(UN)Professional Ethics: Authors' Op-Ed

My previous Op-Ed post proved to be surprisingly refreshing and therefore I will jump into another "tirade" while I am still experiencing the current urge to rant. 

This particular piece is closely related to the previous one...although it hits a more fundamental point of interest:  Ethics.  More specifically, professional ethics.  Although typically defined as a set of moral principles, morality is paradoxically subjective...therefore definition of ethical behaviour is also subjective and open for infinite debate and discussion.  However, when you extrapolate this discussion into the world of health care / health services, the concept begins to condense and become much more explicit.  In my personal opinion, the fundamental issue is not necessarily what you do...rather how you do it.  In other words, even if you are engaging in what could be considered improper professional ethical behaviour, if you are explicit about your objectives and means, people will inevitably make their own decisions...therefore the definition of ethics travels through the concept of transparency.  Regardless of intrinsic good intention or honorable objectives, if an individual or organization engages in the practice of misinformation and subterfuge...the inevitable impression (and ultimate conclusion) is that they operate with an agenda that is not aligned with those they claim to serve.  It would be somewhat naive to assume that my position is the "moral high ground"...or that I exist on a different level...however, in recent months I have been exposed to the extremes of this mindset.  On one hand, I have witnessed this practice of subterfuge first hand...and on the other, I have experienced the benefits of implementing focused efforts in transparency....both of which clearly "bracket" this fundamental idea.

self-definition, transparency, authenticity and accountability

These are the hallmarks of ethical practice...if these fundamentals are not met, the individual or organization is subject to understandable scrutiny.  This general framework must be integrated into a functioning system that includes rules of conduct, values, moral principles, and ethical practice.  These need to be "built-in" metrics that are subject to internal and external assessment...and should also evolve with the changing dynamic of health care seekers and health care providers.  

I am certain that everyone who reads this will extract their own personal experiences from it...those who know me well may (or may not) be able to speculate where this is coming from...however, regardless of who is speaking or who is being spoken OF, the notion of better professional practice benefits all...and the practice of subterfuge is effectively apoptosis (self-suicide) and only serves to demonstrate a clear and definite need to re-define and re-examine.   

Good ideas don't need to be "sold", intentions should be explicit and transparent, and subterfuge is a poor weapon...especially when it is a weapon of choice.  

 

Sustainability

The paradoxes within the medical construct are numerous.  The merging of health "services" with private corporative interests results in a landscape that is almost impossible to navigate...further, it becomes so polluted that the "environment" of confusion and chaos tends to result in simple apathy.  "It is the way it is...so we just need to comply."   This confusion isn't by design, per se...rather a symptom of the realities and challenges of providing care to the masses.  However, although the "macro"system is essentially to large and integrated to adapt, the "micro" system is what matters...and, paradoxically, likely to yield the most beneficial impact to the individual care-seeker.  This "micro" system involves the interactions between the care-seeker and individual care provider...it is at this basic level that the most fruitful decisions are made.

With this being said, the overall strategy of "how to navigate" is still quite ambiguous and elusive.  However there is one simple term that can be imported into this discussion and should present some insight into direction, course, and focus:  SUSTAINABILITY.  The human organism is a self-sustaining system that is engineered to self-heal and self-regulate.  As with all things biological, it is subject to entropy...but it's elegance is mirrored by the infinite complexity and ability to "take care of itself" and adapt.  What does this mean?  This "organic" reality is paradoxically opposite to the strategic formulation of the "macro" system:  The idea that there is a "pill for everything" and that all biomechanical challenges can be "fixed" with simple inorganic concepts is purely mechanistic!  How is it possible to understand and accept that the human organism is infinitely complex, organic, and self-sustaning and similarly attempt to import mechanistic concepts in an attempt to "fix what is broken".

It seems that, if we consider the body similar to the ecology, we only need to provide the necessary stimulus that will help to promote sustainability and self-regulation.  Within the ecological context, this is equivalent to planting more trees, reducing pollution, reducing impingement onto natural resources, etc...  In the biological context, it means "help the body to help itself".  It isn't necessary to solve all of the mysteries of the human body...they are not ours to manipulate.  The only flaw is self-awareness...which lends to ideas of the ability to manage a complex system with simplistic strategies.  Focused strategies on respiratory development, hydration, lymphatic drainage, and reduction of general muscualr tension will facilitate exponential increases in the ability to manage and auto-regulate...essentially "fertilizing" the body so that it can more effectively receive and absorb positive stimulus.

As once quoted by DaVinci:  "simplicity is the ultimate sophistication"...supporting sustainability is well within the grasp of the individual care-seeker and care-provider and therefore should be a resource that is well examined and integrated into every rehabilitative strategy.

Cheers!

Interoception: Balancing Inside and Out

One of the most insightful terms I have come across in a long time is the term: Interoception.  Although quite intuitive, I had never heard of it expressed with an actual term.

Interoception is formally the same concept as the more familiar term "proprioception"...however it is fundamentally exclusive.  Proprioception is sensitivity and sensory information received from the external environment such as temperature, gradients, pressure, velocity, etc.  Interoception is defined as: sensitivity to stimuli originating inside of the body.  

To expand on this a little more, the interoceptive process is autonomic, involuntary, and exists on what is essentially a "primitive" level.  It has been associated with visceral sensory neuroscience...which effectively theorizes that there is a high level of afferent (towards the brain, sensory) activity that is being generated from the internal organs and visceral organizational network that ultimately affect our mood, sense of well-being, and emotions.  This is an obviously fascinating topic for me simply due to the fact that this term lends to the fundamental understanding of systemic homeostasis...and perhaps more importantly, provides insight into potential "management strategies" to expand, enhance, and broaden rehabilitative strategies.  Further, this presents a viable bridge (or at least realistic extrapolation) to the idea that visceral manipulation (in its varied forms --- Osteopathy, Fascia Therapy, etc...) can essentially generate improvement in those elusive "intangible" and qualitative metrics (happiness, sense of self, relaxation). 

Like most innovative ideas, this perspective and form of thought came from Russia and Eastern Europe starting with Pavlov...however, it seems that even with our supposed "advanced technological capabilities" we cannot even seem to rationalize that which can't be measured quantitatively.  Interoception involves slightly smaller nerve bundles that access higher and deeper functioning within the brain and therefore is "lumped" within the context of the autonomic nervous system. 

The theoretical and conceptual formulation may yet take time to fully resolve and crystalize...however from a practical perspective, this further confirms what many practitioners have objectively observed for quite awhile...there is a definite link between visceral manipulation and global enhancement of health and well-being.  Further, that the myth that the brain and nervous system are somehow elevated to a "higher plane" is debunked...and the realization that they are fundamentally material comes into perspective.  Material is subject to mechanical influence and therefore the logical extrapolation of fact is that what we do has a direct impact on "who we are".   Although we are far from fully understanding what can perhaps be considered as "metaphysical" process...it should none-the-less be given adequate consideration and study so that treatment outcomes are more effective and manifest their maximum potential.