Over the past year, I have been faced with the challenges of being a consumer of the health system that I confront daily from the physician perspective. My health needs ranged from a stubborn sinus infection to a terrifying brush with Guillain–Barré syndrome. I sampled experiences ranging from the clinic to the urgent care and then the emergency department and even dappled in the forbidden territory of self-diagnosis.
All experiences rendered technically sound care, delivered by competent and courteous professionals. Diagnoses and treatment plans were generally developed in a thoughtful manner. Rooms were clean. Wait times were much shorter than I anticipated. I was provided with warm blankets, a snack if I desired. I could check my lab results by phone, email my doctor with questions and concerns. There was nothing I could have complained about on a post-visit survey. By all measures, I received excellent care.
And yet, I often felt worse when I left than when I went in. The technology and diagnostics diminished my experience to quantifiable facts. I was no longer “Susan, the mother, wife, and physician,” but the “red foot,” “nausea and vomiting” or “hand numbness.” Each interview was symptom based, a checklist for bodily function. I knew why they were asking the questions, what they were ruling out. I rationally understood. But a part of me felt marginalized, dehumanized. I knew that unless I was “sick” with quantifiable symptoms that could be confirmed by labs, x-rays or medications, my suffering would only be superficially acknowledged, if at all.
I wanted someone to care for me. But not in the sense of how care is framed today with coded visits, blood draws, post encounter summaries. The care of someone knowing you as a person outside of your body’s physical symptoms, helping to address your fears as if they were partly their own, the kind that says “I’m here for you. We’ll get through this together.”
I struggled against the polite indifference that is now standard for most traditional health care encounters. I myself use polite indifference when I don’t have the time or emotional bandwidth to establish a meaningful relationship. This is often done in the name of self-preservation; I desire those relationships, find that I am happier when I do so and am much more effective in treating my patients, but I also constantly struggle to work within a system that separates biology from healing, one that places a premium on efficiency and profit generation over the less tangible human condition.
As both a patient and physician, I have grieved the loss of healing. Healing, a sacred process that requires space, slowness, compassion and flexibility, has become an afterthought, superfluous to more quantifiable measures and technological advances. The things that are currently done in the name of excellent patient care and satisfaction stifle the flexibility, space, slowness and creativity that allow compassion, empathy, and relationships to build.
Health care has lost its heart; patients and providers know this and feel it deeply. It will not be rediscovered in surveys, quality measures, capital investments, technology, but in eye contact, tears, humor, and touch. Technological advances and health care delivery models are important, but their impacts are significantly diminished when we lose sight of the why; when we replace the relief of suffering with polite indifference.
Susan Hecker is an internal medicine physician.
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