ACOFP Blog

By Tejal R. Patel, DO
2021 ACOFP Diversity, Equity and Inclusion Award Recipient

What does it mean to treat the whole person, not just the disease?

Imagine that the health of an individual patient presents to you in the form of a View-Master. Each slide depicts a different part of a patient’s experiences. Even though you do not see them simultaneously, events impacting each patient’s health have happened—and are still happening—outside of your view. The realization that those separate events are occurring is just a few clicks away. How long would you need to spend on a slide before you feel like you have fully taken it in and can move on to the next?

As family physicians, our brains have neither the luxury to think in a methodically ordered fashion nor the ability to spend the same amount of time with each patient. In one room, we are counseling about disease prevention, and, in the next, we are reviewing end of life care. Throw in some osteopathic manipulative therapy, a couple acute visits, a few chronic disease follow-ups, a newborn exam and a perioperative evaluation, and you have covered the whole gamut of primary care before noon.

It would be great to have a View-Master for each patient to inform us of the psychosocial stressors that are impacting their care before we enter the room. Maybe we could spend a few minutes on each slide, contemplating their layers of education status, literacy level and other financial determinants that impact their health. But what would the experience of racism look like? Or prejudice? Or marginalization?

Many of us—as patients and as providers—identify with one or more labels depending on where we are: at work, I am a physician; at home, I am a mom and wife; among friends, I am a dancer; at a restaurant, I am a vegetarian; on surveys, I am South Asian or Asian American. These are the different stories you would see when clicking through a View-Master about me.

You would have to see them all to understand my literacy level, beliefs, values, preferences, and so on and so on. You might also see the times in my life when my patients have assumed that I would speak with an accent because my skin is brown (I have lived in Ohio my entire life, so I guess you could say I have a Midwest accent). You might see the several times patients have been surprised that I am a woman (they expected to see a male-identified provider when they saw the name “Dr. Patel”). You also might have seen the moment when I decided to pronounce my name differently in public versus when I am at home.

My experiences are not unique to me, and my experiences have little comparison to the tragic, awful things that have happened—and have been happening—to other individuals in the Asian American Pacific Islander (AAPI) community. Less than one month ago in Atlanta, Georgia, eight people were killed, six of which were Asian women. Our AAPI patients and providers have been judged differently and stigmatized in public over the past year due to the origins of the novel coronavirus.

A reporting center called Stop AAPI Hate recorded nearly 3,800 hate crimes in the past year. The victims of those crimes have also had to say goodbye to loved ones, have not been able to hug close family and friends and have been dealing with mental health issues related to isolation. They have layers of experiences that impact their health. Their individual View-Masters tell a story about who they are and what impacts their health. How can we help as providers?

In order to serve our patients from a holistic, osteopathic approach, we need to look at the whole person. This requires an understanding of the experiences that have impacted their health. We all likely have different religious, cultural and political points of view, yet our end goal—better health for our patients—is the same.

How do we get to that same end goal? Break the View-Master open, and look at the whole wheel of slides. Rearrange them. Seek out and spend more time contemplating and processing the slides that make you uncomfortable. Contemplate the reasons why they make you uncomfortable: Did you know those slides existed? Are you having a hard time understanding them? Do you disagree with them? Can you resonate with them?

The more we ask ourselves these questions, the more we will be open to learning about each other and our patients. Some of us will have shared experiences, while many of us will hear about experiences. Some of us will find our niche in cultural medicine, while many of us will continue to ask questions. We have to start somewhere, and stepping back and looking at the big picture—with all the slides in one view—is a great place to start, and being inquisitive, remaining engaged and asking questions help too.