The first point addressed by Clark's review determines that a fundamental change in medical perspective had begun to transpire with the assumption of varying clinical research investigations on the subject.
This would contribute to what Clark identifies as a major shift in the way that physicians had begun to perceive and treat terminal illness. As opposed to a cut and dry preparation of the patient for the certainty of death, Clark points to a juncture in the mid to late 20th century at which medical professionals had begun to adopt "an active rather than a passive approach to the care of dying people was promoted in which the fatalistic resignation of the doctor ('there is nothing more we can do') was supplanted by a determination to find new and imaginative ways to continue caring up to the end of life." (Clark, 2002) In addition to serving as a fundamental motivation for the continuing investigation of ways to extend life expectancy with or without the presence of supposedly terminal illness, the optimism here reflected serves to improve the quality of life for those in the final phases. The simple expression of optimism -- not unrealistic or patronizing but conducive of an emotionally connected assurance that all possible measures will be taken to preserve life -- can have the impact of promoting a sense of value and support for one on the cusp of death. Even where life cannot be preserved, the expression of optimism suggests that these moments of life can be made more tolerable by the perspective taken by healthcare providers.
This idea speaks to another fundamental inflection point in the way that healthcare professional have begun to treat the emotional orientation of patients. Clark points to a "growing recognition of the interdependency of mental and physical distress created the potential for a more embodied notion of suffering, thus constituting a profound challenge to the body-mind dualism on which so much medical practice of the period was predicated." (Clark, 2002) This period, late in the 20th century, has led us to the current consensus that there is indeed a real and tangible value to the emotional fortitude of one enduring a physical breakdown. The presence of hope in the healthcare provider, we can clearly see, is likely to improve the prospect that even a terminally ill or age-advanced patient might adopt a hopefulness as well. This speaks to the opportunity for the healthcare provider to display personality through interest in the patient's emotional disposition. The patient is likely to respond positively where capable to indications of an interest beyond the physical body. This has even greater implications to a patient's life than a single visit or stay in the hospital though.
This is to indicate that the emotional disposition and preparation which the individual undergoes in the individual health circumstance will correlate to a lifetime of experience with the healthcare system. Positive and negative experiences involving hospital visits, concerning interactions with physicians and relating to past health concerns will precede one's entrance into a new healthcare experience. Therefore, one's emotional constitution can have a direct relationship to a history or pattern that speaks positively or negatively to expectations for a hospital or physician visit. According to the text by Zerbe et al. (2006), "it is suggested that in healthcare it is the patients' journey through their lives (the macro contest), as well as their individual encounters with the system at different times of need (the micro context), that iteratively constitute the construction of the emotional terrain." (Zerbe et al., 146)
This principle of emotional terrain transcends the concept of emotion relating to a single physician visit or stay in a hospital or long-care facility. The patient will bring with her the weight of all manner of experiences. For adult and senior healthcare patients, a visit to or stay at a healthcare facility will be given emotional prelude by a personal history in which poor treatment by healthcare professionals, long waits for treatment in hospital emergency rooms, negative outcomes as a result of treatment practices or even a long lapse in medical attention manifesting as an unfamiliar fear of the hospital and the implications of serious diagnoses can have a stultifying psychological impact. Indeed, as discussed here throughout, this can have distinctly negative treatment outcomes. To the text by Zerbe et al., this functions as an indicator that there is a need for medical practitioners and facilities throughout the healthcare sector to approach all patients through a continuum of positive emotional orientation. Standards dictating facility orientation should...
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