As a family physician, I occasionally have the opportunity to see 3 generations of one family in the same examination room. I also, on occasion, am blessed to bear witness to tender moments that hint at some ineffable aspect of healing. Today I was to encounter both.
My patient, a 30-year old woman sitting quietly but despondently on the examination table, is accompanied by her grey-haired, stern-faced mother ensconced in the corner chair and her shy, 8-year old daughter, who looks at me with large, soft brown eyes. Bouts of depression have buffeted this woman’s life as she has tried to weather a failed marriage and subsequent divorce. Ongoing criticism and judgment by her conservative mother, who is plagued by worry and concern, and the multiple challenges of being a single parent and breadwinner have worn her down. Her daughter knows in an intuitive way mommy is not quite well, and I know through clinical experience what profound effects depression can have on the well-being of a child and a family.
I want to help. So we have tried various medications, some with side effects, some seeming to work; we have tried counseling, which has served as a supportive sounding board; we have tried exercise and nutrition; we have checked her laboratory values. Despite best intentions, her work schedules, domestic duties, and insurance issues have stymied our efforts and any noticeable progress. Her growing reluctance to use medication led us to explore other nonpharmacologic approaches. Having been trained in acupuncture, I offered a trial. After discussing the philosophy and techniques, she agreed to give it a try, and she responded well.
Today is a follow-up visit. After the usual history and physical examination, we decide upon another treatment. It is the first time the patient’s daughter and mother are present for the acupuncture, so I explain what will happen. I then attend to the treatment moving about the patient, who is now lying down supported by some pillows and covered with a warm blanket. My acupuncture needles are arranged on the counter, each in its individual, sterile package among alcohol prep pads, various charts, and books. I begin, and I am very much focused upon my task. Thus as I turn for another needle, to my surprise a small hand passes me one. “Here,” she says quietly standing by my side. The little girl is up and helping me, assisting in her mother’s care. I am moved by her innocent and spontaneous gesture to help. Will such intention facilitate healing? Are our actions as important as our words and medications?
Just as grandmother begins to reprimand her granddaughter’s action, I reassure her that “it’s all right.” So we continue—without words—silently working together. She knows when I need another needle and diligently and carefully brings them one by one. Her mother sees she is helping, and I note that a hint of a smile emerges. Will the treatment be more effective today? And if so, is it placebo? Or is it Qi? Or might meaning and context be playing a role? I also wonder how will this child view acupuncture as part of health care? As part of an office visit, as part of a healing ritual? In the gift of this moment, I realize the importance of the roles that culture and context, meaning and intention play in our society’s perception of health care and doctoring.
Indeed, our current health care system is undergoing tremendous change driven by such diverse factors as public demand, insurance coverage, and corporatization of health care delivery. Money, power, and politics continue to impinge on the once sacred domain of the doctor-patient relationship. As widespread dissatisfaction mounts, many thought leaders and organizations have noted that these symptoms point to the complicated process of transformation—not only within our currently unsustainable system of health care, but also for our entire global community as well.1,2 The expected course? A rocky road to paradigm shifts. More importantly and at this moment, however, the prognosis and outcome rest in our hands.