2023-07-31 03:00:11
What is a sick person?
Introduction
Let me start with the typical proud-of-himself doctor anecdote. A long time ago, around 1970, three sisters asked me to visit an elderly aunt who was so weak that she could not get out of bed. I went to her house and the patient had such anemia who was literally as white as the sheets. But she had no other symptoms; except for the anemia, she did not appear to be suffering from any disease. I diagnosed a pernicious anemia and admitted her to the hospital, where the diagnosis was confirmed. The patient was cured with a vitamin B12 treatment. I was very pleased to have been diagnosed with pernicious anemia during a home visit.
This typical anecdote refers to an event: the diagnosis of a rare disease during a home visit. But the thing does not end there. How did I get to that house? The three sisters were my patients – I had known them well for almost a decade – and they all shared a flat. Therefore, when I visited the aunt, they did not consider me a stranger. Thanks to which, the aunt – who was very modest – allowed me to examine her and offered no resistance to admission to the hospital. She then continued to be my patient for many years until her death. This lady saw me as a trusted doctor in the traditional role of the kind doctor diagnosing and treating disease and protecting against death.
Where does a doctor learn to behave correctly with patients, to value them and to tune in with them? He is learned in the medical school and in training once he graduates. Medical educators call it “informal curriculum”, since it is not actively taught, as if these topics were not considered important. Understanding patients may not have been thought important in the 1970s, but understanding patients is now critical to good medical practice as illnesses have changed, as has medical care. The lady in the story could be cured with an injection of vitamin B12 a month, but contemporary diseases are not usually of this type.
The typical diseases of our time are chronic conditions, such as cancer, heart failure, HIV-AIDS, arthritis, chronic lung diseases, dementia or diseases of aging. Chronic diseases are not primarily cared for by doctors, but by the patients themselves, by the family and by other caregivers with the advice of doctors. Many of the people who suffer from these diseases make numerous trips to the hospital over the years and end their lives in the hospital. Knowing who they are as people and how the disease transforms their condition as a person improves the care that these people receive.
What is the disease?
We believe that people are sick because of their condition – their cancer, their kidney or heart failure – and this stems from our definition of a sick person as someone who has a disease. I would like you to consider another definition of the disease that is more useful and is more related to what it entails be y feel sick. Patients are sick when, due to functional impairment, they are unable to pursue their goals and objectives.. The reaction of doctors to what patients tell them, what their examinations reveal, and all the technical information they discover is aimed at making a diagnosis and make a decision about the treatment. They must remember that the diagnosis it is not something in itself; diagnosis is nothing more than a name that has been assigned to an abstraction. This is a very useful abstraction—the name of the disease and what it means—because with that name one can discover many things about the disease that are the result of decades of experience, laboratory research, and all the accumulated wisdom about the disease. said disease.
Illness, regardless of whatever name or meaning we assign to it, is “a disorder or abnormality of function”. The disease is greater than the condition to which the name of the diagnosis refers and greater than the patient’s experience of disease, since it includes aspects of which neither the patients nor the doctors are aware. For example, if a patient’s thinking is affected by illness, or his emotional expression, or his ability to maintain relationships, but neither the patient nor her doctors are aware of it, these aspects would not be included in disease definitions. His disease encompasses more than symptoms and the experience of patients. There are, then, three “entities” that describe what is happening to the patient:
disease as disease: a characteristic of the patient that is made up of all the discomforts or disorders of the function that occur.
The disease as a disease: the subjective attribution to the manifestations of the disorder of a name, a description or a belief, by the patient, as experienced by himself.
disease as a condition: the name or disease process to which the physician or diagnosis attributes the patient’s disorder.
Illness, illness and condition? Is it about dividing the person in the same way that, for example, it is divided between mind and body or person and body (the famous dichotomies)? No. There is only one sick person who suffers from functional disorders, which actually exist in that person. It is as if functional disorders, disease as illness, were a text that the patient read in one way and the doctor in another. None of the above is what we mean when we want to better understand the meaning of disease as ailment to describe a sick person. If we contemplate the functionality from a different perspective, however, we realize that functional deterioration occurs in all sick people.
What is functionality?
Human functionality is an exhaustive and absolute set of activities that includes the whole range, from the cellular to the spiritual; eating, thinking and loving are all functions among thousands more. In the achievement of objectives, aspirations and goals, a hierarchy of functions is involved, ranging from the molecular to the social and spiritual. Does not exist none boundary between the body and the other parts of the person with regard to their functions and the objectives they support. the disease as disease It is made up of all the phenomena that happen to the sick person: personal, emotional, social, physical and spiritual.
