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The Director Discusses:

“The foundation of medicine is friendship, conversation and hope.”

Photo: John F. Greden, M.D.Public radio periodically provides me with poignant snatches of wisdom, some deeply profound, usually from unexpected sources.  While listening to “Morning Edition” on NPR on a recent Sunday (Liane Hansen’s last broadcast, her devoted fans may recall), I couldn’t pull myself away from the words of a self-described “country doctor,” who in culling from his years of experience tending to the people of Belfast, Maine, offered insightful reflections on America’s healthcare.  His list of “Hippocratic aphorisms” offers important messages on the relationship between medicine, hope, and human nature.  At first glance his list does not appear to offer anything particularly earth-shattering, but his statements radiate truths about preventing and treating depressive illness.  With enormous gratitude to Dr. David Loxtercamp, I wanted to reflect upon a select few of his adages:

The most common condition we treat is unhappiness.
Depression and bipolar together are among the most common diseases, affecting more than one in five of us during our lifetimes and bearing responsibility for immense human suffering.  These mood disorders are so entwined with all bodily systems that no branch of medicine can afford not to consider the contributions of brain function, mood regulation, and complex human nature as essential partners in everyday healthcare and wellbeing.  Widespread screening for earlier detection should be a “must.”

Risk factors are not disease.
While healthcare providers look for clues to determine who might be most at risk for illness, such factors are guidelines, not destinies.  We know that a complex mix of circumstances contribute to a person’s wellbeing and that wellness falls along a continuum.  Risk factors do not portend certain disease development; they do not automatically presage pessimism.  Rather, they are part of the variation that makes us gloriously human while serving as head start warning signs that may help many of us avert troublesome stresses and actually begin to prevent mood disorders.  This is a goal for “Personalized Health Care.”

To fix a problem is easy, to sit with another suffering is hard.
Those who are battling through depressive episodes sorely need the support of loved ones.  Such support is not always easy for family and friends to sustain.  When battling depression, this aphorism perhaps should be modified from “sitting” to walking, talking, sharing, holding hands, and being active.  Exercise and its effects on our brain’s neurotrophins are potentially powerful contributors to improvement.

Doctors expect too much from data and not enough from conversation.
Health professionals must rely on various measures and examinations to gauge wellness, explaining why the Depression Center is working so hard to develop personalized biomarkers (lab tests) for depression and bipolar disorder. Insightful information also depends upon the intimate, one-on-one dialogues between provider and the individual seeking recovery.   

Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between.
The suffering individual uniquely experiences the depth of depression’s impact, its pain, and its temporary stifling of inspirations and passions.  This limits healthcare providers somewhat in their ability to help individuals feel better, no matter the root cause of their illness, but it makes it all the more essential that they treat people with dignity and respect their sense of purpose, and, of the utmost importance, listen to and validate their concerns – this is the only way to build relationships that create healing.

[Key parts of] the foundation of medicine [are] friendship, conversation and hope.
Indeed!  Knowledge heals, but works much better when accompanied by these wonderful companions. 

Dr. David Loxtercamp, a family doctor in Belfast, Maine, and the author of "A Measure of My Days: The Journal of a Country Doctor." Listen to his May 29 interview on “Morning Edition,” or read the transcript here.

Merci,

John F. Greden, M.D.


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