What’s The Difference Between Healing, Curing, Treating And Managing A Disease?
The blogger’s note:
My most learned friend Great Sifu Dr. Lim Ju Boo emailed me on 17th March, 2021 his latest blog write-up about his personal journey as a patient in Hospital KL (see:
https://scientificlogic.blogspot.com/2021/03/my-personal-journey-as-patient-on.html) and suggested that I may also post his experience in my blog.
I purposely chose today 20th March, 2021 to publish this article, a date in conjunction with Dr. Lim’s 82nd birthday, as a “birthday gift” to him.
Here it goes:
Now, when science is strong and religion weak, men mistake medicine for magic.”
(Thomas Szasz, The Second Sin)
I have a recurrent chronic venous stasis leg ulcer since ten years ago, and was hospitalized for many months each time, but that wound, sometimes on my right leg, sometimes on my left leg, never healed permanently.
The last hospitalization I had was from December 23, 2020 till January 25, 2021, a total of 33 days at the height of the Covid-19 pandemic where I slept among Covid-19 infected patients, left and right, and in front as they came and went for days and nights for over a month.
I was supposed to be placed into a single-room first class ward as my eligibility, but all the first class wards have to be closed due to the Covid-19 pandemic, as I supposed all the Covid-19 cases have to be isolated in a first class ward.
So I was placed in a common classless ward for other cases where there were no Covid-19 cases initially.
But as more and more Covid-19 cases came in, and the designated hospital meant for them was full, they spilled into the first class isolated wards. But the cases were accumulating beyond control, till they spilled from first class into my classless ward where I have to sleep among them day in, day out, for days and days.
This was repeated as more new Covid-19 cases came in.
I was supposed to be given radio-frequency ablation surgery or the endovenous glue ablation method for my venous stasis leg ulcer, but because of Covid-19 cases, they have to refer all surgeries for emergency cases.
Hence, all they could do for me was to give me IV antibiotics Unasyn - (ampicillin sodium/sulbactam sodium) for my cellulites, followed by oral doses, all sorts of analgesics including morphine, codeine, paracetamol, oxycodone and other opioid analgesics, none of which has any effect on my pain.
I slept with my legs dangling beside my bed to get pain relief where no analgesic could do the same. The other thing I got was daily dressings for my wound.
During the height of the Covid-19 pandemic, most of the specialists in my ward did not want to go to the ward anymore for their morning ward rounds.
They all leave the job to the medical officers and housemen to report to them.
If they do, as with all the other doctors, nurses, medical assistants, including all the patients, they all wore face masks day in and day out, many with face shields, gloves and all.
I was the only exception who refused to wear any mask while sleeping among Covid-19 patients with other conditions for 33 days. They tested me for Covid-19 five times during the period, but I was found to be completely free from Covid-19 infection without wearing any mask.
A lot of the medical staff in my ward wearing face masks, aprons, face shields and gloves came down with Covid-19. I was the only one who wore a face mask less than 4 hours throughout my entire 33 day stay among Covid-19 patients who came and went without getting infected.
The reason why I refused to wear a face mask when repeatedly advised, please see here for the reason:
https://scientificlogic.blogspot.com/search?q=face+masks+does+not+protect
and also here:
https://taionn.blogspot.com/2021/03/facts-and-figures-about-sars-cov-2-and.html
I was discharged exactly with the same condition as I went in. My ulcer never got healed.
The previous hospitalization over a year ago was on the other leg where I was admitted for over 5 months. I was told by the specialist who treated me the length of my stay in the hospital was a record by any patient.
Finally the wound slowly, slowly the ulcer healed by itself, not with the continuously antibiotics given to me for 5 months to manage the accompanying cellulites, and the daily wound dressing, but I also treated myself with regular leg exercises together with a good state of mind.
Writing Case Management vs. Health Education:
As a doctor, I observed what the junior doctors did the entire day in the ward while the specialists come only in the morning for their ward rounds.
This was what I observed. The housemen or house officers as we now call them now hardly do any clinical work. They spend 99 % of their entire day clerking and writing notes, and asking the patient the same questions over and over again as each new house officer comes in.
