Maganin zamani ba ya gazawa saboda rashin ilimi. Yana gazawa a ƙarƙashin nauyin kansa mai sarkakiya. An bayyana wannan zamani ta hanyar samun bayanai mara misaltuwa, fasahar zamani, hanyar sadarwa ta ƙananan ƙwararru da ke faɗaɗawa, da kuma tsarin gine-gine mai yawa na ka'idoji da ma'aunin aiki. Kusan kowane fanni na kula da marasa lafiya yanzu ana iya aunawa, ƙididdigewa, da daidaita su. Shiga tsakani da ba a iya tunanin su ba shekaru da yawa da suka gabata yanzu sun zama ruwan dare. Duk da haka duk da waɗannan ci gaba, wani muhimmin abu ya lalace. Wannan rushewar falsafa ce.
Magani ya tara ƙwarewa mai ban mamaki, amma ya rasa fahimtar manufa. Bugu da ƙari, yana aiki a matsayin tsarin da aka inganta don ayyuka maimakon sana'a da aka tsara wa marasa lafiya. Bambancin yana da sauƙi amma yana da mahimmanci. Ba tare da fahimtar manufarsa ba, magani yana fuskantar haɗarin zama ingantaccen tsari wanda ke ba da kulawa ba tare da fahimtar mutumin da yake yi wa hidima ba.
A ƙarni na 12, Maimonides (Rabbi Moses ben Maimon [1135–1204], wanda aka sani da Rambam), ɗaya daga cikin fitattun masana falsafa na tarihi kuma likitan kotu a Masar, ya yi aikin likitanci a zamanin da babu binciken zamani, gwaje-gwajen da ba a yi ba, ko kuma kula da hukumomi. An horar da shi a cikin al'adun ilimin Andalusian da na Musulunci, kuma falsafar Girka ta yi tasiri sosai, ya haɗa lura ta gwaji tare da tunani mai zurfi da alhakin ɗabi'a. Duk da cewa bai da kayan aikin zamani, yana da wani abu mafi mahimmanci: bayyananne. A cikin Tsarin Lafiya, ya yi ikirarin cewa babban nauyin da ke kan likitan shine kiyaye lafiya maimakon kawai magance cututtuka¹. Wannan ƙa'ida ta bambanta da tsarin zamani, wanda galibi ke fifita shiga tsakani fiye da rigakafi.
Likita A Matsayin Mai Ilimin Hankali Maimakon Mai Fasaha
Maimonides ya ɗauki magani a matsayin fannin ilimi wanda ya samo asali daga lura, tunani, da daidaitawa. Rubuce-rubucensa na asibiti koyaushe suna jaddada kulawa ta musamman da aka jagoranta bisa ga hukuncin likita, maimakon bin ƙa'idodi na gabaɗaya². A cikin samfurinsa, likitan ba kawai ƙwararren masani ne ba, amma ƙwararren mai tunani ne wajen shawo kan rashin tabbas.
Maganin zamani yana ƙara jaddada bin ƙa'idodi. Ka'idojin asibiti da ƙa'idoji, kodayake suna da amfani, sun faɗaɗa har ta kai ga suna bayyana aiki maimakon kawai su sanar da shi. Maganin da aka yi amfani da shi bisa shaida, wanda aka fara ɗauka a matsayin haɗa ƙwarewar asibiti tare da mafi kyawun shaidar da ake da ita, yanzu ana aiwatar da shi akai-akai azaman bin ƙa'idodi masu tsauri.
Idan aka yi amfani da bin ƙa'idodi a matsayin babban ma'aunin inganci, ana ɗaukar karkacewa a matsayin haɗari. Duk da haka, babu wani majiyyaci da ya yi daidai da yawan mutanen da aka yi nazari a kansu a gwaje-gwajen asibiti. Maimonides ya fahimci wannan a ɓoye, yana kula da mutane maimakon ƙididdigar ƙididdiga. Wannan bambanci ba wai kawai falsafa ba ne; yana da sakamako mai amfani a gefen gado. Likitan da aka horar don bin ƙa'idodi na iya ba da kulawa ta fasaha, amma ya kasa gane lokacin da majiyyaci ya faɗi a waje da yanayin da ake tsammani.
