my interest in clinical medicine” “Find practice richer and more fascinating” “I marvel at my lack Afterof homoeopathy knowledge” GPs feedback “How did I manage without it?” Reilly D. Taylor M. Developing Integrated Medicine. Comp Ther in Med October 1993;suppl 1:1-50. 1988 Patients As Our Teachers “See a different doctor at each visit” “I feel rushed.. unlistened to” “Only seem to prescribe drugs” “Ignore me as a person, more interested in my disease” Vision for 21st Century Health Care Care is based on continuous Care is based primarily on healing relationships visits Care is customised Professional autonomy according to patients’ drives variability needs and values The patient is the source of Professionals control care control Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine 2001 take account, too, of people’s inherent ability for self-healing and recovery. support people to have more control Integrative Care of their conditions and their lives and promote their efforts to enhance their !Fragmentation health and wellbeing " Coherence in a person and/or the adoption of a holistic approach their care * focuses on the person, not the disease, and Community applies a holistic approach to meeting the Care physical, practical, functional, social, emotional A good GP was one who and spiritual needs of patients and carers listened to them, believed them, supported them and Self-Care CAM empathised with their situation, Orthodox Integrated pain and distress. an approach to care which is person centred and based on neither Therapies Care diagnosis nor prognosis but on patient and carer needs * Reilly D. Enhancing human healing. BMJ 2001;322(7279):120-1 LTC Action Plan. Living & Dying Well. Getting to GRIPS With Chronic Pain the feeling being that quality of life/suffering issues are not given sufficient priority. The negative comments outweighed the positive experiences and observation by a rate of about 5:1 drawing on the power of people’s stories; no emphasis on self- management or dedicated input, were common experiences. the increasing importance which we expect NHS Boards to place on issues relating to the quality of people’s experience of services. equip staff for new roles and action is taken to create the conditions approaches to care that support a productive partnership between informed and empowered Developing structures to allow people more time for consultations and promote continuity of care based upon a structured, systematic and ‘bounced from pillar to post’, integrated approach to the provision of care. trying drug after drug LTC Action Plan. Living & Dying Well. Getting to GRIPS With Chronic Pain Inspiration… Emerging Maps? © Centre Painting Alex Gray, Images David Reilly Dopamine placebo Changes in brain function of depressed subjects during treatment with placebo Fuente-Fernandez, R. et al. Expectation and Leuchter et al dopamine release: QEEG American Journal of Psychiatry, 159 mechanism of the (1):122-129, January, 2002 placebo effect in Parkinson's disease. Quantitative EEG Science, 293, 1164 - 1166, (2001). Response to antidepressant showed objective change in the Dopamine - brain chemical lacking in Parkinson's prefrontal cortex. BUT so did response to placebo Placebo injection - released comparable amounts to real drug of the brain chemical Jon Stoessl -leader- brain-imaging study. "The magnitude of the response is striking," “suggests in some patients most of the benefit obtained from an active drug might derive from placebo effect” “Expectation can be an effective drug”. Reilly DT, Taylor MA. Developing Single Blind: Integrated Medicine. Compl Ther. in Med 1993;1 Suppl 1:1-50. Placebo - Team knew, OPICS explained patient did Better not) 1 month later Baseline Double Blind: The thick black pen line (Team & is the Patient’s View of Patient don’t Worse Worse their Overall Progress - know if:) filled in interactively Active with the Doctor - who Treatment clarifies not judges OR a 2nd Placebo Lancet 1994;344: 1601-1606. A B A B Placebo Placebo Placebo Placebo C D C D Placebo ACTIVE Placebo Placebo OPIC solution Reilly DT, Taylor MA. Developing Integrated Medicine.Compl Ther in Med1993;1 Suppl 1:1-50. OPICS p 26-28 Reilly DT, Taylor MA. Developing Integrated Medicine.Compl Ther in Med1993;1 Suppl 1:1-50. OPICS p 26-28 Is this experimental? Views through a window SEEING the cinema IMAGINING & Psychoneuroimmunology? movies of SEEING the mind IMAGINING TIME 12/2/07 White cell Goebel MG et al Behavioral conditioning of immunosuppression is possible in humans.