By Nathan Webb
Medicine is a forever-changing practice. Originally, it was a luxury, existing as a novel concept which the earliest humans saw as an interference of God’s will. Slowly, heeling became an expected commodity to more developed societies. The brightest individuals started to experiment on the sick, documenting their findings and refining their techniques until success was finally accomplished. Medicine was an intimate study requiring healers to create a relationship with their patients to understand the full extent of their physical and mental ailments. Doctors spent hours upon hours studying their patients to create a comprehensive list of symptoms that could provide clues to how they should treat each illness. Through analysis of common trends of disease, doctors were able to piece together protocols for each disease so that patients could live to see another day. This healing process created relationships that aided the mental health of patients so that physical healing was the main priority.
Medicine has lost that intimacy. Doctors now treat patients as if they are just another last name, social security number, and health care plan. A surgeon’s skill in suturing is now more valued than her bedside manner. A nurse’s efficiency with paperwork is now more valued than the emotional support that he provides to a patient. An oncologist’s survival statistics is now more valued than the way she shares the news of imminent death with patients. The burning question now exists: what has caused medicine to become so inhumane?
The Story to Save Lives Project, conducted by the Southern Oral History Program, provides insight that helps answer this question. More generally, the project features interviews with North Carolinians who share their life stories, and in particular, their experiences with healthcare. Based on various interviewees’ life stories and extensive research from outside sources, the transition from personalized medicine to apathetic care appears to occur throughout the twentieth century due to the increasing demands of medical training and sheer workload during residency.
In one such interview, Lyman Henderson, a dentist from Warren County, shares his experience with healthcare as a child growing up in the 1950s. With aspirations of being a clinician one day, his doctors provided an interactive experience during visits which fostered his love for medicine. Henderson’s allergist even allowed him to “come in and draw [his] own medicine,” and “he would show [him] how to look at the milliliters and whatever [he] wanted” (07:46-07:54). Doctors no longer have time to create informative experiences for their patients and instead have to rush through checklists so that they do not delay the next appointment. That is exactly what medicine has become: a schedule. Because doctors are forced to treat such a high capacity of patients, they have no choice but to allot small amounts of time to each of their patients. These small slots of time for each patient ultimately create a rushed experience during appointments.
The time crunch is just one factor in the increasingly impersonalized health care experience. The greatest cause of dispassionate care lays in the medical training that students must receive before becoming a doctor. To begin with, most medical schools give skewed values to the wrong attributes of applicants during the admission process. While social skills are a part of the criteria that med schools view as important to future physicians, it is still not valued enough. Instead, admission personnel tend to give spots to students who have the best grade point averages and MCAT scores, creating an influx of individuals who are incapable of properly communicating with and gaining trust from their patients. Furthermore, once students have gained admission into medical school, they are taught to be wary of emotional attachment with their patients. While doctors should be cautious in becoming too involved in the outcome of patients, they should also care for and communicate to their patients in a manner that will gain trust.
Once students have matriculated through medical school and internships, residency features a high-capacity workload for newly certified doctors. Residents are forced to do the brunt of the work which lowers morale and induces apathy over time. Ahilan Saviganesan, a neurosurgeon resident at Vanderbilt Medical Center, expresses how residency subtly eliminated his desire to emotionally connect with his patients. He argues that patient needs “become issues that need to be ‘handled’- new tasks for my to-do list” (par. 7). Saviganesan perfectly summarizes these sentiments saying that “a patient’s inadequately controlled pain, then, is not the gnawing discomfort of a 40-year-old mother of two, but rather a new un-checked box on my to-do list. A grandmother stranded in the hospital, with no transportation, means I have to keep an extra patient on our list” (par. 7). Hospital administrators must find a solution that will eliminate apathy and inspire a level of emotional connection to patients so that doctors can eventually teach the next batch of residents to care for “patients as if they were our loved ones” (par. 10).
Ysaura Rodriguez, a single mother and immigrant from Mexico, perfectly synopses how doctors should communicate with their patients to demonstrate sympathy and care to their patients. She states that doctors “need to allow the time to the patients to express themselves” which she believes will provide “that opportunity to gain that trust” (54:51-54:59, 55:32-55:36) Once trust has been acquired, physicians will be able to influence their patients to make the correct decision for their medical needs. Rodriguez feels that doctors immediately ask “what’s wrong with you” instead of allowing patients a chance to develop a rapport with their providers (55:42-55:44). If doctors do not have the social skills to hold conversations with their patients, they will be unable to properly provide care because patients will be hesitant to disclose the extent of their illnesses.
Some doctors will also lack social awareness which is at an even higher premium than communicative ability. Lata Chatterjee is an immigrant from India and a professor at Boston University who experienced severe ethnic discrimination by physicians at Johns Hopkins. While Chatterjee had simply contracted mononucleosis, doctors were “convinced [she] had a tropical disease” as they tested her continually for foreign diseases (32:11-32:14). Doctors neglected to perform a simple test for mono, and instead tested Chatterjee for so many random illnesses that she was convinced “They [were] going to kill [her]” (32:20-32:22). This experience caused Chatterjee to be “scared of the American healthcare system” and yearn to go back to India (34:22-34:26). Furthermore, distrust of the health care system does not only resonate with minorities. The general American population seems to have a deep-rooted fear of the system as confidence in leaders of medicine has decreased from 73% in 1966 to 31% in 2006, deduced from a poll by Harris Interactive (See Table 2 in Blendon et al.).
Clearly, medicine has changed for the worse. Although technology and research have substantially improved overall life expectancy across the world, the patient-provider relationship has suffered. Doctors must improve their social skills and allot more time for patients so that people feel comfortable sharing all the details of their illnesses. In medical school, students should be required to take courses that improve social skills and teach compassionate and appropriate bedside manner. Also, hospitals must staff as many residents as it takes to provide a manageable workload that allows doctors to create a relationship with their patients. These solutions will work together to improve the patient-provider relationship, inclining more people to trust their doctors and finally receive the care they deserve.
References
Blendon, Robert J, Mollyann Brodie, John M Benson, Drew E Altman, and Tami Buhr. “Americans’ Views of Health Care Costs, Access, and Quality.” The Milbank Quarterly. Blackwell Publishing Inc, Dec. 2006. Web. 28 Apr. 2021.
Chatterjee, Lata. Interview with Nicholas Allen. 11 December 2018 (Y-0084). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Henderson, Lyman. Interview with Darius Scott. 9 July 2018 (Y-0030). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Rodriguez, Lyman. Interview with Joanna Ramirez. 29 June 2018 (Y-0044). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Sivaganesan, Ahilan. “Resident Reflection: Holding the Line Against Apathy.” Blog post. 13 Aug. 2015. Web. 28 Apr. 2021.