System's theory and integrative studies provide the backbone for such a science. The whole healing model presented above contains within its structure sufficient latitude to embrace both reductive and holistic approaches, conventional and alternative. The primary care practitioner of tomorrow must be capable of carrying out his activities with an attention to the multi-factor influences on disease and health, and the full array of potential approaches to healing. This is best accomplished through an educational process that promotes a scientific perspective which includes an observational process that extends from the laboratory to the "bedside" and from there out to the family, community, and environment. Such a broad based science views the human experience from an ecological perspective rather than exclusively focusing on a reductive physiology-centered perspective. With such a background it becomes possible to both focus out in an ecologic manner and focus in with an analytic and reductive perspective.
It either instance, it is the eyes and ears that make both a good scientist, and also a good caretaker. The former allows for accurate outer observations and the latter for empathic listening, the essential component of a healing relationship. Empathic listening is the capacity of the listener to silence his own inner dialogue, which is invariably cluttered with personal perspectives, for the purpose of fully and non-judgmentally entering the experience of his client. This serves two purposes. First, given the limits of the human experience, it allows for the most accurate interview that is possible, as the practitioner is hearing the experience of the client spoken from the client's unique world view. Second, empathic listening is the basis of the trust and acknowledgement that are the cornerstones of a healing relationship. Empathic listening is a teachable skill, and in addition to training the practitioner in listening to others, it bestows a further gift, the capacity of the practitioner to listen to his own experience, an encounter which as a holographic microcosm provides him with a direct and highly empathic understanding of life outside of the boundaries of his skin.
Empathic listening requires self awareness and self-understanding, qualities that only arise from inner reflection. The image of the wise healer is an ancient one which existed long before the very recent emergence and dominance of the "wisdom" of the laboratory sciences. An educational process that devalues humanistic and aesthetic studies, emphasizes the rapid and unquestioned assimilation of technical knowledge, and promotes long an excessive hours in clinical training and practice does not leave time for the self reflection and personal maturation that characterize the wise healer. This has been a great loss for all of us, personally and professionally. The educational process of a practitioner must encourage a life long process of self-study that should occur within the context of a broader and more liberal education.
Thus far I have spoken of two important facets of the training of the new primary care practitioner: a knowledge of system's theory as it applies to issues of disease and health, and the capacity to mature with each client a healing relationship based on the trust and acknowledgement resulting from empathic listening. There is also the core content of the elements of clinical practice. For the physician, this resides in the skills and capacities related to an expanded biomedical model. For other practitioners the content will differ. As I have stated, each practitioner must learn that his approach is relativistic and culture based and therefore has "proprietorship", over only one segment of reality.
Given the array of healing modalities it becomes necessary for the primary care practitioner to have a large, accurate, and up-to-date information base at his "fingertips". As I have noted previously both the upsurge in interest in acquiring reliable research data on alternative approaches and the availability of online information will allow the primary care practitioner ready access to the information he needs. A fluency in online information gathering will invariably be a part of the future educational process.
I have mentioned a few of the key elements in the education and training of the new primary care practitioner. In many instance these elements were clearly seen and recommended by Abraham Flexner in his 1910 report on medical education, a report which re-shaped the character of medical education. Many have seen this report as the primary factor in the development of a medical curriculum that emphasizes reductionism. As George Engel points out, Flexner spoke for a broader based science whose essence has yet to be incorporated into medical training.13,14 The recent publication of the Pew-Fetzer Task Force Report on Advancing Psychosocial Education has providing us with further insights into the dynamics of a revised approach to the training of medical practitioners, one that unlike the Flexner report, a report which emphasized the importance of the clinical and laboratory sciences, re-asserts the primacy of the client-practitioner relationship.15
Reclaiming The Passion and Spirit of Healing
Rene Descartes, much as is our circumstance today, lived at a time of great change. When he published his Discourse on Method in 1637 the medieval world was disintegrating and a new world, a modern world of enlightenment and progress was slowly emerging. Although his firm believe in reason as the most reliable path to truth must be understood in the historical context of his time, it nevertheless resulted in the mind being split off from body, subject from object, and matter from spirit. Life was devitalized and the multi-demensional living process was no longer seen as a legitimate area of study or research.
There are two great streams of knowledge available to the human mind: (1) sensory based knowledge, and (2) intutive knowledge. When one way of knowing becomes over dominant its counterpart rises to restore balance. Descartes emphasis on the intellectual and sensory based observations was a necessary historical response to the over dominance of the preceding religious perspectives. We now discover that history has come full circle again. The dominance of sensory based knowledge has left us with a devitalized world, one that lacks meaning, purpose, and direction. It is in such circumstances that the human psyche constellates the opposing tendency, and we begin to become aware of the rise of intuitive knowledge and empathic understanding - the second great stream of knowledge.
It is only when these two streams of knowledge intersect that we feel, personally and culturally, the full creative potential of life. This is occurring in our time. For example, the rise in feminist principles, hologographic and chaos theories, the ecological movement, and the effort to bring a holistic viewpoint into medicine each share a common core, a resurgence of intuitive knowlege and empathic understanding which, in contrast to an intellectual sensory based knowledge, conveys a knowledge of patterns, relationships, and wholes. It is in the convergence and balanced use of these two ways of knowing that passion and spirit is fully released.
As healers begin to again approach their clients and the healing process using both their intellectual sensory based knowledge and their empathic intuitive knowledge the practice of medicine will be re-vitalized. Every individual will become another experiment, an anomaly to be studied, a unique expression of life. Each client will teach us something new about ourselves, expand our personal and professional horizons, and force us to approach healing with a mind that is emptied of standardized views of disease, health, and the human condition. We will be able to tap into our extraordinary technical and sensory based knowledge and apply it within the context of the meaning and purpose conveyed by an intuitive and empathic understanding of the circumstances of a unique individual life. We will be fully engaged, and our art will be fully restored.
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