‘Participatory Medicine’

What is ‘participatory medicine’? Essentially, it is a collaborative model of healthcare that invites the patient to engage in their treatment and share in decision making. It describes a modality that moves away from the tradition Western medical framework of the physician adopting a position of authority, rendering the patient a passive recipient of their treatment or prescription.

I came across this term in an article by Jon Kabat-Zinn (author of one of my favourite-ly titled books, Wherever You Go, There You Are) outlining a study that found improved outcomes for patients when they were engaged in their therapy as active participants. It struck me as a great description of the kind of healthcare that we are trying to achieve with Miller’s Way, where all of our core practitioners are committed to engaging their clients in their own ‘healing’, and replacing the agency that is so often removed by Western approaches and the idea that the all-knowing Doctor will ‘fix’ our broken or dysfunctional body.

It is worth asking the question of what exactly we mean when we talk about healthcare, and considering how often in our pursuit of health are we essentially losing touch with how to fully live? Full spectrum health checks are becoming increasingly popular, high tech and expensive. There is no shortage of imaging, scanning, testing, and health related bench-marking available to arm us with more analytical data than we can possibly know what to do with. I can’t help wondering how helpful all of this is in the long run? Is there not a danger of becoming so caught up in these markers that we lose touch with how we actually feel? In out-sourcing so much responsibility for our health we open ourselves up to a whole extra level of stress and uncertainty, at the mercy of our test results and the arbitrary optimal ranges that tell us where ‘normal’ lies. The increasing number of wearable tech options (be it Oura, Whoop or a smart watch) will even tell us how well we have slept, and grant us a strain and a recovery score for each day, further weakening our interoceptive muscles to tune into how we actually feel and determine these aspects for ourselves.

In his book Beautiful Practice, Frank Forencich identifies the propensity we have as humans to treat our bodies as “alien or adversary”; a consequence of our brain centred worlds where education and business are so often driven from the neck-up. This Cartesian hangover of body and mind dualism, he argues, renders the latter an afterthought, or even a nuisance, often viewed as mysterious and unpredictable, or something to be tamed and beaten into shape. He advocates strongly for the necessity of appreciating the true interconnectedness of the physical and the mental, and for understanding that methods done by us rather than to us can have dramatic and hugely beneficial impacts on our wellbeing. Ultimately, he reminds us that we need to take back the agency that empowers us to become creators of our reality rather than victims of our circumstances. 

What does this mean in practice? Things we can do for ourselves include meditation, movement, creative pursuits, self-enquiry, healthy dietary choices. Those done to us would be surgeries, pharmaceutical prescriptions, therapies where the expectation on the therapist is to do the fixing. The latter absolves us of responsibility – our symptoms are the fault of fate, bad luck, uncaring doctors, unsuccessful surgeries etc. However if we take charge of our health by consciously making choices to benefit our physical and mental health, then we are embracing the challenge of living head on, whilst simultaneously and significantly improving our chances of success.

So how do practitioners at Miller’s Way encourage and demonstrate participatory medicine? We make it explicit that healing is something only our patients can do for themselves, albeit with our help and guidance, and explain to them what we think is going on for them and how they might be contributing to their situation. We watch how they stand and walk, offering corrective stretches where appropriate. We check how they are breathing, and after helping to free up any obvious restrictions, invite them to investigate how they might breathe better, whether that is deeper, fuller, slower or just more mindfully. We enquire into their eating and drinking habits, suggesting achievable changes they can make for the benefit of their digestion and energy levels, referring for herbs if greater shifts to their physiology are necessary.

Last but not least, we encourage dynamic movement – not necessarily ‘exercise’ (the former is essential, the latter optional, as Forencich points out) which means regularly moving joints through all available planes of motion, especially hips and knees which function as crucial gateways for circulation in and out of the legs, and which are frequently underused in our increasingly sedentary and mechanised world. We advise rounding out linear exercise regimes such as running and cycling with activities that twist and turn and squeeze tissues (think yoga, tai chi, functional workouts) to encourage good blood perfusion and mobility. We remind them that the body needs to be challenged to be robust. Muscles need to pull on bones to keep them dense and strong (Wolff’s Law), and movement patterns need to not be monotonous to capitalise on the plasticity of our brains and ensure new neuronal pathways keep being laid down.

This is just a handful of the most general approaches we adopt. The bespoke nature of our medicine means until we have an individual in front of us, until we can take their pulse, see their posture, sense their disposition, assess their countenance, we cannot know what exactly they will need from us or how exactly we will help. What we can know though is that the success of their treatment will depend a lot on how willing they are to participate, and ultimately that is what our approach attempts to encourage from the moment they step through our door.

Article – Jon Kabat-Zinn, 2000. European Academy of Dermatology and Venereology JEADV (2000) 14, 239-240

https://jonkabat-zinn.com/wp-content/uploads/2023/01/JonKabat-Zinn_Participatory-Medicine.pdf

Wherever You Go, There You Are. Jon Kabat-Zinn, 1994, Hyperion Books.

Beautiful Practice, Frank Forencich, 2014, Exuberant Animal.