1. Communicating about Alternative Medicine Who’s Listening... James Hallenbeck, M.D.

2. There’s no place like home... Importance of home and comfort for the dying. Home- –a place –a reflection of self

3. Cancer- a threat to self Cancer eats away at the self, not just the body Tasks of the cancer patient: –physical healing –preservation/restoration of self self healing finding one’s home

4. Cancer as an experience More than physicalMore than physical Change in lifestyleChange in lifestyle –Healthcare system part of cancer experience We may be seen as part of threat to selfWe may be seen as part of threat to self

5. Alternative Medicine healing of self as a goalPhilosophies, therapies vary greatly but tend to recognize healing of self as a goal Examples: –Chinese Medicine –Modern American Herbal/Vitamin Therapy Underlying principles

6. Western Medicine Exception to this principle Mechanistic approach –tends not to recognize self healing as a goal of therapy

7. Active Listening Letting go of my agenda Recognition of patient’s agenda Listening as healing –Examples THE STORY THE LEGACY

8. Are you listening, Doc? The story The test Sensitive subjects –such as the use of alternative medicines Of fish and lightening...Example: Of fish and lightening...

9. Addressing alternative medical practices Self reflection –? Knowledge base, opinions, perceived threat Respect for the patient –recognize/acknowledge effort to participate in own healing –courage required to discuss with Western practitioner

10. Understanding the patient Common themes: –Return to traditional practices –Need for self-expression/control –Need to emphasize healing in addition to curing –Distrust of Western medicine What does the practice choice say about the patient?

11. Understanding the practice –Why did the illness occur? –How did it happen? –What is the normal course of such an illness? –What is proper therapy? –How should various people relate to this episode of illness? Kleinman’s Explanatory Model

12. Explanatory Model Chinese Medicine Why, How? –Imbalance of inner forces, affected by outside forces such as wind Normal course? –Progressive imbalance, unless corrected Proper therapy? –Herbs, massage/acupuncture to restore balance Relationship of people? –Healer prescribes/treats, patient complies

13. Explanatory Model Western Medicine Why, How? –Mechanistic. Due to attack, bad luck, bad choices, obsolescence Normal course? –Progressive malfunctioning, unless repaired Proper therapy? –Destroy invaders, replace damaged parts, tune-up Relationship of people? –Prescribes/mechanic, patient complies

14. Synthesis With compliance Healing of self Example: a cup of tea... Understanding alternative practice helps:

15. SUMMARY Healing of the self and the body are important tasks for cancer patients Alternative therapies may address the need to heal the self Addressing alternative medicines can be less a barrier than an opportunity to create a healing relationship, helping us understand our patients and ourselves

16. Just Listen If only we can... Just Listen