Heroes Not Zombies

The core of health care is the relationship. Every patient is unique. Their differences matter. But every doctor, nurse or therapist is also unique. Don’t their differences matter too?

We’d expect any doctor to have good skills and knowledge. In fact we can expect all doctors to have good skills and knowledge. But every doctor is a person with unique characteristics, values, beliefs, attitudes, ways of being. They bring all of themselves into their doctor patient relationships. How could they not?

Yet in clinical trial reports (research studies), the person who is carrying out the treatment is never mentioned. Clinical trials are group studies and the patients aren’t identified or described, except in their possession of a limited number of characteristics. But the therapists, the prescribers, aren’t even mentioned. How many were there? What do we know of their characteristics? It’s as if it doesn’t matter at all who they are. They don’t count.

In industrialised health care managers describe jobs, with required knowledge skills and attitudes. But as long as the employee ticks the relevant boxes any of them can do the exact same job. It’s as if it doesn’t matter at all who they are. They don’t count.

I think this dehumanises doctors, nurses and therapists, and in the process dehumanises the whole health care system.

When I worked in General Practice each of the four partners had their distinct patient cohorts. Certain patients would routinely seek the care of specific doctors. If, say, Dr A was on holiday you could often tell that a particular patient was only consulting you because Dr A was absent. It wasn’t that only certain doctors were popular, it was the fact that, in Medicine, the relationship is important and no doctor would be the “right” or “preferred” one for every single patient.

That fact is in danger of being lost in the deliberate dis-integration that comes with mechanistic reductionist health care. Patients are not machines to be fixed by mechanics. They are unique human beings, and their carers are too.