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jeudi 10 décembre 2015


There is a shortage of Primary Care Providers so the burden has been shared with not so well prepared Doctor’s Assistant and Nurse Practitioners. Unfortunately both of these para professionals, they are called mid-level for a reason, are modelled after the broken metaphor of a dominant male biomedical model of Disease care.
Biomedicine has deviated so far away from the social aspects of the suffering of the patients that these mid-level professionals have become much like car mechanics. Attending to the problem, but with the added prejudices of objectification and depersonalization as if the body is a machine and that no one actually lives in it.
I had one such experience today at a hospital and ER clinic catering for a poor community of American Indians in a remote part of USA.
Mr. E had come to see me, I have known him for a while. He has type 2 Diabetes but his life is complicated by the fact that he is at the end of a failed surgery for his back and is in constant pain and in fear of a second surgery. He had gone to the dentist the day before and had one of his molars pulled out, adding to his pain and discomfort.
When I saw him this morning, his Blood sugar was elevated and clinically I could determine that he was a little dehydrated. I sent him to the ER attached to the clinic where I consult, requesting that he be given one litre of fluids with some insulin.
When the drive through (temporary) mid-level saw him, he began accusing the patient of not taking his insulin and began victimizing him.
This poor man, in his sixties had gone to get some relief but was being abused by someone who had no knowledge of his social circumstances and the medical history of what was taking place except the fact that he had high blood sugar.
He looks at the paper, the end product but does not have the intelligence to look at what has made that blood sugar high. It was a very unpleasant experience for the patient who does not wish to see the drive through temporary mid-level provider again.
They are very bad copies of the bio medically oriented medical doctors
It reminded me of what that wonderful poet of the beat generation of Americans had written
You’re just a copy
Of all the candy bars
I've ever eaten.
Richard Brautigan
This is yet another form of colonialism, continuing from an earlier sort, but with the same dire consequences.

My Meskwaki teacher had taught me
Each patient must be treated with respect, regardless of age and how they are dressed. If you respect them and love them a little you will never go wrong
This has been my motto during all these years of working with Indians of USA
Let them leave the consulting rooms happier than they came in and we must do everything to meet that objective.

“I learned a long time ago that I can't control the challenges the creator sends my way, but I can control the way I think about them and deal with them” 
― Wilma Mankiller, Ex-Chief of the Cherokee Nation of Oklahoma 

Lessons for Health Care Providers
Try to have a relationship with the patient. Learn a little bit about him.
As Dalai Lama has said: if you want to make another person happy, be compassionate.
To be truly compassionate, you need to walk in their moccasins, you must feel something for what they are going through, you must cultivate empathy.
Empathy is respectful and soothing

I am so fortunate to work with MS, who is probably the best Diabetes Nurse Educator in the world, with compassion towards all and assertion of how to achieve a better health status for them.