The virtuous cycle
James Fleck: Anticancerweb 12 (08), 2020
The practice of medicine presumes a strong connection with the patient. Empathy, which supports doctor-patient relationship, is a cognitive process. It is the result of experienced medical care, in which the doctor has the ability to identify and understand the nature of the patient's feelings. Empathy depends on sensitivity, but goes further, as it implies psychological learning. The cognitive approach is an essential part of multidimensional patient care, leading to a synergistic relationship between the intelligences of both, doctor and patient. The cognitive approach in the doctor-patient relationship applies the concept of collective intelligence in health care. Studies have shown that the quantification of collective intelligence is generally greater than the simple arithmetic addition of individual intelligences (factor c). However, doctor and patient must speak a clear and simple language, a fundamental condition for generating collective intelligence. This is the first step in overcoming natural challenges and achieving fruitful communication. The advantages are bilateral. The patient understands the disease and modulates his behavior to facilitate problem solving. The physician obtains greater effectiveness in the proposed interventions, better understanding how to deal with the patient's subjectivity. This is the basis for creating a virtuous cycle.
The essence of the virtuous cycle is subliminal. It is supported by immaterial values. These values should not be understood as essential human needs, such as survival, security, belonging, self-esteem and self-realization. These needs are basic and explicit. The lack or deficiency of any essential need is responsible for varying degrees of unhappiness and/or social problems. Addressing human needs should routinely be the first medical intervention. Through a structured health system, the physician will seek in multidisciplinary care the best way to meet the essential human needs of his patient, even if temporarily. It is an effort of professional and family cooperation to restore patient's dignity. Only from that moment it is possible to work with immaterial values. These values are individual, specific and often difficult to identify. Exercising empathy, at the interface with the patient, the doctor will have to unveil his scale of immaterial values. Using the scale, it is possible to identify a predominant value, which I called the anchor value. This is the key to starting the virtuous cycle. Once the anchor value has been identified, the doctor will use it as an interactive resource, strengthening the doctor-patient relationship. The anchor value will facilitate the aggregation of other immaterial values, creating a virtuous circle, promoting collective intelligence and improving the cost-effectiveness of the proposed interventions. In October 2019, I presented at the ASCO Breakthrough: A Global Summit for Oncology Innovators, held in Bangkok, the preliminary results obtained with the use of collective intelligence in assisting cancer patients. In the figure below, you will find a representation of the virtuous cycle and the central role of the anchor value in the integration of multiple immaterial values.
Collective intelligence can be exercised through clinical simulations. The table below shows six clinical simulations. In each clinical simulation you will find the primary tumor of the fictional patient and the anchor value that guided the doctor in the generation of the virtuous cycle. Reading each clinical simulation, you will see how the virtuous cycle creates collective intelligence, improving doctor-patient relationship.
You can better understand how the anchor value generates collective intelligence by activating the link below, which gives you full access to all clinical simulations published sequentially on Anticancerweb:
1. James Fleck: Conexão Anticâncer: As múltiplas faces do inimigo interno, Editora Movimento, 320p, Porto Alegre, 2013
2. Anita Williams Woolley, Christopher F. Chabris, Alexander Pentland, Nada Hashmi, Thomas W. Malone: Evidence for a Collective Intelligence Factor in the Performance of Human Groups, Science Express: September 31st, 2010 DOI: 10.1126/science.1193147
3. James Freitas Fleck, Ricardo Preger, Luis Fernando Venegas, Henrique Träsel: Multidimensional Integrative Medicine applied to Outpatient Cancer Treatment in Southern Brazil: Preliminary Cost-Effectiveness Analysis, ASCO Breakthrough: A Global Summit for Oncology Innovators, Bangkok, Thailand, October 2019