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Dehumanised in the hospital – who is to blame?

TAUREEF MOHAMMED “WHO are you?” the doctor said. The patient looked confused. The doctor rephrased: “Tell me about yourself.” The elderly, widowed mother of four glanced back and forth between her son and daughter, still confused. “I know what they (the referring doctors) have said about you,” the doctor said, pointing to the computer, “but what do you have to say about you? Where were you born? What kind of work did you do in the past?” And then the story – including the diagnosis – rolled out effortlessly over about 30 minutes, with the doctor having to do – or say – very little. It was the most effortless assessment of a medically complex patient that I had witnessed as a junior doctor observing a senior doctor do their thing. The visit started with a jolt. Everybody – including myself – was taken aback by the doctor’s opening lines. Maybe I had never heard a doctor say those lines before to a patient, so it took me by surprise – it seemed novel. If I’d heard it before, it definitely was not the norm. Because today in medicine, by and large, we don’t treat people anymore – those days are gone. We treat diseases, organs, and, not infrequently, ourselves, doing what we think is best for the kidney, heart, lungs, and – with no lack of encouragement from Hollywood – our egos. So why ask about such pointless details like hobbies, occupation, and a person’s family life? They are irrelevant in the doctor’s office today. In the doctor’s office today, you are more likely to be asked to describe the pain – sharp, dull, location – as though the pain is some kind of separate entity living inside your body, rather than being asked to describe your experience as a human with pain. Medicine has become so depersonalised that it would make no difference, for example, if it was a gallbladder sitting in the doctor’s office or a human. That someone is admitted to a hospital and is seen and treated as a heart walking around on two legs or a pair of kidneys lying down in a bed being dialysed three times per week is not some kind of dark dystopia – it is, too many times, the reality. Yes, it is messed up. Have we doctors simply become cold individuals wrapped up in white coats and colourful scrubs? No. That is too simple an answer. The issue of dehumanisation in medicine is more complicated than simply blaming it on a callous surgeon acting as though she is talking to a gall bladder. Alas, the surgeon is a victim, too. In an article in the journal Perspectives on Psychological Science, Omar Haque, psychiatrist and social scientist at Harvard University, and Adam Waytz, psychologist at Northwestern University in the US, described the causes of dehumanisation in medicine. “Dehumanisation in medicine does not necessarily result from malicious intent on the part of caretakers,” they pointed out. Instead, they suggested, dehumanisation in medicine was the by-product of “common and otherwise effective medical practices and institutional situations.” Some level of dehumanisation, they explained, referencing other behavioural and neuroscientific studies, was necessary to solve complex clinical problems. They said the mechanisation of the human was necessary to problem-solve, adding “doctors often have to sacrifice empathy for cognitive objectivity.” The role of every physician, Dr Haque and Mr Waytz wrote, was “in effectively balancing empathy with cognitive problem-solving skills,” and aiming to find the “golden mean.” Other practices and institutional norms were unnecessary and could be discarded, among them the white coat. Drawing an analogy with soldiers in uniforms, white coats, they explained, were like uniforms that impersonalised and anonymised doctors, “diminishing their feelings of culpability for their actions,” How ironic, they wrote, that “white coat traditions (which originated in the US, and continues to be common in North America) may serve to prevent medicine from being as humane as it could become.” Other unnecessary practices the researchers highlighted were stripping patients of their dignity by covering them in hospital gowns that barely covered their private parts; identifying patients by numbers; and labelling patients with their diseases (Mr R is a diabetic). Practices that dehumanise patients are pervasive and, in some cases, intrinsic to the practise of medicine today. How do we fix the problem? The researchers made several suggestions, one of which was simply finding out who is the patient with the disease, getting the answer to the question: who are you? Taureef Mohammed is a physician from TT working in Canada E-mail: taureef_im@hotmail.com The post Dehumanised in the hospital – who is to blame? appeared first on Trinidad and Tobago Newsday.