One of the major precepts of ancient Chinese thought that westerners are most familiar with is the concept of yin and yang, action and non-action, fullness and emptiness.
The emptiness of yin is not a passive waiting, however. It is not sitting around waiting for the yang to recharge enough in order to use it, like a phone. Rather, it is like the flipside of action without which nothing would manifest, a creative receptivity that is alive with the potential that is then expressed in the yang.
In Emptiness and the Medical Encounter, Suzanne Cochrane, who has practised and taught Chinese medicine for 30 years, talks about the yin that is required of practitioners as they treat their patients.
The Chinese medical literature recognizes a hierarchy of skills in the art of encountering that particularly relies upon the disposition or ‘heart’ of the practitioner. The ancients valorized those healers who, fostering an inner silence, could open themselves to receive their patient-other as fully or as clearly, with as little interference, as possible. Their task was to discern the nature of the disorder and find the correct way through and then out of the situation of disorder – they needed to manage the reality of the situation
There is a vulnerability for the doctor as she empties herself in order to ‘take in’ the patient in front of her.
How do western doctors find the time and space to practice this flipside of action? This is the space where trust is built up between the doctor and the patient whose body they are about to subject to invasion. No wonder so many people resist visiting doctors. It is a fragile space when you are ill. How is it not counterintuitive to foist yourself into a space full of a million beeping machines, and a human whose relentless schedule and paradigm disallows them to be the people you really need them to be? How, as a doctor with patient after patient, to make yourself the open space that lets your patient in?
The patient, the whole reason for the institution’s existence, is so easily sidelined in the name of having treatment performed upon them. Western patients’ bodies are stolen from them twice – once by what ails them and then again by what accosts them in the name of healing them. And doctors’ abilities, knowledge and assistance are sidelined in service to the profit-making system.
It is hard to be well-bodied under the weight of austerity.
It is very easy for a western patient to feel from the beginning to the end of their consultation that they are not once actually seen by their doctor. It is as if the myriad tests, machines and diagnostic equipment are proxies for the doctor themselves, making them their a ghost rather than anything that will help the patient to feel in control of their own experience. The practitioner, Suzanne Cochrane says, to be an effective practitioner, must step into the “disorder” of the patient’s experience in order to understand it.
An image that emerges is of an empty vessel, the very emptiness of which allows the intrusion/inclusion of material from outside – to allow information from the encounter to ‘pour’ in of its own accord, to be received, and only then to be ordered and sifted.
How can doctors with the best of intentions hope to achieve this in, say, a busy hospital with its beeping, its relentless push to be efficient, to do more? The very existence of the machines take the authority from the doctor, and for them to have this sort of approach not only seems impossible, but it would be seen as insane.
It would be interesting to know how those doctors are faring here in Australia who are making more house calls. A federal government intiative in 2013 added funding to the system to enable bulk-billed house calls on weeknights, weekends and public holidays. One of the aims of the service was to reduce the weight on bulging emergency departments in hospitals. Though the Tasmanian Australian Medical Association President said that there had been no reduction in EDs in Hobart, I can’t help but wonder about the non-measurable efficiencies – you know, those ones that don’t have space on the economic spreadsheet, which are to do with the wellbeing of both the doctor and that of a patient being able to remain in their own home. These wellbeing benefits aren’t directly measurable, but commonsense tells us that the greater wellbeing experienced in a society, the better the economy functions. It’s the yin, the dark invisible. It comes from a paradigm which places humanity at its core, with the economy serving us. The opposite of austerity.
Imagine how much better the doctor-patient interaction would be in home-based settings wherever possible. What an increase in bedside manner practice for a doctor whose day has built-in buffers to recuperate between patients. They don’t have to plug the next patient in from the waiting room straight away. They get to recharge going from one patient’s house to the next. And yes, that may be a less efficient way of doing things. But perhaps that just means that we long ago came up against the edge of efficiency and veered off the cliff into the law of diminishing returns.
At least, that’s what a report back in 2011 suggested, where it predicted that practising a “Hospital in the Home” model for six different conditions, including infectious diseases and oncology, would save 22%.
Sounds good to me.