Sabanin haka, likita da aka horar don tunani zai iya gano bambance-bambance, daidaitawa a ainihin lokaci, da kuma ƙalubalantar zato idan ya zama dole. Tsarin Maimonides ya buƙaci haɗin kai na hankali tare da kowace hulɗar majiyyaci. Tsarin zamani, a ƙoƙarinsu na daidaita kulawa, suna haɗarin rage wannan hulɗar. Sakamakon ba lallai bane magani ne mara daidai ba, amma sau da yawa magani ne mara cikakke.
Rigakafi A Matsayin Babban Ka'idar Kula da Lafiya
Maimonides ya sanya rigakafi a matsayin babban ka'idar magani. Shawarwarinsa game da abinci, motsa jiki, barci, da daidaiton motsin rai suna nuna fahimtar tsarin kula da lafiya a matsayin babban alhakin likita¹. A cikin tsarinsa, cuta galibi tana faruwa ne sakamakon rashin daidaito.
Maganin zamani ya fahimci mahimmancin rigakafi amma, a tsarinsa, yana ƙarfafa shiga tsakani. Gudanar da cututtuka na yau da kullun galibi yana da alaƙa da magunguna, yayin da masu yanke shawara na sama ke samun kulawa mai ƙarancin tsari. Wannan yanayin yana nuna ƙarfafawa ta tsari maimakon rashin fahimtar kimiyya. Frieden ya yi jayayya cewa ingantaccen yanke shawara na asibiti dole ne ya wuce gwaje-gwajen da bazuwar don haɗa fa'idodin fa'idodi na lafiya. Tsarin Maimonides ya yi hasashen wannan hangen nesa ƙarni da yawa da suka gabata.
Wannan rashin daidaito yana bayyana musamman a cikin kula da cututtuka na yau da kullun, inda hanyoyin magani suka bayyana sosai, amma dabarun rigakafi suna ci gaba da aiki ba tare da wata matsala ba. Marasa lafiya na zamani galibi suna shiga tsarin kiwon lafiya bayan cutar ta riga ta ci gaba, wanda a wannan lokacin hanyoyin magancewa sun fi rikitarwa, sun fi tsada, kuma ba su da tasiri. Mayar da hankali kan halaye na yau da kullun (misali, abinci mai gina jiki, motsi, da matsakaici), yana nuna fahimtar cewa ana gina lafiya akan lokaci maimakon a dawo da shi a lokaci-lokaci. Wannan yanayin magani na ɗan lokaci sau da yawa ba a yaba shi sosai a cikin samfuran kulawa na zamani.
Haɗakar Lafiyar Hankali da ta Jiki
Maimonides ya fahimci cewa lafiyar motsin rai da ta jiki ba za a iya raba su ba. Ya bayyana tasirin yanayin tunani akan aikin jiki kuma ya jaddada cewa magani mai inganci dole ne ya magance duka biyun.
Abin takaici, tsarin kula da lafiya na zamani sau da yawa yana raba wannan haɗin kai. Ilimin halin ɗan adam, maganin ciki, da lafiyar ɗabi'a galibi suna aiki a layi ɗaya maimakon a cikin tsari mai haɗaka. Saboda haka, majiyyaci ya rabu zuwa tsarin da yawa. Epstein da Street sun nuna cewa kulawa mai mayar da hankali kan majiyyaci tana buƙatar fahimtar cikakken mahallin ƙwarewar majiyyaci¹². Hanyar Maimonides ta ƙunshi wannan ƙa'ida.
Rarrabuwar kulawa kuma tana canza fahimtar likita game da alhakin. Lokacin da aka sarrafa fannoni daban-daban na majiyyaci ta hanyar tsarin daban-daban, alhakin ya zama bazuwa. Babu wani likitan da ke da alhakin haɗa duka. Hanyar Maimonides ta kauce wa wannan rarrabuwa ta hanyar buƙata. Tsarinsa a bayyane yake buƙatar likitan ya haɗa abubuwan jiki, motsin rai, da muhalli cikin fahimtar juna game da majiyyaci. Wannan alhakin haɗin kai yana da wahalar dorewa a cikin aikin zamani.
Aikin Ɗabi'a Tsakanin Matsi na Tsarin Mulki
Ga Maimonides, magani ya kasance abin koyi ga ɗabi'a. Aikin likitan ba tare da wata shakka ba ne: ya yi aiki don amfanin majiyyaci. Likitoci na zamani suna aiki a cikin tsarin da aka tsara ta hanyar matsin lamba na gudanarwa, kuɗi, da na shari'a. Relman ya bayyana fitowar "tsarin likitanci-masana'antu," wanda ƙarfin tattalin arziki ke tasiri ga isar da kulawa¹⁰.
