Cleveland Clinic published an article that cited the work of Cynthia Kubu, PhD, a neuropsychologist in Cleveland Clinic’s department of psychiatry and psychology. She examined the potential of focusing on relationship center care to help provide good care and long-term care giving for physicians. Cleveland Clinic uses the REDESM (relationship, establishment, development, and engagement) which focuses on the provider-patient relationship as the premise for care. The idea is a physician will care for those she knows and care of.
“We need to learn how to maintain good results,” says Dr. Kubu. “It makes sense that physicians and patients have more positive experiences during more relational interactions. Our brains respond chemically when we engage in relationships. We just feel better.”
The training provided improved empathy and sustained practice that arguably avoids physician burnout and improved patient satisfaction.
I write stories about humanity in medicine. I write articles about preserving the humanity in medicine. I am curious always with the volume of cynicism and even absolute rebuttal to the value of and the needed space afforded to humanity in medicine.
Let us then envision decompassion as the stage for medicine.
Tear the current system totally down. Take down the warm lights and take out the chapels within the hospital. Fire the clergy and volunteers and stop putting up the damn signs that welcome and express concern and gratitude.
Put up the white walls and doors and rooms with no windows. Don’t speak unless spoken too.
When the sick come in have them sign forms and take down only concrete facts. If they cannot express facts clearly write how you attempted facts but check the “could not obtain” boxes. Consider no element that is intangible or social.
When presented with grievances make people take numbers and wait in long lines regardless of age and ability. Check validity only. Disregard impressions or feelings.
Call it health services instead of health care. Call it engaging or encountering or servicing instead of caring.
Set the expectation as renderings of facts and procedures. Give handouts not hugs.
When approached by anxiety and confusion repeat facts and cite policy and statues.
Clock in and clock out.
Move people and their problems around like widgets the universe can contend with. In fact just tell yourself over and over, “That’s their problem.”
Expect no thanks and never reply with “You’re welcome.”
Only touch to diagnose. Only call to inform. Be technical and political. Be neutral but accurate. Be decompassionate.
Then … be the patient one day. Be the family waiting one day. Be the dying one day. Be the emotionally freaked out one day. Be the one looking for the “archaic and hippy” compassion in a doctor-patient relationship you scoffed at as dead and worthless.
Then tell me what is broken in our system of health deliverance and deliver us from the evolving expectation of servicing and demanding.
Doctoring is not dead or dying. It’s suffocating from lack of faith in humanity and awareness of the true gravity of the human illness of suffering alone. Doctoring requires developing relationships with people.
Jean Robey is a nephrologist who blogs at ethosofmedicine.
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