The only clinical work they do is to insert a cannula into your arm often unsuccessfully for IV infusion of drugs prescribed by the specialists or take blood from the vein for lab investigations as required by the specialists.
They neither set up IV drips, monitor the flow rates, dress up your wounds, take your blood pressure, temperature, oxygen saturation levels in the blood with an oximeter, give the injections, or oral medication, monitor your fluid intake and urine output..etc.
All these clinical work were done by the nurses who spent most of their time for this, while the junior doctors spent 99 % of their time all day long asking almost the same questions day in day out and clerking them so that they can brief the specialists who come in the morning for their ward rounds what they “investigated”.
While they were busy writing notes, the patients just lie down helplessly hardly attended by them.
Yet, among the medical doctors they call each other as clinicians when it was the nurses who do most of the clinical work like monitoring the patients vital signs and functions, taking blood pressures, setting up IV infusion, giving injections and medication, monitoring fluid intake and urine output, bed baths, wound dressing, etc.
Physicians hardly do clinical work except clinical examinations. Even blood tests and radiology are not done by them.
However, surgeons and anesthesiologists do a lot of clinical work in an operation theater which of course a patient does not know when he is unconscious.
Time Wasted:
Phone Advice from my colleagues and friends:
Many of my former colleagues are specialists doctors and medical researchers and also friends who phoned me when I was hospitalized.
They gave me very lengthy advice over on the phone for over an hour when I told them my experience in that hospital.
I thought to myself those were the reasons why my leg ulcer never got healed if I were to just lie down on the bed, while the doctors were so busy writing notes into numerous files, with each doctor writing different notes, into different files as they changed duties.
No wonder after lying down in a hospital bed for 33 days, I left the hospital with a leg ulcer exactly the same as before as when I entered.
All those time they wasted writing medical history, case management would have being well-spent if the doctors were with the patients, explaining them why they have the disease, and what they can do to help themselves to restore their own health instead of relying on medicines and drugs of all kinds in increasing numbers, because the root causes were never explained to them, and how they can help themselves to manage their condition instead of depending on medications, drips and injections.
These patients would be completely healed in no time and need no more follow up with any more medication on their discharge if they were educated about their condition.
That bad experience I had prompted me to write this article the differences between healing, curing, managing, treating and helping a person who is ill, especially in lifestyles chronic illnesses.
If we made a search in Google it defines the difference between “cure” and “healing” as in this example:
“A cure signified the banishment of physical illness, but a healing could mean not just a physical cure, but a repairing and strengthening of the mind and spirit to improve the quality of life even when no physical cure was possible.”
- Susan Howitch, Absolute Truths
A Book I Bought:
I finally found one less than a week ago. It is called “Integrative Medicine” complied by Dr. David Rakel MD who is Professor and Chair of the Department of Family and Community Medicine at the University of New Mexico School of Medicine, Albuquerque, New Mexico.
In this fourth edition of the book, there are 118 chapters. They were written and contributed by 148 medical experts who are all specialists in their various disciplines of medicine.
All the authors and contributors in that book are very well qualified doctors, medical researchers as well as clinicians who are qualified both in conventional as well as in alternative systems of medicine.
Most of the contributors there are not just an MD but also hold the doctorate degree of PhD. They write with very good scientific, mental, social, moral and spiritual sense.
Let me quote what both David Rakel MD and Andrew Weil MD in their opening first chapter on page 7 of the Fourth Edition on Integrative Medicine has to say:
“Health” comes from the Old English word Hal, which means wholeness, soundness, or spiritual wellness.
Health is defined by the World Health Organization as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.
Cure, on the other hand, refers to doing something (e.g. giving drugs or performing surgery) that alleviates a troublesome condition or disease.
Healing does not equal curing.
We can cure a condition such as hypertension with a pharmaceutical product without healing the patient.
Healing would facilitate changes that reduce stress, improve diet, and promotes exercise and the increase the person’s sense of community.
In doing this we help improve the balance of health of the body that may result in the ability to discontinue a pharmaceutical agent and thereby reduce the need for a cure.
The authors then went on to compare two trees A and B showing how tree A is in a better state of health than tree B because of tree A ability to be in balance with the environment.
