Monday, May 16, 2011

MORE ART, FEWER DOODADS

Most of us agree with the truism that healthcare is a science and an art. But during the past few decades the art has gotten lost behind the MRI machine. "Use it or lose it," we say in this business. Less utilized, healthcare's art atrophied. Now we seniors remember it, but too many younger docs aren't aware healthcare was ever anything but science.

Science is about the objective, measurable world. It's about logic and precision, which we're awfully good at. Our remarkable scientific hardware lets us perform wonders undreamed of a century ago. Lacking the softer edges art conferred, though, it's drifted from human experience toward more manipulable technology. Check out the reports of robot "doctors" and online psychiatric algorithms, for example. I joke about medical care dispensed from vending machines, but we're not far from it today.

When we in the healthcare professions comprehend our work as essentially science, we gradually abdicate our interpersonal art, the skill of communication. We begin to lose our senses of compassion, forgiveness, joy, skepticism, perspective, and humor.

Patients daily tell me about their healthcare experiences. Most are praiseful and grateful, especially for the medical science that's been applied to them. When they express dissatisfaction, their complaints are uniformly about personal contact. Patient A says his doctor faces his laptop instead of him. Patient B says the staff lost his records. Patient C complains that a nurse was condescending. Patient D says his doctor devastated his hope.

We can replace organs, but it sometimes takes two weeks to fax a test report. We can obliterate germs that once wiped out half a continent, but fail to hear our patient telling us we're not adequately treating her pain. Our hi-tech is great, our low-tech often wanting.

Our science outperforms our art simply because we place more focus on it, and here's why: it makes money.

When I was in training, we handed penny balloons to post-op patients with instructions to blow them up a couple of times a day. The back-pressure kept their lungs inflated, and so warded off pneumonia. No balloons these days, though. Instead, patients are given complex, expensive gadgets that do the same thing at a hundred bucks a pop. We're not just talking about these breathing doohickeys here, but thingamabobs and doodads throughout the medical office and hospital. If you wonder about the source of healthcare's skyrocketing costs, here's a good place to look. We overuse medical technology, and mainly for these reasons:
  • It gets marketed heavily.
  • Having heard about it in many forms of infomercial, patients demand the "latest."
  • It's expensive, so needs to be used in order to amortize its costs.

Compare that with, say, communication. This low-tech intervention doesn't get hawked because no one has yet been able to patent language and so corner the market on it (though I'm sure a number of corporations are looking into it). Since communication isn't commercialized, consumers don't hear about it; no wonder they assume healthcare and technology are identical. Finally, communication is free, so what could it possibly be worth?

Still, some practitioners here and there are intent on preserving healthcare's diminishing humanity. You can tell who they are. They sit still when they're with you, look you in the eye, touch you, ask you questions about you as well as your illness, and listen to you carefully without interrupting. Robots can't do that.

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