Last week I wrote about bereavement care for surviving family members. The day the article went to press I attended the funeral of a family friend in the eastern part of the state. He was a well-respected 95-year-old true gentleman who had been a practicing physician for over 50 years. Hearing the words spoken at the funeral made me realize how complicated the context of my article last week had been because of a tangled web of healthcare and insurance companies. The solution is pure and simple:
About his practice as a physician, it is said that he treated the whole patient, not just the medical problem. Also, he treated not only the whole patient, but the whole family. Holistic care is caring for the person psychosocially, emotionally, mentally and physically. This concept is a fundamental part of nursing. His care delivery approach is heavily biomedical in focus. However, this does not exclude the physician from this valuable and effective perspective.
If you look back at the role of the physician, he was taking care of the whole patient and the whole family. And the village was taking care of the neighbor when it needed to. So family medicine and public health existed because of basic human decency.
As medicine advanced, it seemed that many physicians branched out into specialties, no longer treating the whole patient, but only treating specific illnesses. In the 1940s, the role and specialty of the general practitioner developed. In the 1960s, this specialty expanded into the specialty of family medicine, whose curriculum sought to “train new physicians in the old ways of relationship…the physician who understands the patient not only as a whole, but also in the context of the social unit of the family and also in the context of the patient’s environment.”
In my article last week, I forgot the history of small, independent clinics and best-of-breed local hospitals and focused on the systems and structural barriers to providing bereavement care as if it were a new concept. Medicine has made incredible advances, but holistic care often seems to get overlooked because it cannot be easily categorized or billed for.
Our society is filled with very large facilities where care is streamlined and delivered the same way whether you live in a big city or a rural area. Insurance can dictate which medications and procedures you can prescribe. The ability of health care providers to care for families who have lost loved ones does not easily fit into today’s system.
But doctors providing holistic care is obviously not a new practice. It took funerals for us to lift our heads from researching how to better serve grieving families and recognize that this is the most basic of cares: look at any Norman Rockwell painting and you see that doctor: we are all connected. We need to get back on the path of caring for patients, families, and villages, while recognizing that America’s fragmented health care system is flawed.
Dr. Kirwan T. McMillan has provided holistic care to generations of patients, their families, and the community. Patients are more than the sum of their symptoms. There are aspects of patient care that cannot be quantified or billed. Dr. McMillan’s legacy is a reminder of that. He was there for his patients in those brief moments of life, between tests and diagnoses, follow-up visits and medications. When we are at our weakest, when we need more than just a prescription refill or a portal check, he was there for those small human moments.
I hope the medical community remembers him and his former colleagues, learns from them, and stays focused on patients and their families. Improving our health care system will require major reforms, but individually we can make a strong start.
Rest in peace Dr. MacMillan. You did a great job in this life and I learned a lot from you.
Take care of yourself and others.
Juanita Karns is a nurse who lives in Westfield and has worked in the hospital emergency department and urgent care facility for 38 years. She served on the Westfield Board of Health for 30 years.
