The Art and Science of Patient Care: Maintaining the Proper Balance Within the Challenges of the Current Health Care System
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. Even with the advent of The Affordable Care Act ("ObamaCare"), many people in the US are still not able to get health insurance, or if they do, the deductible on the lower-end plans is so high that's it's worthless. Access to care will continue to be a serious problem. There are simply not enough doctors - especially primary care doctors. 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 a 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.
A 15 minute visit with an 80 year-old patient who has diabetes, arthritis, heart failure, and hypertension out of control, and who has just developed shortness of breath recently, and who needs 6 prescriptions rewritten is woefully inadequate. 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.
There are very few medical offices that can survive independently. Most doctors have had to join large administrative groups to share expenses and to have the ability to negotiate with third party payers (health insurance companies). In return, these group administrators usually require a certain amount of productivity from each provider. In other words, the provider has to be able to see 25-30 patients a day in order to stay in the organization.
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. This art is popularly known as bedside manner.
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 a very small percentage of the total educational package.
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 disciplines of art and science, and how well it is done in the confines of a rather adverse environment of our current health care system, 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 of patient care 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, nurse, care partner or therapist 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?
Peabody, Francis W., The Care of the Patient, JAMA, Volume 88, Number 12, 19 March, 1927, pp. 877-882. (1927;88(12):877-882. doi:10.1001/jama.1927.02680380001001)
Christenson, Gary A., Conceptualizing the Arts as Tools for Medicine and Public Health, Journal of Applied Arts & Health, Volume 4, Number 3, 1 January 2014, pp. 247-264(18)
This site was written primarily as a reminder of why we are here as health care professionals. I have heard so many people complaining about the absence of concern and generally poor manners at the bedside or in the office and the psychological effect that this has on many patients and families, that I have begun to wonder if we are inadvertently adding to the suffering of our patients rather than reducing it.
These pages contain many of my experiences and observations over almost forty years of medical practice as an internist and a hospitalist. It is my hope that by reading this, some health care professionals will recognize that perhaps there is a better way to practice. We need to change our approach to patients and lead our society to develop better ways of delivering health care that will take into account the needs of our patients and those of our providers as well. I am also hopeful that each one of us will recognize the need to improve ourselves, so that we can become much more people-oriented, humanitarian, professional and 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 our patients. If we can do this, we will earn and perhaps regain our patients' trust, and ultimately they will receive better care, which is the real goal, and your best reward.
"The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." - Sir William Osler
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This site was last updated on June 19, 2020.
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