Cecil Helman is many things: old-fashioned General (Family) Practitioner, psychiatrist, cultural anthropologist, storyteller, poet and artist-and all this comes together in Suburban Shaman, a beautifully written, devastatingly honest (and often very funny) account of an audacious and adventurous life.
Cecil, a South African Jew, was my teacher where I studied Medical Anthropology in London, later he became a a good friend and was instrumental in helping me offer the first ever course in Medical Anthropology in Havana, Cuba.
He passed away in 2009, I miss him and a homage to that is his appearance in my eyes and his words in my heart, when looking at the Medical Practice with an Anthropological Eye.
It happened when American Diabetes Association published their recent recommendations regarding care of patients with this chronic illness.
First I give you a summary published by a writer who is not a medical doctor but who has concerns of the society and the patient in mind; to be followed by a summary by a "diabetes Expert" who has only drugs and body as a machine metaphor in his mind. What a pity..
First I will quote from Cecil's book, in his words:
It took me some time in practice to realise that a fundamental aspect of Family Medicine was its attitude to uncertainty. After literally tens of thousands of consultations with patients, and many hundreds of house-calls, clinnical practice eventually taught me one big, and rather soberinng lesson: It's that the more you know about doctorinng and why it works (or does'nt work), the more you realise how much you don't know. For despite its patina of science at its core medicine -and not just Family Practice-is not really about certainties, nor ever has been. To the disappointment of some of the new breed of "techno-doctors" as I've called them, it's also about doubt and ambiguity, and ethical dilemma that are sometimes difficult or evven impossible to solve. It's also about the limits of human expertise, especially with serious, chronic or incurable diseases.
When I began working with American Indians, one of the first lessons they taught me was the acceptance of ambiguity, and chaos present in one's life, over which may be superimposed some form of suffering from an illness.
Here is the same recommendations of American Diabetes Association presented from a patient's or the societal point of view and those of an Techno-Doctor who is more interested in numbers and paper print outs.
The American Diabetes Association (ADA) recently issued its revised Standards of Care for 2017 (summarized here). There are several changes to these guidelines this year. Therefore, it is important that anyone involved in the care of a patient with diabetes read them. The overall standards are long and detailed, but are summarized in one of the articles in the supplement. Here, I highlight and summarize are few of the most important changes.