Introduction:
This concludes my autobiographical three part series concerning tomorrow’s medicine today in which I share thoughts based on my experiences in hopes this will help others to ask the right questions and get better answers. In these three October Blogs, I'm also addressing why medicine remains the fastest growing failing business in the world today!
Patient Compliance and Rational Health Choices:
My practice and professional association with physicians made me aware of problems motivating patients to take better care of themselves and “follow doctor’s orders,” in their own behalf beginning with New Year’s Resolutions. In the context of crisis medicine (i.e., sickness-care) patients are inclined to take care of themselves. In the context of prevention (i.e., wellness- care) patients are inclined to cheat and ignore issues of weight reduction, diet, alcohol abuse, exercise, smoking, food addictions, stress, etc. It’s not uncommon patients in preventive medicine programs to throw caution and enlightened self-interest to the wind with la belle indifference.
My interest in personal motivation, self-reliance, and rational health choices focuses on making such choices and the struggle to be mindful of the risks involved. Do you suppose there is a co-dependency between society and the patient? This might be true if society caused anxiety or depression, but more likely true with individuals professing a strong sense of entitlement. However the problem may not be one of commission, but one of omission on society’s part; depending on how much of a libertarian you are, how much you believe in the virtue of self-reliance, the vice of entitlement, or how much you believe in helping fallible human beings overcome personal problems.
Individuals and society share a stake in controlling insurance and medical costs. Medical inflation hurts everyone, reduces productivity and ultimately degrades standard of living. Meanwhile opportunistic drug pricing, rather than value pricing, results in bankruptcies that sometimes destroy marriages and families.
__________
I will avoid “pathologizing” irrational health choices by looking beyond Psychology and Positive Psychology to Moral Psychology and Moral Education which I view as the ultimate Preventive Psychology to complement Preventive Medicine.
The Moral Psychology I have in mind is Axiological Psychologyand not the Moral Psychology of a hundred years ago. It is founded on a science of values. It is a psychology that encourages and supports rational health choices. It views such behavior as a scientific virtue and the failure to make such choices a scientific vice; but not a virtue or vice in any religious sense.
The revival of concepts such as virtue, vice, good, and evil works for me because I ground them in the new science of values; making possible the development of moral education to complement the learning of our ABCs and 123s. It also allows the development of societal or cultural carrots and sticks to reward rational health choices and discourage irrational health choices. By rational I mean pro-self, pro-social behavior and vice versa.
Do I have concept approval? Do you think we’re ready to move in this direction? Do you think that day will come? Do you think societal sponsorship of moral education can morph into a sort of “Third Person” (i.e., societal proxy) in the doctor-patient relationship…without shouts of “Orwellian,” “Skinnerian,” or “Brave New World?” (1)
I think we can all agree that it is desirable for patients to become more mindful of the importance of rational health choices, but is moral education, sponsored and required by society, a good way to achieve this; or is it too Orwellian, Skinnerian, and Brave New World? Do you think promoting Moral Science (i.e., Axiological Science) and moral education might even help us avoid the very Orwellian future that some see in our discussion of concepts like virtue, vice, good, and evil?
Theoretical Medicine:
Medicine is complex. It needs a theoretical medicine discipline to guide it, guide innovation, and the safe use of statistics which tend to blind doctors to the individuality of uniqueness (i.e., biochemical individuality) of patients. I want to see a Theoretical Medicine for the same reasons physics benefits from Theoretical Physics.
Preventive Psychology:
As noted, moral education is preventive psychology. But, you might ask “whose morality?” Catholic, Protestant, Islamic, Hindu, Buddhist, etc.?” None of them! I’m referring to basic moral reasoning based on the science of values (i.e., axiological science). This science derives from the convergence of philosopher Hartman’s Theory of Value and psychologist Pomeroy’s empirical validation of this theory, supported by successful business applications of this science.
This convergence of philosophy and psychology, along with their foremost applications of valuementrics and axiological psychology, gives humankind something it never had before; namely the seeds of moral education and preventive psychology. It identifies Feeler, Doer, and Thinker dimensions of moral reasoning which vary in sensitivity, balance, order of influence, and plasticity; all of which can be measured, modified, and improved as needed.
Conclusions:
I’ve offered an autobiographical discussion of medicine touching on several topics. My purpose is to address important unfinished business in the professions of medicine and psychology.
Let’s not allow the historic success of drugs treating infectious diseases to blind us to the failure of drugs to prevent and heal age related, chronic, degenerative diseases. Geriatric medicine requires integrated medicine of the sort that recent advances in molecular biology, genomic mapping, immunotherapy and stem cell therapy make possible.
My metaphorical “Third Person,” (i.e., a societal proxy) present in the Doctor-Patient Relationship represents the future of greater societal involvement. I believe that society has a role to play in motivating fallible human beings to overcome procrastination and make rational health choices that benefit themselves and society. In the end society will adopt carrots and sticks to reward virtue and discourage vice insofar as making healthy choices is concerned. This will require the surrender of some freedoms in the name of the greatest good for the greatest number; not unlike what’s happening right now in our fight against terrorism…whether we like it or not.
My call for “Tomorrow’s Medicine Today” is a way to draw attention to the importance of biochemical individuality and the goal of individualizing or tailoring medicine to address this reality rather than the statistical abstraction of the average person who doesn't exist. References to the average person appear in medical literature and it is the average person that the pharmaceutical-industrial complex, and FDA, refer to when claiming the safety and efficacy of drugs. We know how a drug will respond when poured into a test tube, but we don’t know how it will respond when poured into your body or mine because we’re not average. This is the weakness of statistics at even the level of controlled, double blind studies. .
Arriving at a moral calculus and moral incentives to encourage and improve patient compliance in preventive medicine programs will take time and education. It may take decades depending on circumstances, but the cost of health care makes this an urgent matter now and in the long run. Today’s evolving science of values and valuations gives us a foundation for progress in this area of medicine. It will allow us to more precisely distinguish between basic moral reasoning and applied moral reasoning; which is the difference between implicit cognitive mechanisms dedicated to moral reasoning and the explicit religious, ethical, and philosophical content we’re all familiar with.
Civilization and its Discontents is the title of Sigmund Freud’s last book, and he wasn’t all that successful in diagnosing what ails both. It appears both (i.e., collective and individual) lack rules to live by of the kind provided by a scientific study of values supporting moral reasoning and moral education....enriched by the wisdom of the ages.
The concept of society playing a more direct role in motivating patients to take better care of themselves will be tested in years to come given the exploding cost of health care. This will certainly give libertarians something to fight over, and humanists something to celebrate.
(1) Note:“Orwellian” refers to George Orwell’s anti-utopian novel Nineteen Eight-Four in which he satirizes the tyranny of “Big Brother.” “Skinnerian” refers to B. F. Skinner’s radical behaviorism unfolding in the pages of Walden Two. Brave New World refers to Aldous Huxley’s negative utopia.
. © Dr. Leon Pomeroy, Ph.D.
http://www.psychologytoday.com/blog/beyond-good-and-evil
The Doctor Patient Relationship Needs Help