They mentioned if a branch breaks on tree A, we can feel comfortable that if we mend the branch, it will likely to heal well, or even heal itself.
If a branch breaks on tree B and we mend it, the branch is not going to heal itself because the tree was not in a state of health.
The point here they emphasized is that our focus in medicine has been on fixing the branch while neglecting the health of the tree. If we give more attention to helping tree B find health either by removing barriers that are blocking its own ability to heal or by removing areas of deficiency, the branch will heal itself – we will not need to spend as much time and money fixing the parts.
Integrative medicine is about changing the focus in medicine to one of health and healing rather than the disease.
This involves understanding the influences of the mind, spirit, and community, as well as the body.
It entails developing insights into the patient’s culture, beliefs, and lifestyle that will help the clinician understand how best to trigger the necessary changes in behavior that will result in improved health and thus bring more value to health care delivery.
Cure and fix when able, but if we ignore healing, the cure will likely not last or will give way to another disease that may not have a cure. (unquote).
However my personal feeling is, we may not be even “cured” any disease by any person outside our own body if the body itself refuses to cooperate.
Body’s Own Healing Mechanisms:
For instance, let us give a simple example.
If we have a cut on any part of the body, it will never be able to “cure” or even heal itself no matter what cream, paste, antibiotics, lotions, or even natural substance like honey together with all types of bandages we care to apply on it if body itself does not wish to cooperate to heal itself.
The healing process of a cut on the finger or any part of the body goes through very highly complex physiological and muti-cellular mechanisms.
First, it involves clotting of the blood to prevent further bleeding. This necessitates platelets and the release of coagulation factors, prostaglandins, enzymes, and proteins to stop the bleeding as part of the clotting mechanism.
Once bleeding stops other mechanisms become operative such as the involvement of growth and cytokines factors, polypeptides, cellular signaling to promote growth and differentiation and cellular remodeling.
It then involves fibroblasts, cascades of biochemical changes leading to matrix formation, granulation and final epithelialization of wound.
This is just an example of a simple cut on the finger. But there are tens of hundreds of diseases and disorders the body suffers such as diabetes, hypertension, metabolic syndromes, infections, and even minute cellular cancers in life that the body’s have either corrective and defensive mechanisms or immunological system that triggers into action without us knowing it.
Yet a change in our lifestyle and dietary modification works wonders for our body to help heal itself. Their existence will silently disappear as they first appear without us knowing it.
Of course there are disorders like congenital, hereditary and genetic anomalies, nutritional or other deficiencies diseases, or blindness the body cannot correct or heal itself.
However the body is living, and because it is living most of the time it can automatically rectify itself if given the right nourishment, stimulant, needling, massage, mind-body control, and stress management, among many others.
Our living body with a soul, spirit and mind within, and its ability to heal itself shows how complex it is, that absolutely no one from outside our own body can do this highly complex job except our own.
“I praise thee because I am fearfully and wonderfully made; thy works are wonderful, I know that full well.” (Psalm 139:14).
“I will restore faith unto thee, and I will heal thee of thy wounds.”
(Jeremiah 30:17).
The Measurements of Health:
When we were in medical research, often we go out to the community to measure their health status. Our team including myself consisted of physicians, nutritionists, biostatisticians, anthropologists, sociologists, psychologists, public health and other medical experts in various fields together with nurses, support lab scientists and technicians will try take as many types of measurements as possible and combine our data to make an assessment.
Even that may not be complete. What about their economic, social and spiritual well-being even if we cover as much as possible from their demography?
Then comes the most difficult part of the question pertaining to the definition assessment of optimal health! How do we measure or know an individual is in optimal health? This was also the question we were asked when we were just students in London University.
Can we answer it as someone with the longest, stress-free and disease-free longevity? Frankly, I do not know the answer. I leave this to someone who has the answer on optimal health.
Jesus Heals, not Cures, Treats or Manages a Disease:
Nowhere in the Bible did it mention Jesus was a doctor who treated and managed a disease using medicines and drugs like we do. Jesus clearly was a Healer, not a doctor or a physician as we know it. The only physician among 70 disciples and 12 apostles appointed by Jesus was Luke who may have been a Gentile. But we have no clue how Luke treats the sick.
