"... the secret of the care of the patient is in caring for the patient."
-Francis Peabody, 1925
Rise and Fall in the Art of Patient Care
There was a time not long ago, when physicians and nurses didn’t have much else to offer patients other than personal attention, comfort, compassion and concern for their ailments. Medical professionals were revered and respected for that and for what little they could do in regard to symptomatic treatment for incurable conditions.
The Twenty-First Century has thrust health care into an era of modernization, precipitated by advances in medical technology and computerization of everything in sight. We have made fantastic strides in the diagnosis and treatment of many serious illnesses. Patients are living longer and more productive lives as a result of these wonderful advances.
However, concomitant with these changes, we have experienced the indisputable depersonalization of patient care. Patients are often treated as diseases or numbers. We often hear medical personnel referring to a patient as “the gallbladder in room 232” or “the COPDer in 476”. We order test after test instead of taking a history because if we don’t “prove” our diagnosis with a test, we may be subjected to a lawsuit later if something goes wrong.
Health care costs have spun out of control. If the Affordable Care Act ("ObamaCare") is repealed, as some have recommended, forty-three million people in the US will still not be able to get health insurance. Access to care will continue to deteriorate. Prenatal care and birth rates are suffering. Medicare patients often have difficulty finding a doctor who will take them. Doctors’ incomes are severely restricted by insurance companies. Busy primary care physicians have to see 30-40 patients a day to make enough income to cover office overhead and pay off their own expenses beginning with a $3-400,000 debt for medical training. Most medical students and doctors are no longer considering ambulatory primary care as an viable option for a career. It's too much work and the compensation doesn't make it worthwhile. Who wants to work from 7AM to 9PM and be on call 24/7 for less than what the average businessman makes? There are just too many sacrifices.
There is no time to spend 20 minutes with an 80 year-old patient with diabetes, arthritis, heart failure, and hypertension out of control who has just developed shortness of breath recently, and who needs 6 prescriptions rewritten. Other patients in the waiting room are feeling ignored. The medical care this person is receiving is hurried and often inadequate. The stress of managing people's lives under these conditions is overwhelming. The reimbursement for a visit like this is less than the cab fare it would cost to get the patient to the office.
These are very difficult challenges. Unfortunately, in the middle of it all, we often lose site of the fact that our patients are people – in many cases, very ill people - who are looking to us for support and guidance as well as medical care. We have to continually remind ourselves why we are here, why we are doing this. What should be the center of our attention? The patient is, of course! Individual patients with unique medical needs. There is an art to providing this support and to personalizing care for each and every patient in the midst of an imperfect environment.
Anyone who works in the health care profession should know there is a right way and a wrong way to approach patient care. They also should know this approach is somewhat different for every patient they encounter due to multiple variables – type of illness, gender, age, background, etc. This is an art that we learn mostly by experience – both by our own personal experience and by observing the experiences of others. How well we assimilate the information from these experiences and how well we use that knowledge determines a very large part of how we interact with patients and how we are perceived as medical professionals. There is usually no formal training for this, and where there is formal training, it usually amounts to perhaps one or two weeks at the most.
The key word here is the art of patient care. For the purposes of this site, the reference is not so much on the science of medicine per se, but rather on how medical personnel can interact with patients to improve the healing process, rather than dismantle it.
This is not to say that science is unimportant; but rather that concern for the humanity of the patient should not be so overwhelmed by science as to be nonexistent at the bedside. Indeed, true clinical competence is a blend of knowledgeable application of medical science along with the recognition and understanding of the human condition. The art of this blend, the integration of these two disciplines, and how well it is done, is what determines the quality of patient care that we provide. One without the other is not sufficient.
This can be a science unto itself. One of the influences that this site will hopefully promote is more discussion and ultimately more research on how to learn and how to practice this art in a more meaningful and fulfilling way for both ourselves and our patients alike. In addition, the more formal exploration and inclusion of these concepts into medical training programs would have a huge effect on the future of medicine in this country.
Some people say you have to be born with this talent. I don’t think so. I do think it comes easier to some than others; but, whatever the genetics and background of the individual, patient care is an art that can be learned and practiced and improved upon, just as drawing or painting a thoughtful picture can be learned and practiced to the point where it can be greatly appreciated by others.
So what kind of doctor or nurse or care partner do you want to be?
What is your approach to patient care?
How do patients perceive your approach to them and your overall competence?
Are your patients doing as well as they could be?
Is your bedside manner conducive to healing?
Read and study the pages on this site. You will become a much more people-oriented professional, knowledgeable about how to approach all kinds of patients and challenging situations, and who will at the very least be perceived as someone who cares and is concerned about his or her patients. You will earn your patients' trust and ultimately they will receive better care, which is the real goal, and your best reward.