Remember that the only real thing is the sick person, who is the amalgamation of all the characteristics of both the disease and condition, which is what the doctor sees, and the disease as a condition, which is what the patient experiences. For example, breast cancer is not simply the characteristic lump and pathology of breast tissue. Breast cancer is the entire spectrum, for the person who suffers from it, of all the physical, psychological, social and personal aspects that have been associated with abnormal breast tissue or have been initiated by it, including treatment: surgery and its effects, radiation, chemotherapy, disfigurement (if it occurs), fear, shame, anger, known or unknown emotional conflicts. All of this is what breast cancer is for that woman (or that man).
Stages of disease as ailment
The hallmark of disease as ailment is the symptoms: from a bleeding nose to excruciating pain. All the symptoms are the consequence of alterations in functionality. People may have mild symptoms, or very bothersome symptoms but for relatively short periods, such as a bleeding nose, sore throat, sneezing, or coughing, in which case they are not usually considered ill. Symptoms such as coughing, the expulsion of phlegm or intermittent wheezing can last for weeks or months, but we accept them or attribute them to everyday causes such as tobacco and we do not consider ourselves sick. Sometimes the weight of the symptoms can be considerable: –pains, difficulties in daily life due to stiffness of the joints, difficulties walking, shortness of breath, abdominal discomfort, intestinal disorders and other similar complaints– but we get used to these things, we change our everyday behaviors, we make rationalizations and excuses for the symptoms, and we don’t consider ourselves sick. There are people who are capable of anything rather than admitting that they have a problem or that they should go to the doctor. There are even extraordinary people who, despite suffering from very serious or life-threatening illnesses, and suffering from serious symptoms, live their lives adapted to their ailment and without considering themselves sick. They do what seems important to them and live their lives as if they were not sick. But then something qualitatively different happens and the disease as suffering occupies a central place in the life of the patient. We are before a condition state.
State of illness
The fundamental characteristic of this state consists in the deviation of all the thoughts and actions of the person towards said state:
Towards hopelessness in a state of despair. Toward pain in a state of pain. Towards the object of love in a state of love. Towards illness in a state of illness.
The impact of a state of suffering in the person is generalized: it ranges from the social to the molecular. What happens to the patient is made up of the entire phenomenon – the personal, emotional, social, physical, spiritual things – that happen to the sick person. this is the experience personal that often remains hidden by the physician’s focus on the characteristics and phenomenon of disease as a condition. But it is this experience personal – decrepitude, frailty, weakness, lack of energy, exhaustion – more than, for example, coughing or loss of appetite, which makes the person know that he is really sick.
the sick person
Now we can begin to describe the sick people and to compare them with ordinary people. We have first had to get rid of any idea of disease (in the sense of sickness) as what patients suffering from disease experience. We have had to get rid of everyday notions of diseases (in the sense of conditions) as if they were the real thing. We have had to understand that the concept of a sick person it is much broader than simply someone who suffers from a disease (in the sense of suffering), even if it is serious. In most cases, sick people have symptoms that are visible and appear to be the entire disease. The experience of the symptoms stands out above the rest; above all the pain. But also nausea and vomiting, dyspnea, or perhaps any symptom if severe enough to dominate the patient’s experience.
fear and uncertainty. These and all other manifestations of the disease as a condition occupy a central place in the life of the patient and in the actions of their doctors. The patient as a person seems to move to the periphery. There are certain characteristics that are present in all diseases (in the sense of suffering) graves, regardless of what disease it is and where the patients are. People with a disease are disconnected from the healthy and from their world. In health we know that we are alive through our connection to the world. Through touch, hearing, sight and the other senses; through our interest in the things around us, our relationships with other people, and our dealings with others. In disease as a condition, however mild, some of these connections are lost. When the condition worsens or becomes a vital state, the patient’s connection to the world is further reduced, a situation made worse by isolation in special places such as hospitals. Or through loss of interest and progressive reduction of the sensory field. The person who suffers from a disease loses the sensation of indestructibility that is normally possessed (what in psychology is usually called omnipotence).
Why is it stupid to tell someone who has just been told that their disease could be fatal that we can all die at any moment? because that person you already know. When the feeling of indestructibility is lost, the world becomes a very dangerous place. The sick person focuses on fears, threats, dangers, risks and fragility. The person suffering from a disease loses omniscience; the fullness of reason. When we are healthy, we think we know things about the body, diseases, doctors, treatments, etc. We believe that we possess a fairly complete knowledge. And today everyone knows everything. But when disease (in the sense of suffering), suddenly, knowledge is incomplete. What we know is not enough; especially in view of all the uncertainties that arise. And if we add to this the loss of interest, it becomes very difficult to think clearly.
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