Are we providing health care, or just delivering health?

As a medical student I have come to appreciate two core goals of health care:

1. Health: The delivery of medical knowledge, assessment or treatment to a patient

2. Care: The compassionate approach to any patient

In my medical training, I have also witnessed clinical medicine practiced across a spectrum of situations.  Taking my time to reflect on these experiences, I am not certain we are meeting our goals.  Too often I have watched a flurry of attendings rush from bed-side to bed-side, witnessed residents spend far more time in front of a computer screen than holding a patient’s hand.

I am not arguing the nature and necessity of our modern system, rather I hope to ask a major question: Do we get so caught up in the delivery of our health care, that we sometimes neglect the care itself?  Are we providing health care, or simply delivering health?

Allow me to frame this in another way.  Have you considered the definition of the word “care”?  One that I rather like defines care as a “watchful attentiveness.”  How often are you watchfully attentive to your patients?  What can be said about the nurses, residents or staff working with you?

At the same time that medical advances allow immediate, efficient, and direct monitoring of patients, these same technologies can so easily disrupt our watchful attentiveness.  New systems, with built in redundancies and alerts have the potential to incentivize complacency and interrupt the patient-physician relationship.  I often overhear residents or attendings say, “Don’t worry about the patient in room 246 until the lab results come back.  There is nothing we can do until then.”  The consequence of this attitude represents a negligence to the value and importance of physician compassion.

Nothing we can do?  What happened to kind words, reassurance, and the offering of a comforting hand?  Sure the electronic record may show normal cardiorespiratory monitoring, no new nursing communications, and no updated lab results – but there still exists a patient, sitting in a hospital bed.  Possibly alone, likely insecure, and almost definitely in need of your care.

Again, I am not arguing that our current system is ineffective in delivering health, nor am I contending the decisions of my peers and superiors.  I have a profound respect for the urgencies and constraints of our modern health system.  But I believe that, in any area of life, self-reflection is necessary for growth.

Somewhere along our medical journey, as we agreed to see more patients then we could handle, and developed advanced technologies that separate patients from caregivers – we may have lost sight of a simple fact.  Fifty percent of our mission as physicians delivering health care is to provide that care to our patients.  To be watchfully attentive over them.  Are we providing health care, or just delivering health?

Aaron George is a medical student who blogs at Future of Family Medicine.

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