That’s one of my favourite Kevin Spacey movie lines.
It’s a phrase which often comes to my mind in relation to health care. We’ve developed a very bureaucratic way of providing health care in Europe and North America. It seems to me that the system comes first now instead of the patients and the doctors.
Health care is a supremely human activity. It involves one human being trying to help another. Both of those human beings are unique and when we reduce the patient to a case of a disease and a doctor to a person who implements a protocol then we de-humanise Medicine.
I think it is important to prioritise uniqueness. We should always be on the lookout for what is new and what is different in every situation. Instead the bureaucratic approach demands we look for what is the same and fit everyone into pre-set categories and treatment paths.
Does anyone know you better than you do? Does anyone really know better what choices you should be making instead of the ones that you are making? Who should finally decide what to do about your life? (How you should eat, how you should spend your time, what “treatments” you should subject yourself to?)
I think it is you!
So when I hear a manager or a “skeptic” tell a patient that they can’t have the treatment which they say is the one which made the most difference for them (relieved their pain, settled their panic attacks, made their breathing easier….whatever) because the “evidence” says that treatment “doesn’t work”, it amazes me.
There not a treatment on the planet which does the same thing for every person who receives it, so there is no such thing as only two categories of treatment – those which work and those which don’t – as some would claim. We need a wide diversity of treatments to be available because human beings are so, well, different….
But I think about this not only in relation to rationing health care, protocol based medicine and so on. I think it’s something to consider in every therapeutic relationship. Here’s the question I’m exploring –
Is it an expert’s job to tell people what to do, or to help them to see how to change, then to support that change?
I’m pretty sure I don’t want anyone telling me what to do!