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Megélés és megítélés

2009.12.21

Megélés és megítélés

 

Gondolataink különböző utakon járnak és a dolgokon nem ugyanazt értjük.

Betegség folyam két oldalán áll az orvos és a beteg. Összeköti és elválasztja őket hömpölygő ár. Azonos szavakat használnak, azonos jelekről beszélnek, de nem ugyanazt értik a magon és természetesen, az okon és okozaton. Organikus betegségek esetén közelebb van, funkcionális eltéréseknél távolabbra kerül a túlpart.

Az orvos visszatérő, vagy állandóan meglévő panaszok esetében arra törekszik, hogy minél hamarabb „kézzelfogható” jól értelmezhető diagnózishoz jusson. A beteg a tünetek enyhülését, vagy megszűnését szorgalmazza.

Azok a jelenségek, amikor a tünetcsokorhoz strukturális vagy biokémiai eltérések nem csatlakoznak sokáig kizáráson alapuló, időnként pejoratív felhangú diagnosztikus kosárba kerültek.

A közelmúltban ezeket a megbetegedéseket legalább 3 meghatározó területen alapvetően új megvilágításba helyezte. Haladás történt a patogenetikai háttér megértésében. Elfogadták a tüneteken alapuló diagnózis lehetőségét és egyénre szabott lépcsőzetes kezelési stratégiát vezettünk be.

A funkcionális gasztroenterológiai kórképek palettáján a panaszok, tünetek, diagnózis, hatékonyabb kezelés többé-kevésbé objektivizálható puzzle darabjai előtt, mögött, felett egy harmadik-negyedik dimenzióban egy további felület, egy mostohagyermek, a szubjektívum világa munkál. Erre az orvosi irodalomban a megélt élet minősége fogalmát javasolják.

A quality of life összegző kép, ami arról ad felvilágosítást, hogy hogyan éljük mindennapjainkat. Olyan tényezők együtteséről van tehát szó, amelyek tartalmához hozzátartozik a nemzeti hovatartozás, a családi miliő, a munkavégzés, az életszínvonal és még ki tudja, hogy mi minden. A betegség kialakulása, vagy fennállása megváltoztatja azt a prizmát, amelyen keresztül a közérzet fogalma tükröződik.

Az egészségi állapottal összefüggő életminőség fogalma nem a diagnózis sikerességére, nem a kezelés költség-hatékonysági elemzéseire, hanem magára a betegre, az érintett egyénre fókuszál. Ha ezt a felületet nem vonjuk be a klinikai döntéshozatali rendszerünkbe, akkor azoknak a bizalmát veszítjük el, akiknek állapotának javítására vagyunk hivatottak. A funkcionális gasztroenterológiai betegségek kritériumai között a társuló gyakori pszichológiai eltéréseket nem kvalifikálták, pedig a panaszhordozásban a tünetek felmutatásában ezek szerepe meghatározó. A perszonalitás a szimptómákat messzemenően kolorálja.

A funkcionális szindrómákban a beteg és orvos egymáshoz való viszonya alapvetően befolyásolja a tünetek változását, tehát a beteg által megélt élet minőségét. Az orvos és a funkcionális gasztroenterológiai kliens kétoldalú kapcsolata tehát a kezelés eredményének kulcsa, eredménytelenségének pedig forrása.

Az orvos-beteg kapcsolata egy ismét és ismét újrarendezett előadás, ahol változnak a díszletek és emberöltőkként könyörtelenül változik a szereposztás. A rendszert mindenképpen meghatározza egy a korokon és korszakokon átnyúló, nehezen vázolható atmoszféra. A találkozásokat különös hangulat hatja át. Az előadás élt és jelenleg is él. Az alapszituáció a talán személytelen, de bensőséges kapcsolat mit sem változott.

A rendszert a társadalom evolúciója nem kerülte el. Az orvos és a szolgáltatást igénybe vevő páciens között kommunikációs zavar alakult ki. A kölcsönös bizalmat a kölcsönös bizalmatlanság foglalta el. Az olló nyílik, a megélés és megítélés távolsága nő.

A gasztroenterológiai betegségek megközelítésénél az orvos nem térhet ki a páciens személyi adottságainak akceptálása elől, mert ez az út, amely segítheti a megélés átgondolását és ezen keresztül a megítélés pontosságát.

A kettősség űrje lehet, hogy oldódik. A megváltozott attitűd ellenére is átívelő hidak épülnek. Egyrre szorosabb információláncok kötik össze újra az orvost és a beteget. Új kötelékek alakulnak ki. Új szemlélet jelentkezik, új igény fogalmazódik meg. A beteg, az érintett szubjektív megítélésének a súlya nő. Itt az alkalom a közeledésre. Az orvos azonban objektivizálható, leszabályozott falak mögül jelenleg védekezik. A szabály, a rend erősödik. Minőség, átláthatóság, ellenőrizhetőség és gazdaságosság vezeti döntéseinket. A beteg által megélt élményanyag súlya ismét halványodik.

Új évezred számtani kezdetén az orvoslásban a megélés és a megítélés ismét távolodik. Rövid pillanat volt csupán a megértés. Lehet, hogy elmúlt. Egyre több szakmában újra éled a vágy, megismerni és befogadni az orvoslás tárgyának, a beteg embernek megélt változásait. Életminőség, egészségi állapottal összefüggő életminőség- vagy betegségspecifikus kérdőívek kísérlik meg pótolni az elfelejtett szót. A megélt betegségélményeket azonban másképpen ítéli meg a páciens, a vizsgáló eszközt alkalmazó, vagy a gazdasági szakember, egészségügyi döntéshozó. Ékek kerültek a megélés és megítélés oszlopai közé. Most már nem csak a beteg és orvos ítél eltérő módon, hanem megjelenik a jobbító, vagy végrehajtó bürokrata döntésvilága is. Egy szakadék helyett több alakul ki. Meg kell újra próbálni megértéssel öntözni a megélés és megítélés széthúzó ágait.

 

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