Background

While illness and disability are common[1], caring for patients coping with illness and disability can be challenging. Much of this challenge stems from developing the requisite skill to diagnose a patient’s condition and to develop patient-centered treatment plans.  In addition, our cognitive approach to diagnosis and treatment can be significantly affected by our reactions to the illness and disability with which our patients cope.  The reactions can be evoked by a wide array of factors, including but not limited to:

• our perception of the severity of one’s illness/disability and its impact on what we consider to be “normal” life
• our perception of illness and injury as “unfair” or “unfortunate”
• our perception of the relationship between one’s illness/disability and their lifestyle choices
• our patient’s age, role in their family (parent, child, etc.), and social status
• the rapidity with which one’s symptoms develop and one’s illness progresses
• the extent to which we can relate and/or identify with our patient
• the likelihood that one’s illness/disability is temporary or permanent; progressive or not

During the panel session on 11/7/2017, our colleagues will share their narratives, including those associated with: illness and injury; trauma and disease; and varying degrees of prognostic uncertainty. It is my hope that your consideration of these narratives and the session readings on this page will afford each of you the opportunity to reflect on your reactions to illness and disability and examine the way these reactions might impact how you care for your future patients.

Note 1: Terminology:

I contemplated replacing the title “Illness and Injury” in lieu of the more commonly used “Illness and Disability”. On further reflection, however, I was challenged by whether the word “injury” is a more accurate one than the word “disability”, which led me to review the etymology of these words.  Both come from the 14th century. Injury comes from from in (not) + jur (right).  Disabled comes from dis (lack of) + able (having sufficient power or means). The reality is that neither is adequate.  With respect to the word “disabled”, I offer you the comments of Master Sergeant Cedric King, a past panelist for contemplation. MSGT King sustained injuries in an IED blast while on patrol in Afghanistan, and later required a right above the knee amputation (AKA) and a left below the knee amputation (BKA). He shared his view of the word “disabled”:

“I hate the word “disabled” – what does that even mean?  I’ve run three marathons in the past year  – how about the rest of you who don’t use prosthetics?  I don’t think that makes me “disabled”, I think it means that I have physical challenges – I want my providers to use those words – physical challenges – so they can realize that we all have physical challenges, it just turns out that mine are related to amputations. I believe those words have a better chance of helping providers to think about my situation, and think about me in an effective way than using the words “disabled or handicapped.”

It is my hope that during this session, you will think about words that are commonly used to describe those with physical or mental challenges and how they shape your thinking.  Words including invalid and crippled are less commonly heard today, replaced in many cases by the word handicapped (etymology here).  I also hope that you consider the use of words to define someone as opposed to describing their situation (the difference between saying “the diabetic in bed 4” as compared to “Mrs. Jones, a 54 year old woman who has diabetes”) One might wonder what all the fuss is about and perceive this as an effort to be politically correct. To be clear, the reason for my pausing a moment to explore this topic is not only because the thoughtless use words has the potential to negatively impact our patients; it is because our use of language shapes the way we think about and care for others.  If you are interested in more on terms related to disability, please check out this site.

Note 2: Range of Illness Is Vast:

The range of illness we, as humans, experience is vast – acute and chronic; treated surgically and medically; affecting young and old; the list goes on and on.  Given the time limitations of the panel, representing every aspect of Illness would be impossible.  This is where the supplemental resources are so valuable – offering greater breadth for your consideration.  Specifically, I call your attention to the first two resources above – the NPR interview entitled, “An Ill Newborn” and the TED talk by Eleanor Longden entitled “The Voices in My Head”.  I cannnot recommend them strongly enough.

[1] The CDC reports that nearly 50% of all adults in the United States have at least one chronic illness while the NHIS reports that 19.4% of all people in the United States have a disability. Given this reality, each of us will commonly encounter patients, friends, and family members who live with chronic illness.

Assignment

Reaction:

1. Reflect on an experience you have had with illness or injury. Set the stage so the reader will understand the context. Identify your reaction to:
   1. being ill/injured
   2. to being limited (to whatever degree)  in your ability to engage in activities the way you otherwise would have.
2. After attending the panel and watching/listening to/reading the supplemental resources, identify your reactions to two or more stimuli (can be panelists’ narratives and/or resources) that struck you as particularly thought-provoking with respect to illness and/or injury

*Note: When writing this section, list your reactions  followed by 1-2 lines describing those aspects of the panel/supplemental resources that evoked your reaction.

Sources: Explore the sources of each reaction. When writing this section, be specific about your experiences and the sources of your perceptions that have shaped your personal context and impact your perspective as it relates to this topic.  In addition, consider sources from multiple phases of your life to date to include:

• your own experiences being ill and/or disabled
• the role fitness and health play in your self-image and perception of others
• your experiences interacting with others, including family and friends, who have a chronic illness and/or disability
• your perception of how chronic illness and disability are viewed in your family of origin and among your peers
• your perceptions of how chronic illness and disability are viewed in the communities of which you have been a part, including the military and medical communities

Implications: Analyze and describe both the positive and negative implications of each of your reactions for how you might care for patients with chronic illness and/or disability in the future.

Plan: Develop a realistic, specific plan you can implement today to mitigate the negative and enhance the positive implications described in the section above. This does not need to be a grandiose plan, but must be something you can do in the next week that you think will help you to gain perspective on the topics you discussed in your paper. Do not offer a goal (e.g. “I will work to be more understanding of patients with mental illness.”) – that’s not a plan. Instead, identify one thing you will do to achieve that goal (e.g., I have a close family friend whose sister has been wrestling with Bipolar disorder for the past 15 years. Between now and our small group, I will call my friend to talk to her about her experience, and ask whether her sister might be willing to talk with me as well.”) 

Panelists

• 2nd Lt Michael Polmear is a member of the USU School of Medicine class of 2019.