Since the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, it has been said that health tech would dramatically revolutionize health care and the patient experience. Advocates have claimed time and time again that it would advance disease diagnosis capabilities, improve patient outcomes, and increase patient satisfaction. Belief in this narrative can be seen in the sharp increase in health tech investments, with Healthcare Growth Partners reporting that investments have grown from $2.8 billion in 2013 to $7.1 billion in 2017.
But despite the investment, patient satisfaction is still lacking. In fact, in a study which set out to determine the effect of electronic health records (EHR) on patient satisfaction, it was found that “EHR adoption was not associated with patient satisfaction even when controlling for the strong relationships between better nursing practice environments.” Likewise, we must ask, is health tech making a positive impact on the doctor-patient relationship, or is it possibly causing technicalization and dehumanization of our medical practice?
This article explores how health tech may be an extension of the increasing medicalization of the patient experience and looks at how anthropological thinking could support physicians in the quest to improve the modern techno-focused patient experience.
Origins of our medical rationale
Since the ancient Greek medicine of Hippocrates, medical practitioners have been exploring biologically-based approaches to disease rather than magical intervention. Hippocrates (5th to 4th century BCE) was a Greek physician, who is considered the father of contemporary medicine due to his revolutionary focus on the physical and rational.
Hippocrates’ theory was based on observation of clinical signs and rational conclusions, rather than superstitious beliefs. He observed there was a relationship between occupation, diet, exercise, and disease. From this point of view, he advocated that physicians need to understand each patient’s medical situation, produce rationale suggestions for their treatment and do no harm in the course of that treatment.
He put forth these ideas in his book, the Hippocratic Oath, which all of us doctors still swear to today. As part of agreeing to that oath, we acknowledge that we “will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
But we ask, do we still emanate warmth and sympathy as we ought to, or are we possibly too focused on the knife and drugs? If we are too focused on the latter, how did we get here, and what can we do to get back to our humanistic origins?
The enlightenment and medicalization
Throughout the Middle Ages, the medical industry as we know it began to take shape. First with the introduction of church-operated hospitals in parts of Europe, and later through the systematic training of physicians in universities scattered across key European cities. This process continued through the early Renaissance and then exploded with the advancements that occurred in biology, anatomy, and chemistry during the Scientific Revolution.
As a result of these advancements, the medical industry continued to expand its influence, and by the 18th century Age of Enlightenment, medicine had become a specialized discipline with a specific set of processes and tools focused on the scientific classification and treatment of disease. With this, grew an increasingly common body of knowledge that resulted in a shared medical discourse among practitioners. As part of this new mode of thought, diseases were generally equated with a disability and subsequently viewed by physicians as something that they must identify, understand and fix through knowledge, observation, and practice.
This new point of view, which was termed the medical gaze by the French philosopher Michel Foucault, is thought to dehumanize the patient by focusing on the disease over the entirety of the human experience. He asserted that by separating the patient’s body from the patient’s humanity or identity, modern medical practices with its mechanization was resulting in a reduction of empathy and moral disengagement, a trend that we believe can still be seen to this day.
But the problem is not simply that the trend is continuing. The problem is that in the age of information technology, the problem appears to be amplified by the regulations and requirements of health tech, if not the tech in itself. To illuminate this point, we would ask you all to think about your own practice of care or your own experiences as a patient. How many of you no longer face your patients when talking, and instead type away responses into EHRs that rarely, if ever, provide us with any true insights or wisdom? How many of you feel the tools we are now required to use have replaced quality time with our patients?
If even one reader of this article has answered yes, then we all must ask what we can do about this? One possible suggestion we have is to infuse anthropological thinking in the practice of being a physician.
Why anthropological thinking?
Anthropological thinking is at its core humanistic. It seeks to understand the human experience of a group of people through their eyes and their context. It focuses on understanding the lived experience of individuals, which necessitates understanding their beliefs, behaviors and social context in its entirety. As a discipline, it is grounded in some foundational perspectives that make it very suitable for use by physicians.
Ethnography. The method of observing and interviewing humans with empathy and openness while suspending judgment to surface unknown insights that the data leads us to versus our own beliefs. It is the hallmark of anthropology, and we argue, the true spirit of what Hippocrates was advocating for.
An emic perspective. We need to seek to understand our patients from their perspective, and not our worldview or the worldview our regulators or EHR software providers. The patient comes first — and if we don’t seek to understand them for who they are, they will never be satisfied.
Holism. We need to understand the entirety of the problem, not just what the EHR requires us to fill out. We need to go beyond our technology and seek to understand the lived experiences of our patients. This includes potential social determinants of health such as their income, insurance coverage, neighborhoods, food and occupation. By seeking to understand patients in this way, we can begin to move beyond the dehumanization or disease-mongering to preventive medicine.
Culture. In a globalized world where our patients are diverse, we need to understand the people we are caring for through the lens of their social context if we are to understand what health and quality care mean to them. If we can’t do that, we can’t provide a satisfactory patient experience.
Health tech is not going to go away. So if we want to try and use it to improve the patient experience, then we, as physicians, need to go beyond its inherent limitations and get back to humanism over purely cold rationalism. We can do this by infusing anthropological thinking into our own practice and use that to augment the rigid technology that we currently have in place. While alone that will not improve the tech, it can improve the patient experience, and ultimately, that is what our oath is all about.
Carolina Severiche Mena is a physician and author of Paciente Oncológico En Cuidados Intensivos. Matt Artz is an applied anthropologist.
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