Monday, January 6, 2014

Drawing the Line

As clients in my practice grow in experience and skill in self care; many become sources of
information for those around them. Growing as a healer to self and family is absolutely part of what I encourage and promote. Expanding that skill to become a source of information to your community is a natural extension of that skill. So while we educate people in healing, we often fail to educate them about limitations and boundaries to providing healthcare to non family members.

There are different levels of healthcare non professionals provide....someone administering first aid in the field, a health food store clerk comparing 2 herbal products, your friend involved in MLM selling healthcare products.... It is easy to feel that with knowledge and experience that you can do good for others.

Treating a cold, managing a cut, trying hay fever remedies are all things that are routinely successfully managed by patients themselves with OTC remedies. But with the advent of the Internet, ready access to information and prescription quality natural substances.... People come into my office every day that are treating significant and complicated illnesses with advice from non-professionals or by looking things up online. I guess the ones that are successful don't step into my office. But the ones that put themselves at risk, cause damage, or at best simply delay appropriate care come in every day.

Here are a few things to consider before providing advice to people outside of your immediate family:

1. What is the complexity level of the situation? Anything beyond basic first aid is not really appropriate for home care on a non-family member.

2. What is their experience with their current situation? Yearly bouts of bronchitis can be managed at home more easily than
 a new condition because of familiarity; but is the help you provide actually solving the problem or just perpetuating a pattern of disease by not addressing underlying problems?

3. What is the potential for creating harm and are you qualified to assess this? Many people in my practice have learned to avoid antibiotics with natural treatments. But just because these treatments have worked successfully on your family does not mean that it is not contraindicated for someone else because of an allergy or other condition.

In medical school, much of what we learn is worst case scenario. That's because we are trained as physicians to assess a situation and compare the risk of the treatment (all treatment carries some measure of risk) against the benefit to the patient. But when people study herbs, homeopathics or home remedies online or in a book; it doesn't usually include an awareness of contraindications, complications or interactions with other substances because the teaching is very superficial. The relative knowledge of a medical education compared to an Internet search illustrates this point. This is a small concern in first aid, but becomes increasingly significant as medical conditions become more complex.

Boundaries in healthcare are something physicians are trained to understand. This includes liability, personal limitations, and the ability to consult or refer to other professionals. In other words, doctors are trained to know what they don't know. That's why physicians operate in the realm of standard of care. Lay providers often don't know what they don't know. They assume their simplistic view of a situation is all there is.

If it's natural it's safe....right? The misconception that natural products used to treat diseases cannot do harm is naive. If it's strong enough to change something in your body for good, it's strong enough to do harm when used in ignorance. People have a sense that natural substances are less harmful than their prescription counterparts.... In some cases this is true....but not necessarily. But lay people don't normally have access to a prescription pharmacy.... Yet many lay people will use prescription natural substances without any awareness of how dangerous they can be.

I have noticed that when people become experts in treating their family; they tend to think other people will respond like family. Physicians are aware of the great differences between how people respond to diseases, treatment modalities and medications and are able to individualize their approach. Lay persons tend to have a very narrow view of treatment that relates to the limitations of their experience.

Knowing your limits as a healer expands as your skill expands.... but usually in the inverse. People
who know less usually take on more. But people with more experience can see their own limitations. If in doubt, do nothing. It may be hard to say no, but if someone is pressuring you to do something that seems to cross the line it's a red flag that they are not adequately informed to understand the risks....and that's a situation to be avoided.

Lastly, I want to remind you that we are a litigious society. While you may share some herbs with your best friends daughter who has an ear infection....remember that a skeptical grandmother or a critical physician may press charges in spite of parental consent - turn you into CPS - even if there is a good outcome. Feeling safe because of the 'Good Samaritan' law? That law is designed to protect lay people from acting in the absence of any other choices. Deciding NOT to go to the ER and treat an ear infection with herbs would not cover you. And finally be aware that the medical community and child protective authorities may be lenient with a mother doing home care ( but not always especially in my home state of Idaho)... But this is unlikely to extend to care you provide another child who is not a relative. Be wise. The risk of legal issues for you or another family should cause you to carefully consider 'the line'.