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Acute vs. Chronic Medical Care

Modern medicine has brought amazing gifts to the world by interrupting acute processes which if left uncorrected would result in death or suffering. Surgeries of many varieties have evolved to radically change human lives. Bypass surgery often gives the heart a true second chance. Intra-abdominal surgeries can prevent life-ending infections and other catastrophes. Antibiotics have allowed the treatment of infections which in years gone by resulted in death. Cancer treatments have led to cures in many cases and life prolongation in others. Post-trauma (emergency) care has become life-saving in miraculous ways. Modern life is truly safer and more protected than 100 years ago.

However, humans continue to suffer at very high levels despite these advances in acute interventions. Why? Modern medicine has NOT progressed much at all in the care of chronic conditions. Chronic conditions are often NOT amenable to acute interventions. They become “murkier” with their chronicity and emotional and spiritual factors evolve to complicate the physical symptoms.

The world is ready for the next level of healing. Acute care medicine has opened the possibility of healing and allowed acute problems to be cured. Now medicine needs to address the world of chronic disease. This is every bit as solvable but new models for healing will have to be added to acute, technological interventions.
Is this a big problem? Absolutely! For people over age 65, eighty percent have at least one chronic medical condition and 65 percent have multiple conditions. The population is aging rapidly. Costs are escalating out of control (largely as a result of applying modern, acute interventions to an increasingly complex population
who need more care than that provided by the acute care model). Morbidity and mortality increase exponentially in individuals with chronic conditions. So, we have an inferno developing and we are approaching it with resources and tools which work in the acute care setting but are not geared to treat chronic problems.

Chronic conditions are not impossible to cure or improve. However, they require different approaches to make meaningful inroads into their more complex structures. Uni-dimensional therapies are NOT effective. Chronic problems are by definition more complicated and complex and the dream of a quick-fix is rarely realized.

Chronic issues develop over time and affect other realms besides their primary target location which make them resistant to uni-dimensional, focused therapies. When an individual struggles with a challenge over time, mental and emotional factors arise as a natural response to the body's struggle. Also, when an individual wrestles with a physical symptom over time,there are additional physical symptoms which arise in in response to or in compensation for the presenting symptom. Additionally, therapeutic side effects may complicate the picture. Lastly, spiritual and social factors also enter in. One's support system may be or become compromised and one's faith can be challenged in the midst of illness.

So what works? What is the challenged patient to do?

Chronic problems CAN be cured. When they can't be cured, they can be managed with success. They require a different approach. The approach needs to be multi-dimensional (as opposed to uni-dimensional) and needs to address all three realms of mind, body and spirit. More holistic approaches and philosophies are truly required in this more complex situation. The individual with more chronic problems (on top of their acute situation) needs MORE in short. What form the MORE takes varies depending on the situation. First and foremost, the full situation needs to be acknowledged and addressed by the patient, the medical provider and ideally with the patient's support system. Keeping the patient connected to his or her support is absolutely mandatory. People always do better when they are not alone in the midst of illness and injury.

Emotions matter in this more complex situation. Illness and injury are frequently accompanied by depression,anger, loss of hope, guilt over asking for help, etc. Ignoring these aspects of the situation is like ignoring the "elephant in the room". Negative emotional states adversely effect healing, immunity and the will to improve. People stop doing what they need to do if they become depressed and isolated. They do not eat as well, stop exercising and lose their faith if they become depressed. None of these promote healing; in fact,they promote more severe illness.

No individual healer can manage the complexity and myriad of challenges involved in caring for the chronic medical patient. Just as the recovering patient needs community support, the care team (both medical and non-medical) needs to be rooted in a team-oriented approach. Physician burn-out and caregiver burnout are very real issues in our world. The answer for these complex challenges is again unleashing the power of community. When doctors feel supported, they become better healers. When caregivers are truly supported, they can rise to much higher levels. When patients do not feel isolated and alone, they can heal faster, get stronger, and their entire world is filled with possibility and light as opposed to fear and despair. A shift happens that is nothing short of miraculous.

The world of healing is truly attached to this concept of connection. When isolation is faced and addressed, doors open and healing can happen. The energy that is released when individuals are guided back to the pack is the fruit of life. We may not understand it or be able to measure it but it is real and it is what life is about.

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