The Bible always uses the word “heal” performed by Jesus. It never uses the word “treat” or “manage” a disease given by Jesus.
He heals the blind, deaf and the mute, the paralyzed, those possessed by demons, maybe of unsound mind, healing of a man with dropsy, a woman with a bleeding disorder, the mother of Peter's wife lying in bed with a high fever, the healing of the man with a withered hand, and the lepers, a boy possessed by a demon, all those who merely touched the edge of his cloak were all healed of their various illnesses. What was even more awesome He even raised the dead.
Nowhere in the Bible did it say Jesus treated or managed the sick, blind, the mute or paralyzed. Neither did the Bible say Jesus used medicines, drugs and the knife to “manage” the sick. Clearly Jesus was a Healer extraordinary.
He was not a doctor or a clinician. Jesus was far, far more than a doctor or a clinician. He did not use drugs, medicine of all kinds, radiotherapy, surgery and vaccines for treatment or prevention of diseases like we do.
His words and other miracles alone were as awesome as His healing powers.
Healer or Doctor:
Integrated Medicine:
I sat in that committee for about 5 – 6 years till my retirement, after which many others committees and sub-committees took over.
In that committee we discussed how best to implement traditional and complementary medicines into the conventional allopathic system at the recommendation of the World Health Organization (WHO).
It was very problematic. We needed to look into the administrative, logistics, training and qualifications of the practitioners, the efficacy and safety and the legal aspects, their acceptance culturally, socially, economically, and even the elements of religion, taboos, ethnicities, among many needed to be looked into. It was a very tough job and decision to make. It took us countless meetings over the years.
Finally long after my retirement some 20 years later, traditional, complementary and integrative medicine was officially recognized as a registered practice by an Act of Parliament.
Initially only 3 government hospitals were involved as a pilot project offering Traditional Chinese Medicine (TCM).
The years that followed due to its very high demand, acceptance, safety and efficacy especially for chronic conditions, today there are 15 Ministry of Health hospitals in the country offering TCM and 2 other Traditional Indian Medicine. A few private hospitals, especially for TCM have also joined in.
The Body is Not a Machine:
The living body is not some kind of a machine with moving parts that needs to be oiled with drugs when some parts are not working well. A patient is a person with a physical body, mind and soul. He is living not dead or some kind of a biochemical machine that requires some “oiling”, or to block out a chemical pathology.
As a physician, a clinician or a doctor or even a medical researcher, whatever we wish to call ourselves, we will merely be controlling the symptoms and signs of the disease using drugs and pharmaceuticals to inhibit pathology.
That’s not even a cure. The patient will be asked to come back for the same in the next appointment, maybe 3 months later. We are not healing him either. We are just treating a case, not a person.
We would only be looking at the biological, chemical and physical aspect of his problem, not heal a person physically, emotionally, mentally, socially, let alone spiritually.
Treatment and Management:
Clinicians normally would prefer to use the term management than treatment, while patients normally would prefer to call it treatment.
Both terms are normally interchangeable and are often confused both by the clinician and the patient.
But to my mind, there is a difference. In my understanding, the management of a disease is more holistic than merely treating a person physically with drugs, medicines and surgery.
Personally I feel it is far more important to provide a patient with wholesome health care, than just physically “curing” a disorder. I feel it more important to provide a patient the much needed mental and emotional help, or even spiritual care given collectively than merely to prescribe some medicine, and ask him to come back for follow-up for the same condition.
It would be back to square one for him with unending medication merely to suppress or control a disease. He never gets “cured”, let alone healed completely and wholesomely.
We would be denying a patient of a wholesome healing and complete health and well-being as defined by the World Health Organization
But above all, whatever systems of health care or medical practice we accept or practice, we all have one first and most important cardinal principal to be followed and that is in Latin:
Lim ju boo
The following photos taken in Hospital KL in January, 2021 are provided by courtesy of Dr. JB Lim as shared in his chat group:
Labels: The Thoughts of Dr JB Lim
posted by taionn @ 12:06 PM
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