The polarization between reductive biomedical science and a whole person integrative model obscures deeper differences relative to human nature. The top-down, fix-it mode of the former is grounded in a fundamental belief that people (a.k.a. “patients”) either do not want to change or simply can’t. Meantime, the time-consuming, get-in-there-and-partner focus of lifestyle-oriented integrative practitioners assumes that the presenting human being arrives with seeds of change seeking ground for germination and growth. A recent Harris poll on perceptions of self-care among conventional medical doctors and their patients that was funded by the Samueli Foundation and led by its integrative health director Wayne Jonas, MD describes the chasm that has opened between the two parties. The patient is seeking an integrative model for self care amidst the present predication of medical delivery on the skeptical view of human nature.

The data in the online poll of 1,006 U.S. adults ages 18 and older and of 304 physicians specializing in internal medicine or family practice presents a compelling picture of dysfunction. Nearly all (96%) of physicians and believe self care is “essential” for their health and an even higher percent (97%) “feel their patients would benefit from a better understanding of self-care.” All good.  Yet at the same time “almost half of physicians (46%) believe their patients do not seem very interested in self-care.” (The full PDF of the report is here.)

That’s not what patients are thinking. Nearly as high a percentage (88%) seriously value self care. Nearly three-quarters (72%) wish their physicians engaged with them about it. Yet 75% of patients report not talking about self-care with their physicians in two years.  The fundamental building block of health is off the table. It’s easy to blame the time crunch of the system. Yet that doesn’t give justice to this apparent error in the operator’s conceits. Despite the non-engagement, the primary care doctors apparently concluded that patients are not interested.

The story deepens. As writer Kelly Gonsalves captured it at MindBodyGreen:

Weird, because 57% of patients say they want to talk to their doctors about what’s important in their lives, 66% wish their doctor would give them more self-care guidance, and 65% want their doc involved in “all aspects” of their health.

According to the full Harris report, “HEALTH AND SELF-CARE: A look inside patient and physician perspectives on self-care,” only 12 percent discussed life goals, 11 percent discussed social and emotional needs, 6 percent discussed spiritual or religious needs and 9 percent discussed the potential self-care tools of complementary or alternative medicine. The human being is hardly present.

The disconnect is startling. Regular medicine boasts of a value-based turn toward “patient-centered care.” This Samueli Foundation-funded poll is a chunk of the patients’ frank guidance. The request, at least from roughly two-thirds of patients, is for far more engagement toward self-care. It’s a call for change-making from human beings who do not see themselves as stuck in resignation’s mud.

The results only touch obliquely on the why of this missed connection. Nearly 60% of physicians say the demands of their jobs keep them from their own self care. Nearly 80% consider lack of time as the barrier to engaging patients. Beliefs also get in the way. Some 44% of patients believe self-care is only for those with time on their hands and 35% only those with money. For 28%, engaging in self-care is viewed as an indulgence.  Some restrictive assumptions about human nature are clearly evident in this set.

Jonas suggests two clinical models to bridge the gap. One is an integrative care model in which one practitioner seeks to fold more of the self care work into a solo practice. In an electronic note following a media briefing, Jonas suggested that use of his H.O.P.E. Note (Healing Oriented Practices and Environments) can be a tool that “does not require too much additional time from the physician – it is simply a way to restructure the patient-physician interaction to elicit insights into the social, behavioral, environmental, and spiritual components that enable patients to tap into their own inherent healing capacity.”

The other corrective model Jonas recommends is team-based care in which nutritionists, social workers, health coaches and others can guide patients in their self care interests. It was beyond the scope of the Harris Poll to torch the entire infrastructure of the medical industry that leans in hard against either of these changes.

Where work can begin is for practitioners to re-think their biases about patients in the light of these data. Both views of human nature noted at the top of this column can be self-fulfilling prophecies. Conviction that a person doesn’t want to, or have capacity to, make changes can justify drug and surgical tools. Success in promoting self care by implementing either the integrative care or team-based model will be enhanced if practitioners actively hold the patient-centered belief that these humans want to engage self-care activities.