Sakamakon waɗannan matsin lamba na tsarin yana bayyana a fili a cikin yawan gajiyar likitoci. Shanafelt da Noseworthy sun danganta wannan lamari da matsin lamba na tsarin da ke raunana gamsuwar aiki⁹. Wannan an fi bayyana shi daidai da raunin ɗabi'a: rashin iya yin aiki akai-akai bisa ga wajibai na ɗabi'a.
Wannan sauyi yana da tasiri fiye da lafiyar likita. Yana shafar amincewa. Marasa lafiya ba za su fahimci cikakken iyakokin tsarin da likitoci ke aiki a ƙarƙashinsu ba, amma sau da yawa suna jin lokacin da kulawa ta hanyar tsarin ne maimakon hukunci. Rushewar aminci a cibiyoyin kiwon lafiya na iya, a wani ɓangare, nuna wannan rashin haɗin kai. Tsarin Maimonides, wanda ya dogara kan takalifi kai tsaye tsakanin likita da mara lafiya, ya kiyaye wannan amana ta hanyar ƙira.
Hulɗar Ilimi, Iko, da Rashin Tabbas
Maimonides ya yi aiki tukuru da ikon ilimi amma bai yi kasa a gwiwa ba. Ya yi nazari sosai kan ilimin da ya mamaye kuma ya jaddada yanayin fahimta na ɗan lokaci.
Duk da tushen kimiyya, maganin zamani na iya karkata zuwa ga aikin da hukuma ke jagoranta. Jagorori da maganganun yarjejeniya na iya zama masu tsauri fiye da tushen shaidarsu. Djulbegovic da Guyatt sun nuna rashin jituwa tsakanin shaidun da aka daidaita da kulawa ta musamman. Yawan tabbacin zai iya hana bincike.
Kulawa ta Kai-tsaye da Hanyoyin da suka shafi Jama'a
Bayanan da suka dogara da yawan jama'a suna da mahimmanci, amma a zahiri suna da iyaka. Manufar "matsakaicin majiyyaci" ta kasance wani abu da ba a iya fahimta ba. Maimonides ya yi wa mutane magani. An daidaita tunaninsa na asibiti da takamaiman majiyyaci maimakon daidaita majiyyacin da wani samfuri.
Montori da abokan aikinsa sun jaddada cewa kulawa mafi kyau tana buƙatar haɗa shaidu tare da mahallin mutum da dabi'u¹⁵. Wannan ƙa'ida ta yi daidai da tsarin Maimonides. Duk da haka, ƙananan masu samar da kiwon lafiya na zamani ne ke amfani da ita.
Ci gaban Fasaha a Rashin Ka'idojin Jagora
Ba a taɓa samun irin wannan fasahar zamani a fannin likitanci ba. Duk da haka, fasaha ba ta da wani amfani a zahiri; ƙimarta tana nuna fifikon tsarin da ake amfani da shi a ciki.
Topol ya yi jayayya cewa ƙirƙirar fasaha na iya dawo da yanayin ɗan adam na magani⁸. Duk da haka, bayanan likitanci na lantarki sau da yawa suna karkatar da hankali daga majiyyaci zuwa ga takardu. Verghese ya bayyana tsarin da majiyyaci ya zama na biyu ga wakilcin dijital¹⁴. Sakamakon haka, haɗuwar asibiti tana fuskantar haɗarin bin diddigin takardunsa. Maimonides ya yi aikin likita ba tare da taimakon fasaha ba, amma ya ci gaba da kasancewa a wurin.
Fasaha, idan aka haɗa ta da tunanin asibiti, tana ƙara kulawa. Idan ta maye gurbin tunani, tana takaita ta. Bambancin ba ya cikin kayan aikin kanta ba ne amma a cikin rawar da take takawa a cikin haɗuwar asibiti. Aikin Maimonides ya nuna cewa rashin fasaha ba ya hana ingantaccen magani, yayin da ƙwarewar zamani ta nuna cewa kasancewar fasaha ba ta tabbatar da hakan ba. Kalubalen ba shine iyakance ci gaban fasaha ba, amma a tabbatar da cewa ta kasance ƙarƙashin hukuncin asibiti.
