In speaking with Bob Lynn6 about this idea, he stated, “A wound might be treated effectively, but the bruise only clears on its own, with time.”
What he was getting at is that clinical care might focus on only one aspect of the problem, with a method that can merely control one part of the hoped-for result of care. That is, even though the patient may be interested in being fully well, by contrast certain improvements are out of the direct reach of clinical care – the patient will be delighted about them when they happen. This is a simple, profoundly important, and helpful framework: focusing on broad healing and improvement, rather than merely focusing on (limited) treatment results.
Direct treatment impacts are known as treatment outcomes. There are other important improvements (not directly caused by known treatments) that might occur with time, or might apparently only occur as a function of time plus alternative therapies. Thus, those other improvements are more properly considered the result of natural healing processes overall, rather than considered a treatment effect per se.
If we had ten thousand or more addiction patients comprehensively assessed over decades, prospectively, and we were innovating to do that, as I have outlined previously (developing indicators, developing measures, and comprehensively assessing them over the long term as we proceed) we might also innovate in our clinical treatment technology. That is, targets that are out of our reach now might be within our reach later.
Healthcare has done this kind of innovation for a long time: what is outside of traditional medicine is found to be effective, later formally evaluated, developed into a technological approach, refined in its method and effect, and finally made part of mainstream care.
Consequently, the signs and symptoms merely associated with “healing” or alternative therapies today might become clinical outcomes tomorrow, as we innovate.
In that way, the notion of healing as a total result is ultimately practical as well.
Thus, there is hope for innovation.
Likewise, routine therapies of today were initially new or innovative. Some initially new or innovative clinical practices were derived from ideas first found in non-traditional remedies. Clinical signs and symptoms currently beyond the reach of our direct capability to treat might be targeted by non-clinical approaches. Researchers might notice how clinical targets were or are pursued by non-traditional remedies, and then begin to examine related questions – toward discovering or developing new, effective treatments.
In short this is the pattern, or motif, by which clinical innovation can roll forward to help our work. As data is recursive to care (improving the care for a single person served), so the same is true for rolling data back in and improving our methods of assessment, treatment, and development of research questions.
But right now, we cannot see forward into the future, for the patient, on a normed basis.
We do not know what to expect will get better, and when – at least not in a comprehensive way.
In that sense we can only work in the existential “now”.
Really, we are working in the dark with just a few measures (just a few small lights on), rather than being comprehensively aware – given our current, general, clinical framework.
6Lynn, B. (2016). Personal communication.
In case you missed it, Part 5: “CARE FOR THE LIFETIME OF THE VEHICLE” is here.