"It is more important to know what sort of person has a disease than to know what sort of disease a person has."Increasingly our Western world culture assumes that most things in medicine can be reduced in to a linear, data-driven, algorithmic processes. One only needs to witness the now-famously heralded article on ICU check-lists to understand the unwavering trust we have in this model. ICU medicine's complexity reinforces our trust in this approach because patients are usually too sick to contribute to their care. While there, intensivists resort to their Fourier transform of all things living, parsing our patient's life into the various frequency spectra of their organ systems. With careful tuning of these harmonics, more often than not the patient survives. And we deem this good. So good, in fact, that the notion of a predictability to medicine has spawned the development of remote controlled ICU's and even robots to replace doctors.
Yet when we consider medicine nothing more than a rational, scientific, transactional exchange between the doctor and patient we become limited. Such interactions miss medicine's sacred, intimate and intensely human, non-linear aspects. After all, people do not travel long distances to see a specialist who merely reads algorithms. Instead, they travel long distances to see highly experienced doctor who takes huge, intuitive, and often illogical leaps. The level of presence required to hear a patient on this level of broad critical thinking is not supported by quotas, checklists, little sleep, and multiple back-to-back seven-minute appointments.
Doctors and their patients are clearly sensing this shift to the omnibus, bean-counter, centralized approach to medicine. For a myriad of seemingly well-intentioned reasons, concern for the patient has shifted to concern for documentation. We see independent thought giving way to guidelines and treatment protocols. Whether these protocols really reduce errors remains to be seen, but we already see the consequences of these processes as patients say privately, "doctors don't care anymore." We should ask ourselves when they say this, are they talking about a lack of their doctor's social graces or a potentially life-threatening disconnection? In fact, if medicine is such a formulaic service-delivery model, then the natural consequence of this rote health care model implies that all doctor shift changes are risk-free and doctors are simply replaceable, rotatable and expendable.
Yet doctors offer little to correct this shifting perception. We console ourselves that centralized certification bodies will assure the maintenance of core health care delivery competencies, but do so at the expense maintaining a yearning for excellence. The results are telling. In the march toward the mirage of error-free adequacy, doctors are being worn down by the emotional withdrawal from their patients. Burnout is common. The loss of emotional connection is not what our most altruistic, bright medical students sign up for when they enter medical school. Will it be okay if our young doctors no longer see the intangible, emotional contact with patients as a necessary prerequisite for providing health care?
Humans are a study in contradictions. We yearn for the thousand points of light only to find, more often than not, they leave us in the dark. We crave the impersonal, the predictable, and the controllable. We cling to the magical thinking that if we just do what we're supposed to, eat right, exercise, and walk the proper line we'll be fine even though each of us acknowledges, eventually, our own mortality. We want the government to provide our health care, yet realize they will never return our calls. We love the glitz, the shiney, the whizbang, but first, we want to talk to the doctor.
Both doctors and patients still want and need these intangibles in medicine. Yet more and more forces threaten to dissolve them. With each new mandate, each new checklist, each new certificate, each new order set, each new performance measure, each new computer screen, we risk chipping away at this critical cornerstone of medicine. Worse, we risk losing our best and brightest in medicine in favor of nothing more than our best remote-controlled, linear, and logical promises.