Patient-Centered Care vs. Disease-Centered Care in High Blood Pressure
As we’ve discussed, in health care, our usual focus is the person level of organization. In conventional medicine, there is a perspective called “patient-centered care.” Patient-centered care, which concerns itself with the issues of who-has-the-disease, is distinguished from disease-centered care, which concerns itself with the issues of what-is-the-disease. In other words, the person is more important than his/her disease label. A person with high blood pressure or hypertension has a problem that manifests in the cardiovascular system. When the heart relaxes between beats, the pressure in the arteries does not fall back down into a normal healthy range.
Sometimes this elevated blood pressure comes from a stiffening of the the walls of the blood vessels. We also know that drinking too much caffeine, being under emotional stress, and many other factors can contribute to higher blood pressure.
Disease-centered thinking in conventional medicine revolves around the cellular and molecular level of scale. However, research has shown that many of us prefer to have a relationship with a provider who gives us patient-centered care in the sense that we are informed about our disease(s) and all of our treatment options and participate in decisions about how to proceed (rather than being told what to do).
Rather than focus just on the elevated blood pressure, which is risk factor for other health conditions such as heart disease and strokes, it is essential to look at the various levels of scale where the problem is showing up.
Organizational Levels of Scale
As said before, you are a system unto yourself, but you are made up of other systems at lower levels of organizational scale (e.g., circulatory system, immune system); and you are a part of still other systems at higher levels of organizational scale (e.g., families, communities, living creatures on earth).
* Higher Level of Organization: For a complex living system, each next higher level of organization has emergent properties, that is, behaviors that the higher level can generate, but that its component parts at a lower level cannot (a person has” behaviors” that a liver or heart by itself does not).
At the same time, there is a bidirectional feedback loop of information, from the global to the local level and back the other way. It is the feedback that allows the global (person level) and local (body parts level) to influence each other’s function, that is, to define your unique “you-ness.”
Levels of Scale from a Systems Perspective
Another way of understanding the holographic qualities of health and healing is to look at levels of scale from a systems perspective – true holism. Many systems, especially living systems, have a self-similarity or theme (also called “fractality”), at every level of scale. The self-similarity is a geometric concept, in which an object is irregular but similarly irregular at every degree of magnification, i.e., close up and far away.
In conventional anatomy, the self-similarity occurs in body parts such as different levels of organization of the bronchial tree. In complementary therapies, the self-similarity is not in physical structure so much as it is in patterns of function or dynamics (change). People can be in self-similar ruts of disease, just as they can be in ruts with relationships or jobs. The same idea is true for processes and functions – such as you, your body, and your health in your life.
Thus, under environmental stress (psychological or physical in nature), a person prone to asthma may experience an asthma attack. Their “rut” is responding with anxiety and asthma under certain environmental challenges. A different person might respond to the same environmental factors with irritability and a migraine attack.
You are literally “doing your own [unique] thing” in your world. And, in chronic illness, you are doing your own unhealthy thing over and over. The names and faces (specific content or details) may change from event to event, but the storyline repeats the same process through time.