Professionalism without Humanism: Pretending to Care
In so many of my blog threads there are responses by my visitors that show that they find that their physicians seem competent but are missing something in their relationship to their patients or seem to have other agendas in their minds by what they say or how they behave. Appearing professional ("acting like a doctor") is one thing but being humanistic ("feeling like a doctor should with concern and caring for the patient as a person")is totally another thing. Medical schools, training students to become doctors, are currently quite aware of the importance of instilling humanism into their students while they describe the duties of a professional. Still, students and others may not understand the relationship between professionalism and humanism. The November 2007 issue of Academic Medicine devotes the issue to humanism and the article by Jordan J. Cohen MD "Linking Professionalsm to Humanism: Why it Matters" helps the reader understand that one is not the other but a doctor just can't be truely professional without being humanistic.
There are many factors which lead doctors to fail to maintain this critical link such as personality development from youth, inadequate education in humanism in medical school or degrading what was learned by poor role models in later training years (the so-called hidden curriculum). In addition, there are the pressures of medical practice, lack of time with patients, need to see more patients to reach some financial goal or standards required by HMOs and the more impersonal technical means now available for diagnosis and treatment.
Hopefully, with more attention being paid at least by those in medical education to the need for doctors to be humanistic as well as professional perhaps the young doctor will be able to go beyond the pressures of medical practice and become the doctor that patients love and not the ones that patients hate. ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:38:00 PM
3 comments
3 Comments:
"there are the pressures of medical practice, lack of time with patients, need to see more patients to reach some financial goal"
In my opinion, this is the primary obstacle and it will be hard to change this. There just aren't enough doctors to cover the number of patients, so a doctor simply does not have much time to do anything other than address the medical problem. There isn't much time for personal interaction, although most doctors that I see do a good job within the limited time restraints.
I can understand the situation well. When I finally get to see the doctor, 2 hours after my appointment time, I know that they are in a bind and need to keep it as short as practical. That is just the way it is and does not mean that the doctor doesn't care.
mj kc, "short as practical", of course may be necessary, but during that short time there should be full devotion to the patient and the problem at hand without the physician having extraneous thoughts or interruptions by office staff. If this is carried out, most patients can recognize a physician's attention and care even if the time is limited. This is the essence of humanistic professionalism: understanding and behaving that it is a human being in distress that is seeking care and not a disease or a name on the appointment sheet that must be disposed of as soon as possible in order to get along to the next disease or name or to have an early lunch or end the day in the office in time for dinner out. ..Maurice.
Two years ago I experienced a change of insurance that, sadly, resulted in a change of practitioner. I have cycled through 3 younger doctors/bustling practices in the new insurance network during this time. I am beginning to believe that my expectations of providers contracting with my new HMO are too high. My primary complaints are as follows:
Professionalism:
1.) Not enough time allowed for visit. When setting appointments, ask for the patient�s agenda in advance and have the medical assistant reiterate the agenda with the patient before the doctor enters the room. If the patient expresses further needs, request that non-critical issues be tackled in a second appointment.
2.)Abrasive reception staff. Basic consideration, such as allowing a patient to escape the waiting area filled with screaming babies for a cup of coffee when it is apparent that the doctor is at least 2 hours behind schedule would help engender goals of mutual respect, trust and adherence.
3.)Doctors� lack of patient recognition despite several visits. (My suggestion: take a picture and perhaps even an informal but personally relevant conversation starter and place it in the file so that on subsequent visits, the doctor can at least act like an acquaintance.)
4.)Using a laptop to take notes during the medical exam. In principle, I like the idea of digital medical records. In practice, the computer often acts as a barrier to physician/patient interaction and such voluminous chart notes can even contribute to patient distrust. Perhaps a HIPPA compliant medical transcription service is not obsolete.
5.)Physician lack of familiarity with participating HMO specialists and pre-authorization requirements. This is a difficult problem to solve, since insurance company lists and requirements change so rapidly. However, a skilled billing receptionist may be better suited to manage the details.
Humanitarianism:
1.)I despise office policies such as �We do not accept patients with worker�s compensation claims or those in pending litigation� posted prominently at the reception desk. The message that this sends to the patient is that if I get hurt at work or injured in a car crash, I am no longer a deserving patient. Thanks a lot! I would far rather see positive images such as pictures of my physician volunteering at a local homeless shelter, Doctors without Borders, or even an office staff birthday party. Such small gestures would help the patient see the physician and staff embedded in a caring community, demonstrating the desire to serve.
2.) I would ask that doctors refrain from the use of scripted statements such as �I can see why you would feel this way� or �I understand that this must be hard for you�. These canned phrases feel very impersonal after the first time that they are heard. Often a simple nod or understanding look is the best expression of empathy.
It is my belief that a patient�s perception of professionalism and humanitarianism starts within seconds of entering the reception area, builds with each subsequent interaction, and concludes with the often brief interaction with the physician. Perhaps offices should take a wider view of professionalism and humanitarianism in medical practice, establishing a shared responsibility for creating a caring and compassionate environment to engender patient trust and, ultimately, rendering patient satisfaction.
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