Heroes Not Zombies

Pamela Hartzband, MD and Jerome Groopman MD from the Beth Israel Center writing in the New England Journal of Medicine make a strong plea for a return to professionalism and humanity in health care. Here’s the problem, as they see it….

We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized. Hospitals and clinics should be run like modern factories and archaic terms like doctor, nurse and patient must therefore be replaced with terminology that fits this new order

It strikes me this current model of health care is not sustainable. Drug costs are spiralling way out of control and those in power seem to think the answer to health problems is to use a “Fordist” solution, creating health care facilities as factories – treating the mass with pre-ordained treatment plans delivered by people with technical skills.

They highlight the distorted use of “evidence based” approaches as a key problem

the new emphasis on “evidence-based practice” is not really a new phenomenon at all. “Evidence” was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies. But the exercise of clinical judgment, which permitted the assessment of those data and the application of study results to an individual patient, was seen as the acme of professional practice. Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.

This “industrial” way of delivering health care diminishes the professionals as much as it does the patients.

Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring. When we ourselves are ill, we want someone to care about us as people, not paying customers and to individualize our treatment according to our values. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs. We believe doctors, nurses and others engaged in care should eschew the use of such terms that demean patients and professionals alike and dangerously neglect the essence of medicine