Muhimman Abubuwan da Aka Rasa da Bukatar Murmurewa
Cassell ya jaddada cewa magani dole ne ya magance wahala, ba kawai cuta¹¹ ba. Wannan ya yi daidai da tsarin Maimonides. Starfield ya bambanta tsakanin kulawa mai mayar da hankali kan marasa lafiya da kulawa mai mayar da hankali kan mutum, yana mai lura da cewa kulawa ta gaskiya dole ne ta magance mutum fiye da lakabin cututtuka¹³. Maimonides ya yi wannan ta hanyar halitta.
Abin da aka rasa ba ilimi ba ne da kansa. A'a, haɗin kai ne.
karshe
Maimonides ba wai yana nuna sha'awar tarihi ba ne, amma wani mizani ne da har yanzu ba mu sake gano shi ba. Maganinsa ya dogara ne akan ƙa'ida: rigakafi fiye da shiga tsakani, hukunci akan bin doka, mutum fiye da matsakaici, ɗabi'a fiye da dacewa.
Magungunan zamani suna da kayan aiki masu ban mamaki. Amma ba tare da falsafar jagora ba, waɗannan kayan aikin suna fuskantar haɗarin amfani da su ba tare da alkibla ba.
Ba za a tantance makomar magani ta hanyar yawan abin da za mu iya yi ba.
Za a tantance ko mun tuna dalilin da yasa muke yin hakan. Domin tsarin da ke auna komai, yana daidaita komai, kuma yana sarrafa komai, amma ya kasa fahimtar majiyyacin da ke gabansa, ba shi da ci gaba. Bai cika ba. Kuma idan ba a gyara shi ba, yana da haɗarin zama wani abu mafi haɗari fiye da maganin da ya tsufa:
Ya zama magani wanda ba ya san menene shi ba.
References
- Maimonides M. Tsarin Lafiya. An fassara ta Bar-Sela A, Hoff HE, Faris E. Philadelphia: Ƙungiyar Falsafa ta Amurka; 1964.
- Maimonides M. Rubutu Kan AsmaA cikin: Rosner F, edita. Rubuce-rubucen Likitanci na Moses MaimonidesNew York: Ktav Publishing; 1971.
- Djulbegovic B, Guyatt GH. Ci gaba a fannin likitanci bisa shaida: kwata na ƙarni a kan. Lancet. 2017; 390: 415-423.
- Rosner F. Gadon Lafiya na Moses MaimonidesHoboken: KTAV Publishing; 1998.
- Rosner F. Maimonides a matsayin likita. Jama. 1965;194(9):1011–1014.
- Frieden TR. Shaida don yanke shawara kan lafiya—bayan gwaje-gwajen da aka yi bazuwar, waɗanda aka sarrafa. N Engl J Med. 2017; 377: 465-475.
- Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Maganin da ya dogara da shaida: menene shi da abin da ba shi ba. BMJ. 1996; 312: 71-72.
- Topol EJ. Magani Mai Zurfi: Yadda Fasahar Zamani Za Ta Iya Sake Sa Kula da Lafiyar Dan AdamNew York: Littattafai na Asali; 2019.
- Shanafelt TD, Mai Hana Hana JH. Jagorancin zartarwa da lafiyar likitoci. Mayo Clin Proc. 2017;92(1):129–146.
- Relman AS. Sabuwar cibiyar likitanci da masana'antu. N Engl J Med. 1980; 303: 963-970.
- Cassell EJ. Yanayin wahala da manufofin magani. N Engl J Med. 1982; 306: 639-645.
- Epstein RM, Titin RL. Dabi'u da ƙimar kulawar da ta shafi marasa lafiya. Ann Fam Med. 2011;9(2):100–103.
- Starfield B. Shin kulawar da ta shafi marasa lafiya iri ɗaya ce da kulawar da ta shafi mutum ɗaya? Perm J. 2011;15(2):63–69.
- Verghese A. Girgizar al'adu—mai haƙuri kamar alama, alama kamar mai haƙuri. N Engl J Med. 2008; 359: 2748-2751.
- Montori VM, Brito JP, Murad MH. Mafi kyawun aikin likitancin da ke da shaidar shaida. Jama. 2013;310(23):2503–2504.
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Joseph Varon, MD, likita ne mai mahimmanci, farfesa, kuma Shugaban Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru. Ya rubuta fiye da 980 wallafe-wallafen da aka bita kuma yana aiki a matsayin Babban Editan Jarida na Magunguna Mai Zaman Kanta.
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